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Purpose of Review This paper explores the complexities of postpartum sexual health. It answers the question on what should be considered normal sexual health after birth and what should be considered abnormal. Recent Findings Many women experience physical sexual health issues in the months after birth, such as dyspareunia, lack of vaginal lubrication and a loss of sexual desire. For some women, these issues can persist 12 and 18 months after birth. Mode of birth is not associated with long-term dyspareunia 6 and 12 months after birth. There is conflict seen in the literature with regard to the association between perineal trauma and short-and long-term sexual health. Breastfeeding and the existence of pre-existing sexual health issues are strongly predictive of sexual health issues at 6 and 12 months after birth. Women have described a discordance in their sexual desire to that of their partner, for some this caused distress but for couples who communicated their feelings of sexual desire, concern over baby’s well-being and adapting to parenthood distress was not experienced. Resuming sexual intercourse after birth was not spontaneous, women considered their mode of birth, the presence of perineal trauma and their physical and emotional recovery from birth. One fifth of women had not resumed sexual intercourse 12 weeks after birth. Summary A discussion is presented on the challenges associated with viewing postpartum sexual health from a physical perspective only, and why prevalence studies alone do not capture the nuances of postpartum sexual health. Future research needs to take account of the psychosocial and relational dimensions of postpartum sexual health as well as physical dimensions.

Sexual dysfunction among persons living with mobility-related disabilities (PWDs) may occur and are often overlooked by health care professionals. This study investigated the relationship among sexual dysfunction, self-esteem and type of disability among PWDs in some selected communities in Enugu State, Nigeria. This study employed a survey design, involving purposively recruited 189 (98 males and 91 females) PWDs aged between 18 and 70 years. The International Index for Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) were used to assess sexual dysfunction in the males and females respectively, while the Rosenberg Self-Esteem Scale (RSES) was used in assessing the self-esteem of the participants. Obtained data were summarized using mean, standard deviation, frequency counts and percentiles. Data was analysed using Spearman’s rank order correlation, Mann–Whitney U-test and Kruskal–Wallis test. Level of significance was set at

Aim: This study evaluated the prevalence of sexual dysfunction in patients with bipolar disorder, while receiving valproate monotherapy. Materials and Methods: Sixty-three clinically stable patients with bipolar disorder were evaluated on the Arizona sexual experience scale (ASEX), Udvalg for Kliniske Undersogelser (UKU) other side effect subscale and brief adherence rating scale. Results: The mean age of the study sample was 38.84 (standard deviation: 12.49) years. About three-fourth of the participants were male (76.2%). About one-fourth (28.6%) were found to have sexual dysfunction as per the ASEX. In terms of dysfunction in specific domain of sexual functioning, depending on the cut-off used, problem with sexual desire varied from 13.33% to 35.41% among males and 6.66%–46.66% in females. Erectile dysfunction was seen in 13.33%–31.25% of males and difficulty in vaginal lubrication was reported by 13.33%–26.66% of females. When those with and without sexual dysfunction as per the ASEX were compared, it was seen that those with sexual dysfunction had significantly longer duration of illness, higher prevalence of abnormal blood pressure and higher mean scores on the UKU other side effect subscale. Both the groups did not differ on other clinical variables. Conclusion: A significant proportion of patients receiving valproate experience sexual dysfunction. Higher prevalence of sexual dysfunction was associated with longer duration of illness, higher prevalence of abnormal blood pressure, and higher mean scores on UKU other side effect subscale.

There is a growing body of evidence-based research in the area of female sexual arousal that has led to improved understanding of the female sexual arousal response and the development of FDA-approved treatments for female sexual dysfunction. The purpose of this paper is to review the existing literature on female sexual arousal and response with a focus on local genital arousal and the mechanisms underlying vaginal lubrication. From May 2000 to May 2020, PubMed and Cochrane databases were reviewed and manuscripts selected, based on keywords, content, references, and relevance to the topic. Vaginal lubrication occurs due to vasodilation of the major branches of iliohypogastric and pudendal arterial beds. The increase in intravascular and vaginal wall pressure forces fluid to pass through the vaginal intraepithelial gap junctions, forming a transudate of plasma. The fluid coalesces to form water-like droplets that lubricate the entire vaginal canal, allowing for ease of penetration during sexual intercourse. Vaginal lubrication is a fundamental component of female sexual arousal and directly correlates with subjective levels of satisfaction and enjoyment. The female sexual arousal response is a complex reflex involving multiple organs and bodily functions. There are numerous age-related, metabolic, environmental, hormonal, and other factors that can negatively impact female sexual arousal and vaginal lubrication. As women age, vaginal lubrication declines due to declining genital blood flow and serum hormone levels. Concomitant reduction in physical activity and other medical comorbidities can also negatively impact vaginal blood flow and lubrication. The new and evolving treatment modalities for female sexual arousal disorder are directed toward optimizing vaginal health, function, and lubrication.

Background: Sexuality is an important part of health, quality of life and general wellbeing. Diabetes has long been considered a major cause of impaired sexual function. Neuropathy, vascular impairment, and psychological complaints have been implicated in the pathogenesis of decreased libido, low arousability, decreased vaginal lubrication, orgasmic dysfunction and dyspareunia among diabetic women.Objective: To investigate sexual dysfunction in diabetic females living at Sohag Governorate.Patients and methods: This case–control hospital-based descriptive study was carried out at the Obstetrics and Gynecology Department, Sohag University Hospitals on two groups; the case (Diabetic) group and the control (Non-diabetic) group. Each group included 100 sexually active nonpregnant women between 20 to 40 years of age. Their sexual function was assessed using Female Sexual Function Index Questionnaire.Results: The rate of feeling sexually aroused, level of sexual aroused, confidence about becoming sexually aroused during sexual life and rate of being satisfied with the arousal during sexual activity were significantly decreased in diabetic group than non-diabetic group. The difficulty of becoming lubricated “wet” during sexual activity and its maintaining until completion of sexual activity were significantly increased in diabetic group than non-diabetic group. The difficulty until reaching orgasm and satisfaction with the ability to reach orgasm were significantly decreased in diabetic group than non-diabetic group. Satisfaction with the amount of emotional closeness, the sexual relationship with the partner and the overall sexual life were significantly decreased in diabetic group than non-diabetic group.Conclusion: The incidence of sexual dysfunction is higher in diabetic women.

Sex is a science of cutting edge but bathed in mystery. Coitus or sexual intercourse, which is at the core of sexual activities, requires healthy and functioning vessels to supply the pelvic region, thus contributing to clitoris erection and vaginal lubrication in female and penile erection in male. It is well known that nitric oxide (NO) is the main gas mediator of penile and clitoris erection. In addition, the lightest and diffusible gas molecule hydrogen (H2) has been shown to improve erectile dysfunction (ED), testis injuries, sperm motility in male, preserve ovarian function, protect against uterine inflammation, preeclampsia, and breast cancer in female. Mechanistically, H2 has strong abilities to attenuate excessive oxidative stress by selectively reducing cytotoxic oxygen radicals, modulate immunity and inflammation, and inhibit injuries-induced cell death. Therefore, H2 is a novel bioactive gas molecule involved in modulating sexual organs homeostasis.

