Do hormones influence women's sex? Sexual activity over the menstrual cycle.

INTRODUCTION: In mammals, the effects of ovarian steroids influence sexual behavior. In humans, there are a few studies that take into account if ovulation occurs. AIM: The study aims to investigate if a woman's sexuality changes during the week and over the menstrual cycle, and if so, in what way. METHODS: This is a prospective cohort study; 1,957 heterosexual women were involved over the period January 2004-December 2011. Two subgroups were taken into consideration, women having a partner and singles. MAIN OUTCOME MEASURE: Sexual interview and the Female Sexual Function Index and Female Sexual Distress Scale questionnaires were used to exclude women with sexual dysfunction. Women with ovulation confirmed by sonography were enrolled. Women were given diary cards on which to report their daily sexual activity. Serum concentrations of estradiol, progesterone, total testosterone, sex hormone binding globulin, and free androgen index were measured during the follicular, periovular, and luteal phase of the menstrual cycle. RESULTS: One thousand one hundred eighty women (age range 18-40 years) were included in the analyses. Of them, 925 had a heterosexual relationship and 255 were single. Women with a partner had more sexual activity during the weekend, while the singles had a constant sexual activity over the week. The sexual activity of singles was higher during the ovulatory phase and lower during menses than that of the women with a partner. A linear correlation between sexual activity and androgenic hormonal profile during the menstrual cycle in women with and without a partner was observed. CONCLUSIONS: Ovarian steroids modulate a woman's sexual activity. This aspect was more evident in singles than in women having a partner, in which a variety of nonhormonal factors can have a role.

Preliminary study on the effect of four-phasic estradiol valerate and dienogest (E2V/DNG) oral contraceptive on the quality of sexual life.

INTRODUCTION: A new oral contraceptive containing the natural estrogen estradiol and a 19-nortestosterone derivate dienogest (DNG) in a four-phasic 28-day regimen may be used by women. AIM: To investigate the quality of sexual life of healthy women on estradiol valerate and DNG (E2V/DNG) oral contraceptive. METHODS: Fifty-seven women (age range 18-48 years) were enrolled. The Short Form-36 (SF-