Background: Sexual dysfunction (SD) is reported in neurological conditions similar to Friedreich ataxia (FRDA). Anecdotally individuals with FRDA report SD including erectile dysfunction and altered genital sensation. Understanding SD in FRDA assists health professionals identify SD issues and improve healthcare for individuals with FRDA. Objective: To quantify if, and to what extent, people with FRDA experience challenges with sexual function and intimate relationships as a result of primary (genital function), secondary (physical) and tertiary (psychosocial) dysfunction. Methods: An online purpose designed anonymous questionnaire explored SD and intimate relationships. Invitations to participate were sent to individuals with FRDA aged 18 years and over on the Ataxia UK and Friedreich Ataxia Research Alliance databases. Date collection occurred between January and July, 2017. Results: One-hundred-and-seventy-nine adults with FRDA participated, of which 107 reported current or previous sexual activity. Erectile dysfunction was reported in 57% (20/35) of males, inadequate vaginal lubrication interfering with sexual responsiveness was reported in 57.7% (26/45) of females, and 47% (51/107) reported reduced genital sensation. In addition, 88% (94/107) reported problems moving their body during sexual activity and 73% (78/107) reported reduced confidence about their sexuality due to FRDA. A significant negative relationship was shown between younger age of disease onset and SD. Conclusion: This study confirmed FRDA impacts sexual functioning, sexual satisfaction and the capacity to form intimate relationships. Understanding the nature and extent of SD is critical to developing interventions and recommendations designed to enhance sexual function, sexuality, and intimate relationships for individuals with FRDA.

Female sexual dysfunction (FSD) is a serious health problem because of its high prevalence and deleterious effects on women's quality of life. Practitioners of women's health must care able to detect FSD in its early stage so that timely treatment could be offered. Also, the clinicians have lack understanding about the approach for identification and evaluation of the sexual problem. The study aimed to investigate the effect of guided psychosexual health instructions on changes in sexual activity among women with reduced sexual dysfunctions (hypoactive). Methods: A quasi- experimental design was used (pre and posttest one group) Setting: The study was conducted at Kebly and Bahary Maternal& Child Health Care Centers at Shibin Elkom Sample 100 participants of women were selected according to their responses in two-scale of sexual dysfunctions and elicited as hypoactive sexual dysfunctions from MCH Tools of the study: 1- Structured interview questionnaire classified into two parts, the first part deal with a biosocial data as age, level of education, and the employment status as well as complaining from physical or gynecological problems hindering them for conducting healthy marital relationship with their partner. The second part was: The Female Sexual Function Index (FSFI), A Multidimensional Self-Report Instrument for the Assessment of Female Sexual Function in a 19-item questionnaire, It was developed by Rosen, et al. (2010) as a brief instrument for assessing the key dimensions of sexual function in women. 2-Sexual Dysfunction Questionnaire It was developed by Infrasca et, al (2011) to assess women's readiness and preparation for sexual functions disorders Introduced as a brief self-report inventory. Results showed that there was a highly statistically significant difference P well as vaginal lubrication, orgasm, and degree of satisfaction during sexual activity. It was concluded that the use of guided psychosexual intervention was effective in managing sexual dysfunctions problems and enhancing satisfaction to reach orgasm. Recommendations. All health care providers should include screening questions regarding sexual well-being as a standard of practice. Treating medical, psychosexual, relationship problems, and addressing sociocultural issues, which can be effective in helping women and their partners dealing with hypoactive sexual desire disorder. Health care providers should involve the woman’s partner in the assessment and treatment of sexual health concerns when it is appropriate and safe to do so. Also, health guidelines protocol of care for (SD) should be providers to involve the woman’s partner in addressing sexual issues

Changes in vaginal blood flow and lubrication are primary components of physiological sexual arousal in women. Despite the existence of well-established tools for measuring vaginal blood flow, there is not yet a consistently implemented measure of physiological lubrication. To address this methodological gap, researchers have begun examining the utility of litmus test strips, primarily in sexually healthy women. The present study builds on this work by examining the utility of an alternative tool, the Schirmer Tear Test strips, in women with (

Objective: Although breast reconstruction has become an important treatment modality following mastectomy, few studies assessed predictors of postoperative sexual outcomes after breast reconstruction. Therefore, we aimed to study three sexual outcomes following implant-based breast reconstruction (IBBR), and associate multiple biopsychosocial factors with these outcomes. Methods: Data collection was part of a multicenter prospective study on IBBR. A predictive model was tested including medical, background and psychological predictors, partner relationship factors and physical sexual function. Data collection included clinical and questionnaire data (preoperatively and 1 year following reconstruction) using the BREAST-Q Sexual well-being scale (BQ5), and questions regarding sexual dysfunction and sexual satisfaction questions (Female Sexual Function Index). Results: The study sample consisted of 88 women who underwent mastectomy and IBBR. Mean postoperative BQ5 scores were lower than before surgery (M = 58 [SD = 18] vs 65 [SD = 20]; P =.01, Wilks' Lamdba =.88). Sexual dysfunctions were related strongest to orgasm inability and vaginal lubrication issues. The tested models predicted 37%-46% of the sexual outcomes: sexual outcomes were mostly predicted by psychosocial well-being, physical sexual function and partner support. Preoperative sexual and psychosocial well-being were positively associated with postoperative sexual well-being (r = 0.45 and r = 0.47). Conclusions: Although moderately positive sexual outcomes were reported after IBBR, some women reported issues with vaginal lubrication, breast sensation and orgasm. Sexual dysfunctions were predicted by vaginal lubrication and medical treatments, while sexual well-being and satisfaction were more predicted by psychosocial well-being and partner support. We advocate supportive care that includes partners and psychosocial functioning to optimize sexual outcomes after IBBR.

Background Despite the fact that childhood sexual abuse can affect a survivor's sexual functioning in adulthood, few studies have examined survivors' adult sexual functioning from the perspective of attachment theory. Aim The present study sought to examine how sexual abuse in childhood might shape the associations between attachment insecurities and sexual functioning among adults. Methods The study sample consisted of 265 participants (166 women and 99 men), 45 (16.9%) of whom were classified as survivors of childhood sexual abuse. Participants completed an online questionnaire about their history of childhood sexual abuse, attachment insecurities, and sexual functioning over the past 6 months. Outcomes The findings of the present study suggest that attachment insecurities may have unique implications for sexual functioning among survivors of childhood sexual abuse. Results Findings indicated that a history of childhood sexual abuse significantly moderated the associations between attachment insecurities and sexual functioning. Whereas the effect of attachment avoidance in predicting sexual desire was not significant among nonabused participants, it was significant among survivors; specifically, higher levels of attachment avoidance predicted lower levels of sexual desire. A different pattern was found for attachment anxiety. Although attachment anxiety did not predict vaginal lubrication/penile erection among nonabused participants, it had significant effects among survivors; specifically, higher levels of attachment anxiety predicted higher levels of vaginal lubrication/penile erection. Clinical Translation Findings from the present study may help facilitate sex therapy interventions for childhood sexual abuse survivors, from an attachment theory perspective. Strengths & Limitations The study included a nonclinical, convenience sample and used self-report measures, which are highly subjective and increase the possibility of social-desirability biases. However, on the plus side, it relied on simple, short, self-report questionnaires that are accessible and can be easily used by professionals to examine a survivor's current condition relative to any of the variables, establish intervention goals, and evaluate treatment. Conclusion A history of childhood sexual abuse is related to 2 opposite patterns of association between attachment insecurity (depending on type) and sexual functioning.

Objective: To assess the role of clinical pharmacists in the identification and management of drug-induced sexual dysfunction in collaboration with the psychiatrist and also to determine the prevalence and pattern of drug-induced sexual dysfunction, identify nature and extend of drug-induced sexual dysfunction, and assess the pattern of management of drug-induced sexual dysfunction. Methods: This periodic prevalence interventional study was carried out among patients who visited the psychiatric department of a university hospital over three month’s period. Patients were screened for sexual dysfunction using the Arizona Sexual Experience Scale (ASEX) by study pharmacists. Results: Of the 100 patients reviewed, only 50% of subjects met the study criteria. Depression (42%) was the most common clinical diagnosis among the study patients. The overall prevalence of drug-induced sexual dysfunction was 16%. A higher incidence of drug-induced sexual dysfunction was observed in men (62.5%). Decrease libido (40%) was the most prominently observed drug-induced sexual dysfunction in both genders. Antidepressant (50%) was the most common class of drugs implicated in sexual dysfunction. Drug-induced sexual dysfunction was pharmacologically managed with vaginal lubrication (40%), Tadalafil (20%) and Tadalafil+Dapoxetine combination (40%). Conclusion: With this study, provided a vision, further how prospective studies in this arena may be carried out for better understanding drug-induced sexual dysfunction and how a clinical pharmacist can contribute for better health care of patients in the sex clinic by collaborating with medical practitioners.

Vaginal dryness is a common condition that is particularly prevalent during and after the menopause and it is one of the most important symptoms associated with vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underreported and undertreated. Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. We evaluated the safety and beneficial effects of a new type of estrogen-free vaginal gel, Feminilove BIO-FRESH moisturizing vaginal gel, using in vitro and in vivo experimental tools. Our results suggest that; 1) Feminilove vaginal gel exhibits minimal cell cytotoxicity on various human vaginal cells; 2) Feminilove vaginal gel exhibits minimal side-effects on the structure of vaginal mucosa stratum of experimental animals; 3) Feminiove vaginal gel inhibits the growth of pathogenic vaginal bacteria (E. coli) while promotes the growth of beneficial vaginal bacteria (Lactobacillus spp); 4) Feminilove vaginal gel elicits an anti-inflammatory response on vaginal epithelial cells; and 5) Feminilove vaginal gel promotes the production of tropoelastin and collagen on cultural vaginal smooth muscle and may restore loose vaginal wall (i.e., tightening effects). In summary, our results indicate that Feminilove BIO-FRESH moisturizing vaginal gel is a safe and effective remedy for the treatment of symptoms associated with vaginal dryness and vulvovaginal atrophy in women. Keyword: vaginal dryness, vulvovaginal atrophy, genitourinary syndrome of menopause, sexual dysfunction, vaginal lubrication, vaginal moisturizer

Sexual dysfunction for women with diabetes is more common than for women without diabetes. The reasons why women with diabetes are a high-risk group are numerous. For example, lack of vaginal lubrication, pain during sex and inability to orgasm can be a consequence of high or low blood glucose levels. Higher rates of depression in people with diabetes can lead to low sexual drive. Wearing of diabetes devices, such as pumps, glucose monitors or lumps from lipohypertrophy around insulin injection sites may affect body image and self-esteem and the inconvenience of self-managing diabetes may affect the spontaneity of sex. This narrative review provides an overview of the problem of sexual dysfunction in women with diabetes, current methods of assessing sexual dysfunction in women, pharmacological and non-pharmacological interventions to treat it and an example of how psychological support for women with diabetes who experience sexual dysfunction can be integrated into a diabetes service. There are still significant gaps in our knowledge of how best to support women with diabetes and sexual dysfunction. However, raising awareness of the problem may help women with diabetes and healthcare professionals to discuss it as part of diabetes clinical consultations.

Introduction Male and female sexual dysfunction (SD) is considered a multifactorial condition. Numerous studies have shown the involvement of inflammatory processes in this pathological condition. Sexual intercourse requires healthy and functioning vessels to supply the pelvic region in both males and females, generating penile erection and clitoral and vaginal lubrication, respectively. Cardiovascular diseases and associated risk factors may contribute negatively to pelvic blood flow, possibly through immune system activation. Aim The study aimed to address the correlation between vascular inflammation driven by immune system activation and SD in males and females. Methods A literature review was performed to identify articles addressing male and female SD and vascular inflammation. Key words included “male and female sexual dysfunction,” “vascular inflammation,” “iliac and pudendal arteries dysfunction,” “genitourinary tract,” and “blood flow.” Main Outcome Measures Management of systemic and local inflammation may be a useful alternative to improve SD and reduce the risk of cardiovascular diseases in the future. Results Increased levels of cytokines and chemokines have been detected in humans and animals with hypertension, obesity, and diabetic conditions. Chronic activation of the innate immune system, especially by pathogen- or damage-associated molecular patterns, and metabolic-related disorders may act as triggers further contributing to an increased inflammatory condition. Due to the reduced size of vessels, SD and retinal vascular impairments have been shown to be predictive factors for cardiovascular diseases. Therefore, considering that blood flow to the genitalia is essential for sexual function, endothelial dysfunction and vascular remodeling, secondary to chronic immune system activation, may be implicated in male and female vasculogenic SD. Conclusions Several conditions appear to play a role in SD. In the present review, we have identified a role for the immune system in generating vascular and tissue impairments contributing to erectile dysfunction and female SD. Calmasini F, Klee N, Webb C, et al. Impact of Immune System Activation and Vascular Impairment on Male and Female Sexual Dysfunction. Sex Med Rev 2019; XX:XXX–XXX.

The objective of the present study was to analyze through a systematic review the ability of Tribulus terrestris to promote the increase of hormonal levels as a mechanism for the relief of menopausal symptoms. We searched the databases SciElo, PubMed, Science Direct and Springer Link in the year 2018, selecting 6 studies that approached the proposed theme. The criteria used for the selection were: studies involving menopausal women and use of Tribulus terrestris as a treatment for sexual dysfunction and / or other menopausal symptoms. It was observed that Tribulus terrestris was better than placebo to reduce somatic, psychological and urogenital symptoms. Four studies reported that women who used Tribulus terrestris had significant improvement in symptoms such as vaginal lubrication, sensation in the genitals during intercourse and others. In studies have found a significant increase in free and bioavailable testosterone after the use of the plant, which has great potential in the treatment of sexual dysfunction and other symptoms of menopause.

Introduction Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. Methods The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. Results The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. Conclusion The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations. Resumo Introdução A disfunção sexual é comum em indivíduos com doenças psiquiátricas e sob o uso de medicações como antidepressivos e antipsicóticos. Várias escalas foram desenvolvidas para avaliar a função sexual desses doentes. A Arizona Sexual Scale (ASEX) é uma escala de cinco itens de avaliação que quantifica desejo sexual, excitação, lubrificação vaginal/ereção peniana, capacidade para atingir o orgasmo e satisfação com o orgasmo. Este artigo descreve o processo de tradução e adaptação transcultural da escala ASEX para a língua portuguesa, com o objetivo de contribuir para a avaliação da função sexual dos doentes medicados com fármacos psicotrópicos nos vários países onde se utiliza essa língua. Métodos A tradução e a adaptação transcultural seguiram de forma detalhada os passos recomendados pelo grupo de trabalho da International Society for Pharmacoeconomics and Outcomes Research (ISPOR), nomeadamente: preparação, tradução inicial, reconciliação, retroversão, revisão da retroversão, harmonização, teste cognitivo, revisão do teste cognitivo, finalização, leitura final e versão final. Resultados O processo foi completado com sucesso, e não foram observadas diferenças grandes entre as fases de tradução, reconciliação e retroversão, tendo sido feitos apenas pequenos ajustes. Conclusão A tradução da escala ASEX foi bem-sucedida, seguindo orientações internacionais de referência. A aplicação dessas orientações é a garantia de uma versão em língua portuguesa que é qualitativa e semanticamente equivalente à versão original da escala. A existência desta nova versão da escala permitirá estudos que avaliem a função sexual dos doentes em países nos quais se fale a língua portuguesa. Estudos futuros poderão atestar a validade da escala para essas populações.

Aging has a powerful impact on the quality of relationship and sexual functioning. One primary cause of decreased sexual desire in postmenopausal women is decreased vaginal lubrication and/or a thinning of the vaginal lining which leads to pain during vaginal intercourse. to evaluate the impact of aging on various aspects of female sexuality. The present study included 150 married women above the age of sixty. The tool of the study was a questionnaire written in English and translated to Arabic. The questionnaire used included 29 items designed by the investigators. the most common age group was 60-64 years (60%) followed by age group 65-69 years (30.7%). Most of them were living in urban areas (53.3%). Regarding educational level, 24% of the studied group were university graduates and the rest of them either finished their secondary school (40%), or can only read and write (36%). The results of this study showed that there is a direct correlation between aging and sexual dysfunction. Coital frequency decreased with aging, 64.3% of women aged 70-74 years reported no coitus compared to 16.7% of women aged 60-64 years. Frequency of spontaneous sexual desire also decreases with aging, 40% of women aged 70-74 years, reported that sexual desire has become rare or almost never occurs compared to 14.7% of women aged 60-64 years

Objective To identify women's help-seeking behavior in relation to sexual health issues after the birth of their first baby. Design A mixed methods sequential explanatory study design was utilized. Phase one of the study consisted of a prospective cohort study to identify the help-seeking behavior of women experiencing sexual health issues at 3, 6, and 12 months postpartum. Phase two consisted of a qualitative descriptive design to explore women's help-seeking behavior for sexual health issues postpartum. Setting & Participants The setting was a large urban tertiary referral maternity unit (greater than 8000 births per year) in the Republic of Ireland. Nulliparous women aged 18 years and over were invited to participate in phase one. Phase two consisted of a subsample of women who consented to being contacted for further research on admission to the study. Findings Few women consulted a clinician for postpartum sexual health issues at each of the study's three, six and twelve month time-points. For example, only 2.9% (n=18) of women experiencing dyspareunia, and 3.6% (n=16) of those experiencing a lack of vaginal lubrication spoke to their General Practitioner (GP) about these issues at three months postpartum. The qualitative data supported the quantitative findings and suggested that even when women proactively sought help from healthcare professionals they were met with unhelpful responses. In the absence of support from practitioners, women became active agents and sought information from other women or the internet. In an effort to improve practice women recommended a greater focus on their physical and emotional recovery from birth. Key conclusions and implications for practice Very few women consulted with a clinician about their experience of sexual health issues after birth. Findings will contribute to and assist policy makers in planning future postnatal services for women to include extending the final postnatal assessment beyond six weeks after birth.

Objective Endometriosis is a common disease in women of childbearing age, leading to sexual dysfunction or loss of libido. We aimed to evaluated the effect of endometriosis on women’s sexual function. Methods We performed a prospective case–control study to determine the effect of endometriosis on women’s sexual function using a self-administered questionnaire from September 2017 to August 2018. The simplified Chinese version of the Female Sexual Function Index (FSFI) was used to assess sexual function. Results We found that sexual function of women in the endometriosis group (n=77) in all dimensions was significantly lower compared with that in the control group (n=63). The total FSFI score in patients was 25.5, which tended to be lower than that in the control group (26.7). Sexual arousal, sexual pain, and satisfaction were significantly different between the two groups. Sexual arousal and sexual pain scores were significantly lower in the endometriosis group than in the control group at the ages of 31 to 40 years. Conclusion Women with endometriosis suffer from sexual dysfunction, especially those aged 31 to 40 years. Our findings suggest that the quality of sexual life in this subpopulation needs to be improved.

Radiation-induced vaginal stenosis (VS) is a common side effect of pelvic radiotherapy (RT). RT-induced VS may have various negative effects on women’s quality of life, in particular dyspareunia, decreased vaginal lubrication and difficulties in sexual intercourse. This narrative review provides the aspects of RT-induced VS pathogenesis, incidence, evaluation and associated risk factors. Available treatment modalities are discussed in the article, putting the focus on preliminary, although promising, experience in the use of hyaluronic acid and laser therapy in cancer survivors after pelvic RT.

PURPOSE/OBJECTIVE(S) Many cancer patients are confronted with a variety of problems in sexual health function due to disease or treatment. Being a component of a patient's quality of life, many oncologists feel sexual health is an important topic of discussion, but only a minority of physicians actually address the patient's sexual health. Our goal was to assess the attitudes and practices among oncologists and their Advanced Practice Providers (APPs) towards sexual health. MATERIALS/METHODS We administered a 19-item survey via email to 286 program directors for Radiation Oncology, Medical Oncology, Hematology Oncology and Surgical Oncology residency and fellowship programs with instructions to distribute among faculty and residents as well as to members of local oncologic organizations. 16 APPs and 70 Oncologists completed the survey. Statistical analysis was completed using Chi Square test via a statistical software. RESULTS 82% of the providers believe that a discussion of sexual health issues is a part of their job, but only 17.4% discuss sexual dysfunction problems often or always. 33.7% of the providers report they discuss the possible effects of the illness on sexual functioning often or always. 38.4% of the providers report they discuss the possible effects of treatment on sexual functioning often or always. Of the cohort, 51.8% to 68.2% had received training in female sexual disorders of reduced libido, orgasm, vaginal lubrication and pain (percentage varied among disorder). Additionally, 48.2% to 62.8% of the providers had received training in male sexual disorders of reduced libido, testosterone deficiency, erection, ejaculation and orgasm (percentage varied among disorder). The data shows providers older than 40, with > 10 years of practice, and who work in private practice ask patients about their sexual health more often. Lastly, 62% never or rarely give their patients a referral to sexual health professionals to discuss sexual issues. CONCLUSION Many providers identify that they have a role or obligation to talk about sexual health, but the practice of discussing sexual health needs and concerns remains infrequent.

Sex is a person’s most fundamental need, and it is also a highly personalized experience. Sexual drive and sex are the products of not only biological desires, but also a person’s sexual experience and a harmonic integration of culture and spirit. Sexual dysfunction is a disorder in all facets of sexual activity and can occur in many ways in patients with disabilities. It ranges from the “low level” of altered function in the sexual organs to the “highest level” of person’s trust. All medical expertise is based primarily on the medical mechanical problems of penile erectile and ejaculatory dysfunction. The main problems of sexual dysfunction occur only when the patient approaches. Sexuality is a complex issue, and although we know our patients well, we often do not progress beyond the medical problem of erection, fertility, or contraception. For biologically effective sexual activity, an erection should occur with predictability, and vaginal lubrication based on adequate sexual arousal should facilitate comfortable sexual intercourse. While orgasm is not a prerequisite to a rewarding sexual experience, having a reliable orgasm with reliability after spinal cord injury is a bonus. Sexual dysfunction (sexual desire, genital arousal, orgasm, and pain with sex), change in sensation, and autonomic dysreflexia can be present in both sexes after spinal cord injury. Autonomic dysreflexia typically occurs in individuals with an injury at or above T6. Sexuality in spinal cord injuries, as well as the medical and neurogenic problems of the sexual organs, is associated with many components, including body control, trunks stability, and the presence of spasticity. The recovery of sexual function is extremely important and constitutes an area of unmet need for people with spinal cord injuries.

Hypertension is one of the most prevalent diseases that leads to end organ damage especially affecting the heart, kidney, brain, and eyes. Numerous studies have evaluated the association between hypertension and impaired sexual health, in both men and women. The detrimental effects of hypertension in men includes erectile dysfunction, decrease in semen volume, sperm count and motility, and abnormal sperm morphology. Similarly, hypertensive females exhibit decreased vaginal lubrication, reduced orgasm, and several complications in pregnancy leading to fetal and maternal morbidity and mortality. The adverse effect of hypertension on male and female fertility is attributed to hormonal imbalance and changes in the gonadal vasculature. However, mechanistic studies investigating the impact of hypertension on gonads in more detail on a molecular basis remain scarce. Hence, the aim of the current review is to address and summarize the effects of hypertension on reproductive health, and highlight the importance of research on the effects of hypertension on gonadal inflammation and lymphatics.

Background Vaginal lubrication is a crucial physiological response that occurs at the beginning of sexual arousal. However, research on lubrication disorders (LD) is still in its infancy, and the role of long non-coding RNAs (lncRNAs) in LD remains unclear. This study aimed to explore the function of lncRNAs in the pathogenesis of vaginal LD. Methods The expression profiles of LD and normal control (NC) lncRNAs were examined using next-generation sequencing (NGS), and eight selected differentially expressed lncRNAs were verified by quantitative real-time PCR. We conducted GO annotation and KEGG pathway enrichment analyses to determine the principal functions of significantly deregulated genes. LncRNA-mRNA co-expression and protein-protein interaction (PPI) networks were constructed and the lncRNA transcription factors (TFs) were predicted. Results From the results, we identified 181,631 lncRNAs and 145,224 mRNAs in vaginal epithelial tissue. Subsequently, our preliminary judgment revealed a total of 499 up-regulated and 337 down-regulated lncRNAs in LD. The top three enriched GO items of the dysregulated lncRNAs included the following significant terms: “contractile fiber part,” “actin filament-based process,” and “contractile fiber”. The most enriched pathways were “cell-extracellular matrix interactions,” “muscle contraction,” “cell-cell communication,” and “cGMP-PKG signaling pathway”. Our results also showed that the lncRNA-mRNA co-expression network was a powerful platform for predicting lncRNA functions. We determined the three hub genes, ADCY5, CXCL12, and NMU, using PPI network construction and analysis. A total of 231 TFs were predicted with RHOXF1, SNAI2, ZNF354C and TBX15 were suspected to be involved in the mechanism of LD. Conclusion In this study, we constructed the lncRNA-mRNA co-expression network, predicted the lncRNA TFs, and comprehensively analyzed lncRNA expression profiles in LD, providing a basis for future studies on LD clinical biomarkers and therapeutic targets. Further research is also needed to fully determine lncRNA’s role in LD development.

Os autores revisam os artigos publicados cujo objetivo principal fosse avaliar a influência da anticoncepção hormonal (AH) na sexualidade feminina. Há uma variabilidade muito grande na resposta das mulheres aos AH e ainda não há como se prever quais mulheres irão apresentar efeitos colaterais sexuais. Estes efeitos, entretanto, podem ser causa de abandono do método e, portanto, devem ser valorizados. Os AH ocasionam uma diminuição dos níveis de androgênios endógenos e, ao mesmo tempo, causam um aumento da SHBG. Essas alterações aparentemente são reversíveis após a suspensão destes medicamentos. Os AH orais contendo baixa dose de EE, 15 mcg, parecem ter um impacto negativo sobre a sexualidade, relacionado a um pior controle de ciclo e menor lubrificação vaginal. Os AH orais contendo EE 20 ou 30 mcg parecem ter boa aceitabilidade no que concerne a sexualidade. A minipílula não interfere na sexualidade feminina e o anel vaginal parece ter os melhores efeitos, aumentando as fantasias e o interesse sexual do casal. Casais com bom grau de ajustamento conjugal parecem ter maior chance de sofrer um eventual impacto negativo relacionado ao uso dos AH.

Background. Approximately 40% of women and 30% of men describe sexual dysfunction, although recognition in medical settings is sub-optimal, due to problems in reporting and eliciting concerns relating to sexual function and satisfaction. Screening questionnaires may help to support this aspect of clinical practice. The Arizona Sexual Experiences Scale (ASEX) includes items that quantify sex drive, arousal, vaginal lubrication or penile erection, ability to reach orgasm, and satisfaction from orgasm. Method. We investigated the validity and other psychometric properties of the ASEX, and the findings from the populations in which it has been employed, by searching MEDLINE, EMBASE and Google Scholar using the terms, Arizona Sexual Experiences Scale, Arizona Sexual Experience Questionnaire and ASEX. We eliminated duplications, letters and papers not available in English, and grouped the remaining papers into the categories of psychometric, epidemiological, and outcome-based studies. Results. After elimination of letters and duplicates, papers not in English, and pre-clinical and irrelevant studies, 104 papers were analysed. The ASEX has excellent internal consistency and scale reliability (Cronbach α=0.9055) and strong test–retest reliability (patients, r=0.801, p

Objective This video tutorial identifies key anatomic landmarks useful in identifying the path of the most commonly encountered pelvic nerves in benign gynecologic surgery. Design This is a narrated overview of commonly encountered pelvic nerves during benign gynecology, their origin, sensory, and motor function, as well as sequelae related to injury. Setting The unintended injury of pelvic neural connections can be a complication of any pelvic surgery, however, surgery for malignancy or endometriosis may increase the likelihood of encountering these nerves. The majority of focus surrounding surgical nerve injury, however, relates to patient positioning [1] . Injury to the pelvic nerves can lead to lifelong sexual, bladder, and defecatory dysfunction [2] . Interventions We review the Genitofemoral, Lateral Femoral Cutaneous, Ilioinguinal, Obturator, Superior and Inferior Hypogastric nerves, Pelvic Splanchnic nerves, and the Sacral nerves. Surgical illustrations are used (Fig. 1) alongside real-time narrated video to help viewers recognize the normal course of commonly encountered pelvic nerves at the time of gynecologic surgery (Figs2–3). Conclusion The surgical management of complex pelvic disease can unfortunately carry significant patient morbidity [3] . The neural pathways traveling through the pelvis via the hypogastric nerves are responsible for proprioception, vaginal lubrication, and proper functioning or the urethral and anal sphincters [4] . Sparing these nerves during pelvic surgery, and especially when anatomic planes are distorted by pelvic disease, requires surgical expertise and an immense understanding of pelvic neuroanatomy [ 4 , 5 ]. Preservation of the pelvic neural pathways is necessary to deliver the best patient outcomes while minimizing unwanted surgical complications. This video tutorial also highlights the origin of these nerves, their anatomic location, procedures in which these nerves may be encountered, and what sequelae occur from their unintended injury.

The aim of the study was evaluation of sexual dysfunction in neuro-Behcet’s disease (NBD). A total of 25 patients with NBD, 22 patients with Behcet’s disease (BD) without neurologic involvement (BDWONI) and 19 persons in control group were prospectively included in the study. We collected all demographic data. A semi-structured interview guided by a Arizona sexual experience scale (ASEX) questionnaire, Beck Depression Inventory and Beck Anxiety Inventory was applied to all of the patients. The sexual dysfunction was significantly higher in patients with NBD (47.9%) compared to patients with BDWONI (35.4%) and control group (16.7%) (p = 0.001). The score of total ASEX, drive, aurosal, vaginal lubrication/penil erection and satisfaction from orgasm were significantly higher in patients with NBD than healthy control group, statistically. Just arousal and lubrication/penile erection scores were significantly higher in NBD group than BDWONI group. Female/Male ratio regarding sexual dysfunction was 43.5/56.5, 29.4/70.6, 62.5/37.5 in NBD, BDWONI and healthy control group, respectively (0 = 0.027). NBD had a negative effect on sexuality in all but especially on arousal and vaginal lubrication/penil erection function based on ASEX questionnaire. Moreover, male sexuality was more affected by BD than female sexuality. Further researches using larger sample sizes are needed to clarify the issues.

Karli, Pervin/0000-0003-4907-5890 WOS: 000506025000001 PubMed: 31907344 Background: The aim of this study was to investigate factors affecting the sex lives of middle-aged women, and whether surgical menopause affects sexual function differently from natural menopause, by comparing effects on sexual performance of women with similar demographic features. Material/Methods: The study included 151 women with surgical menopause (SM), 357 women with natural menopause (NM), and 186 perimenopausal women (PM). The women were asked to complete a 6-question survey of sexual performance parameters. The relationship between the demographic and clinical features and hormone levels of the groups and sexual function parameters were evaluated. We also compared these parameters between the 3 study groups, and paired comparisons were made between the SM group and the NM group. Results: Demographic features, serum DHEA-S, total testosterone, and FSH levels were found to have statistically significant effects on sexual performance of women (p

Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien–Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, appear to persist over time. Surgeons and women have to be aware of the incidence of this kind of complications.

Dyspareunia can be described as continuous unremitting or intermittent pain associated with intercourse. It can be classified based on the location of the pain - entry or deep dyspareunia, or based on when the pain was first experienced - primary or secondary dyspareunia. There are different causes of dyspareunia and some of the most important causes include the following: vulvodynia, postpartum dyspareunia, endometriosis, inadequate vaginal lubrication or arousal, and other anogenital causes such as hemorrhoids and anal fissures. In this review, our objective is to apply the anatomical knowledge of dyspareunia to patient care, increase awareness among clinicians about the diverse etiology of dyspareunia and ensure that the whole patient, not just the pain of dyspareunia is being treated as the causes of dyspareunia can be due to various pathologies. Clin. Anat., 31:1013-1017, 2018. © 2018 Wiley Periodicals, Inc.

Introduction Female sexual dysfunction (FSD) is a common disease with serious potential hazards, but it has not received much attention. The pathogenesis of FSD is urgently needed for the diagnosis and treatment of FSD. Aim To investigate the role of microribonucleic acid (mRNA, miR)-137 in FSD. Methods Vaginal epithelium tissues from 15 women with lubrication disorder and 15 women with normal function were collected for this study. The expression level of miR-137 in lubrication disorder and normal function women were measured by microarray analysis and Real-time Quantitative Polymerase Chain Reaction (PCR, qPCR). miR-137 was overexpressed in vaginal epithelial cells VK2/E6E7 by lentivirus infection. The cell water permeability was measured using the calcein-quenching method. Cell apoptosis was analyzed by flow cytometry. The potential target of miR-137 was predicted by bioinformatic analysis, then verified by luciferase reporter assays. Main Outcome Measure The expression level of miR-137 and aquaporin-2 (AQP2), cell water permeability, cell apoptosis, and luciferase reporter assays were examined. Results miR-137 was found to be highly expressed in vaginal epithelial tissues of women with lubrication disorder. Additionally, functional in vitro studies suggested that overexpression of miR-137 leads to a decrease in cell permeability. By combining target prediction and examination, we identified AQP2 as the direct mechanistic target of miR-137 that affected the water permeability of vaginal epithelial cells. Conclusion Our results point to a novel role for miR-137 and its downstream effector AQP2 in vaginal lubrication, which can be manipulated as therapeutic targets against lubrication disorder and its related disorders.

BACKGROUND Although sexual dysfunction is common after hematopoietic stem cell transplantation (HCT), interventions to address sexual function are lacking. METHODS We conducted a pilot study to assess the feasibility and preliminary efficacy of a multimodal intervention to address sexual dysfunction in allogeneic HCT survivors. Transplant clinicians screened HCT survivors ≥3 months post-HCT for sexual dysfunction causing distress. Those who screened positive attended monthly visits with a trained transplant clinician who: 1) performed an assessment of the causes of sexual dysfunction; 2) educated and empowered the patient to address his or her sexual concerns; and 3) implemented therapeutic interventions targeting the patient's needs. Feasibility was defined as having approximately 75% of patients who screened positive agreeing to participate and 80% attending at least 2 intervention visits. We administered the Patient-Reported Outcomes Measurement Information System (PROMIS) sexual function and satisfaction measure, the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and the Hospital Anxiety and Depression Scale (HADS) to evaluate sexual function, quality of life (QOL), and mood, respectively, at baseline and 6 months postintervention. RESULTS Approximately 33.1% of patients (50 of 151 patients) screened positive for sexual dysfunction causing distress and 94.0% (47 of 50 patients) agreed to participate, with 100% attending 2 intervention visits. Participants reported improvements in satisfaction (P

Introduction After spinal cord injury (SCI), individuals are typically considered by the general public to be asexual. Handicapped women have more problems with socio-sexual adaptation, stemming from low self-confidence, low self-esteem, and the absence of spontaneity. Aims To determine changes in the sexual lives of women after SCI. Methods A self-constructed questionnaire was used to map sexual function after SCI. We retrospectively compared sexual function in 30 women with SCI with that in 30 without SCI who led an active sexual life. Descriptive and inductive statistics were applied using the Student paired and non-paired t-tests and the Levene test. Main Outcome Measures The main variables were presence vs absence of sexual dysfunction in a group of women after SCI and a comparison of the incidence of sexual dysfunctions in women after SCI with that of a control group. Results A significant difference was ascertained in women with SCI in sexual desire (P < .001), lubrication (P < .001), and reaching orgasm before and after injury (P = .030). A comparison of the two groups showed a significant difference in the realization of coital sexual activity (P < .001), erotogenous zones of the mouth (P = .016), nipples (P = .022), and genitals (P < .001), and in the ability to reach orgasm (P = .033). The negative impact of incontinence on the sexual life of women with SCI proved significant (P < .001). Negative factors for sexual activity in women with SCI were lower sensitivity in 16 (53%), spasms and mobility problems in 12 (40%), lower desire in 11 (36%), pain in 4 (13%), and a less accommodating partner in 3 (10%). Conclusion Intercourse was the preferred sexual activity in women with SCI. Compared with the period before injury, there was significant lowering of sexual desire, impaired lubrication, and orgasmic ability after SCI. A comparison of the two groups showed a difference in erotogenous zones and in reaching orgasm.

Objectives: Sexual dysfunction is highly prevalent nowadays and is a threat to healthy marital life. The aim of the present study was to determine the factors associated with sexual dysfunction in newly married women referred to the urban health comprehensive services centers of Zanjan, Iran in 2015-2016. Materials and Methods: This descriptive-analytical cross-sectional study was conducted on 300 women married in the last 5 years who referred to the health centers in Zanjan. The participants were selected through cluster sampling method. Data were collected using a socio-demographic characteristics questionnaire and the Female Sexual Function Index. Descriptive and analytical statistics including independent t test, one-way ANOVA, and the general linear model were used to analyze the data. Results: Sexual dysfunction was found in 66% of the women. The frequency of sexual dysfunction was 33% for arousal, 31% for pain, 28.7% for desire, 23% for satisfaction, 3% for vaginal lubrication, and 16.3% for orgasm dimensions. According to the general linear model, breastfeeding and contraceptive method had a significant relationship with the mean score of sexual function. Conclusions: About two-thirds of women in their early years of marriage had sexual dysfunction, and given its impact on all aspects of marital life, it seems necessary to include sexual counseling in the pre-marital counseling program. © 2018 The Author (s).

Background: Woman’s orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. Objective: The aim of this study is exploring obstacles to orgasm in Iranian married women. Materials and Methods: This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Results: Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was “Multidimensionality of women’s orgasm obstacles”. Subcategories and some codes included: Physical obstacles (wife’s or husband’s boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems), relational obstacles (husband’s hurry, having a dispute and annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children’s bedroom from their parents, lack of peace at home). Conclusion: For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman’s life is necessary.

OBJECTIVE The aim of this study was to evaluate the effectiveness of a genital vibratory stimulation device in improving sexual function in women with arousal and orgasm disorders. METHODS In this single-arm, prospective study, baseline and 1- and 3-month assessments were performed to evaluate women with sexual arousal and/or orgasmic disorders, who received therapy using a genital vibratory stimulation device. Sexual function, satisfaction, and distress were evaluated using the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale, and the Female Intervention Efficacy Index questionnaires. Genital sensation was evaluated using quantitative sensory testing. RESULTS Seventy women, aged 19 to 64 years, were evaluated from October 2009 to August 2013. Forty-seven (67.1%) and 37 (52.9%) women completed 1- and 3-month follow-ups, respectively. The FSFI arousal and orgasm domain scores and total FSFI scores improved at 1 and 3 months (P < 0.001 for all outcomes). Mean (SD) total FSFI scores increased from 20.04 (4.65) (baseline) to 25.03 (5.21) (1 month) to 26.66 (5.42) (3 months; both Ps < 0.0001). Female Sexual Distress Scale scores reflected significantly decreased distress at 1 (P = 0.0006) and 3 (P < 0.0001) months compared with baseline and at 3 months compared with 1 month (P = 0.03). Neurological sensation was increased at all genital sites at 1 and 3 months (P < 0.0001 for all). After adjustment for age, there was a significant interaction between arousal domain scores and clitoral and right labial sensation. At 3 months, perceptions of increased vaginal lubrication, orgasm, and genital sensation were reported by 67.5%, 65.0%, and 82.5% of the participants. No major adverse events were noted. CONCLUSIONS Genital vibratory stimulation device use resulted in uniform improvements in sexual function, satisfaction, sexually related distress and genital sensation.

Objectives To evaluate the safety and long-term efficacy of fractional CO 2 laser treatment in reducing the severity of symptoms of genitourinary syndrome of menopause (GSM) in menopausal women. Study design 102 women presenting with symptomatic GSM were treated with the fractional CO 2 laser (MonaLisa Touch, DEKA) system across a series of treatments delivered at intervals of six or more weeks. The Australian Pelvic Floor Questionnaire was used to gather data on sexual function and side-effects at three time-points across the study period (prospective panel design study). Wilcoxon signed-rank tests were used to detect statistically and clinically significant changes in sexual function and side-effects occurring from pre- to post-treatment. The primary outcome of this study was an improvement of the symptoms of GSM. The secondary outcome included bladder function and prolapse symptoms. Results A total of 102 women suffering from moderate to severe GSM were recruited. Eighty-four percent experienced significant improvement in their symptoms after CO 2 laser treatment. Scores on measures of sexual function, dyspareunia, and bothersomeness of sexual issues were improved from pre-treatment to long-term (12–24 month) follow-up. Furthermore, there were improvements on measures of bladder function (P=0.001), prolapse (P=0.001), vaginal sensation (P=0.001), vaginal lubrication (P&nbsp

In the shadows of the cultural obsession with male erections, women’s vaginal lubrication and experiences of wetness have received surprisingly little academic attention. Framed largely as a biological or normative behavioral “sexual function” issue and not as a subjective experience, no previous qualitative studies have asked women to discuss their feelings about their vaginal lubrication and wetness. This study analyzed semi-structured interviews with 20 women from a diverse 2014 community sample collected in a large Southwestern U.S. city in order to examine American women’s subjective feelings about their own vaginal lubrication and wetness, particularly the sensations they experience and the meanings they make around wetness. Results revealed four themes in how women described vaginal lubrication: (1) wetness as pleasure, joy, and connection; (2) wetness as physical and biological phenomenon; (3) anxiety about insufficient wetness; and (4) having excessive or “too much” wetness. Tensions surrounding women’s sexual anxieties and where they place responsibility for “too little” wetness is discussed in tandem with analyses of how pleasure and arousal may (or may not) overlap with feelings about sexual normality and health. Ultimately, renewed attention to the complexities of women’s sexual arousal and function, particularly in stark contrast with pharmaceutical efforts to medicate women’s sexual arousal and reduce it to “brain chemistry,” are examined.

Spinal cord injury (SCI) affects sexual health of both male and female, but little attention has been given to sexuality of SCI women. Similar to penile erection, vaginal lubrication represents a neurovascular event and then both denervation and vascular damage might contribute to its impairment. Nevertheless, the relative weight of lesion location/degree and vascular risk factors in determining hypolubrication in women with SCI has not yet been investigated. The aim of this study was to recognize among putative determinants of poor sexual arousal in women with SCI, neurogenic and vascular/metabolic independent predictors of vaginal hypolubrication. Twenty-eight consecutive female patients admitted to a rehabilitation program because of chronic SCI (≥ 1 year) underwent clinical and biochemical evaluations, including assessment of vaginal lubrication by the Female Sexual Function Index (FSFI). As, in people with SCI, waist circumference overestimates visceral fat mass due to abdominal muscle paralysis, metabolic syndrome (MetS) was defined according to specific criteria proposed for SCI population: BMI ≥ 22 kg/m2 and two or more of the following: triglycerides ≥ 150 mg/dL (or actual treatment), HDL

Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO2 , vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de-coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated-they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat. 32:136-145, 2019. © 2019 Wiley Periodicals, Inc.

Background Systematic review and metaanalysis results of sexual dysfunction in patients with systemic lupus erythematosus are contradictory. We investigate the quality of sexual activity in 74 patients with SLE receiving standard care of therapy and the addition of monthly injections of belimumab. Methods The Female Sexual Function Index (FSfi), obtained by applying a 19-item questionnaire that assesses six domains (sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain), was used. Results The mean ±SD was desire 162.9±10.02 arousal 143.4±8.6 lubrification 213.7±13.4 orgasm 214.4±14.8 satisfaction 222.4±19.9 pain 165.6±11.7 Conclusions The FSFi in SLE patients are decreased when compared with what is reported in placebo populations but its magnitude is reduced when compared with results reported in other severe chronic diseases. This findings suggests that further studies are needed to find out if belimumab treated SLE patients have some degree of protective effect in sesxual dysfunction. Funding Source(s): Funding source Institutional and GSK.

Background Little is known about sexual problems and genitourinary health of older sexual minority adults, who comprise up to 4% of the adult population but may differ in experiences of genitourinary aging, given known health disparities and behavior differences. Aim To examine and compare genitourinary and sexual complaints among older sexual minority and sexual majority adults. Methods We analyzed data from the 2010–2011 National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of older community-dwelling U.S. adults. Sexual minority men were defined as those who have sex with men or with both women and men. Sexual minority women were those who have sex with women or with both women and men. Descriptive statistics, weighted frequencies, and the chi-square test were used to compare outcomes by sexual orientation group and gender. Main Outcome Measures Structured questionnaires examined sexual activity, practices, and genitourinary problems such as erectile dysfunction, insufficient vaginal lubrication, and urinary incontinence (UI). Results Of 2,813 participants (median age 69.6 years), 4.2% were sexual minorities (5.3% of men, 3.5% of women). Among men, sexual minorities were more likely to report UI (35.6% vs 21.8%; P = .029), but otherwise the 2 groups had similar prevalences of other urinary symptoms, importance of sexual activity, sexual practices, sexual activity within the last 3 months, and erectile difficulty (P > .10 for all). Among women, sexual minorities were more likely to report receiving oral sex (42.5% vs. 21.2%; P = .004), but otherwise the 2 groups had similar prevalences of UI, other urinary symptoms, importance of sexual activity, sexual activity within the last 3 months, and difficulty with lubrication (P > .10 for all). Clinical Implications Sexual activity and sexual problems may be as common among older sexual minority adults as in their sexual majority counterparts, whereas UI may be more common in sexual minority men compared with sexual majority men. Therefore, clinicians should employ culturally-relevant health screening, diagnosis, and treatment to ensure reaching all adults regardless of sexual orientation. Strengths & Limitations Strengths include a national population-based sample of older adults that describes sexual and genitourinary health. Statistical power was limited by the small numbers of sexual minority individuals. Conclusion Here we provide new evidence that older sexual minority men may experience UI more often than sexual majority men, and that sexual practices may differ between sexual minority and majority women, but frequency of sexual problems is similar. Given the challenges faced by sexual minority individuals in accessing equitable health care, clinicians must ensure that diagnosis and treatment are relevant to people of all sexual orientations.

To assess the potential uptake of HIV pre-exposure prophylaxis (PrEP) products among female sex workers (FSWs) vulnerable to HIV infection, we examined the influence of product attributes on willingness to use products among 271 HIV-negative FSWs in Tijuana and Ciudad Juarez, Mexico (2016–2017). Via five-point Likert scale ratings, participants indicated their willingness to use hypothetical products with six attributes: formulation (pill, gel, liquid, or ring), frequency of use (daily, on-demand, or monthly), cost per use (10 or 200 pesos), effectiveness (40% or 80%), side effects (none or mild), and access point (healthcare clinic or non-governmental organization). Conjoint analysis was used to determine the impact of attributes on product ratings and identify preferred product attributes. Multinomial logistic regression was used to identify factors associated with formulation preferences. In both cities, formulation and frequency of use had the greatest impact on ratings. Participants in Ciudad Juarez indicated a strong preference for oral pills, whereas participants in Tijuana indicated roughly equal preferences for oral pills and vaginal gels. Monthly product use was preferred in both cities. Compared to preferring oral pills (38%), preferring vaginal gels (28%) was associated with practicing vaginal lubrication (adjusted odds ratio = 2.08; 95% confidence interval: 1.07–4.04). Oral PrEP may be acceptable to many FSWs in Tijuana and Ciudad Juarez; however, continued development of behaviorally-congruent vaginal PrEP products may also facilitate uptake and ensure sufficient coverage.

To evaluate the impact of radical cystectomy and urinary diversion on female sexual function.A Medline search was conducted according to the PRISMA statement for all English full-text articles published between 1980 and 2016 and assessing female sexual function post radical cystectomy and urinary diversion. Eligible studies were subjected to critical analysis and revision. The primary outcomes were the reporting methods for female sexual dysfunction (FSD), manifestations of FSD, and factors associated with FSD, postoperative recoverability of FSD, and awareness level regarding FSD.From the resulting 117 articles, 11 studies were finally included in our systematic review, with a total of 361 women. Loss of sexual desire and orgasm disorders were the most frequently reported (49% and 39%). Dyspareunia and vaginal lubrication disorders were reported in 25% and 9.5%, respectively. The incidence of sexual dysfunction was 10% in 30 patients receiving genital- or nerve-sparing cystectomy vs. 59% receiving conventional cystectomy.Although female sexual function is an important predictor of health-related quality of life post radical cystectomy and urinary diversion, the available literature is not enough to provide proper information for surgeons and patients.

Physiologic changes in a woman’s life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman’s quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.

Background and Objectives: The Quercus (oak) fruit and especially the internal layer of the fruit (jaft) is rich in tannin (polyphenolic compound) and due to its astringent effects on the smooth muscles, we decided to evaluate this effect of extract of Oak Gall for vaginal tightening and rejuvenation in women with vaginal relaxation. Methods: This double blind clinical trial was performed on women with vaginal relaxation at Asali Hospital in Khorramabad from May to October 2012 and was candidate for colporrhaphy due to different types of pelvic organ prolapse. Sampling method was done on nonprobability basis according to the number of patients referred to clinic. Using blocked random allocation method, the participants were divided into 4 groups of 30 patients (three intervention group and one control group) who were age-matched. Then, an extract of Oak Gall in specified concentrations (10 - 15 and 20 grams in 1.5%, 2% and 2.5% jells) were administered to each intervention group. Finally, the obtained data were analyzed with Chi-square, Pearson, Fisher’s exact test and ANOVA using SPSS software version 19. Results: A total of 120 patients entered into the study with mean age of 36 ± 5.4 years. The evaluation of mean scores showed that sense of sexual satisfaction and orgasm, sense of vaginal tightness during intercourse, sense of vaginal lubrication and loss of vaginal dryness was significantly improved in patients in intervention group. Also other parameters including urinary incontinence, sense of vaginal mass exit, lack of orgasm, sense of air outflow during intercourse, sense of calmness after sex and loss of libido were significantly reduced in the group of patients who received jell 2.5% compared to other groups (P < 0.0001). Conclusion: Our findings show that using topical jell of Oak Gall not only is associated with contracting effects, but also improves vaginal lubrication and reduces its dryness. Regarding the lack of previous studies in this field and considering some limitations of this study, we suggest that Oak Gall to be used for management of women with vaginal relaxation.

Background: Men's participation is an important issue in family planning and reproductive health. Coitus interruptus and condom use are two reversible and non-hormonal methods of contraception to engage men in family planning. The present study is aimed to evaluate the relationship of male condom use and withdrawal as contraception with female sexual function and satisfaction. Methods: A cross-sectional study was conducted on 215 married women aged 15-45 years in Ahvaz. Necessary data were collected using three demographic, female sexual function index (FSFI), and female sexual satisfaction questionnaires. The data were analyzed using SPSS software version 22 and descriptive and analytical tests (independent t-test and Pearson's and Spearman's correlation coefficients) were used. A P level of less than 0.05 was considered significant. Results: Although there was no significant difference in the areas of sexual desire (p=0.31), sexual arousal (p=0.18), vaginal lubrication (p=0.63), and pain (p=0.06) between two groups, but significant differences were found between the areas of orgasm (p=0.004), sexual satisfaction (p=0.009) and overall sexual function index (p=0.04) in both groups, which were higher in the condoms-used group. There was a significant direct relationship between female sexual function index and satisfaction in the condom method (p=0.001, r=0.48) and the withdrawal method (p=0.001, r=0.38). Conclusions: Female sexual function and satisfaction in the users of male condoms is higher than the withdrawal method of contraception, while significant direct relationship was found between female sexual function and satisfaction in both methods. For a more detailed conclusion on female sexual function and satisfaction of users of these methods, longitudinal studies are suggested to be done by performing follow-up periods before, during and after cessation of method.

Objective: This study aims to describe the factors affecting successful nursing care intervention on sexuality. Methods: A one-group pre- and post-test design was used. Fifty-three cervical cancer survivors and their spouses were administered with nursing care intervention on sexuality in three sessions and evaluated after 6 weeks. Results: Sexual intervention reduced dyspareunia symptoms, improved vaginal lubrication, improved sexual satisfaction, and enhanced sexual arousal, sexual desire, and orgasm among cancer survivors and their spouses. The other influencing factors also simultaneously contributed to the success of nursing care intervention. Conclusions: Nursing care intervention on sexuality could be a part of supportive nursing care and an important aspect in standard nursing care for cancer patients in Indonesia.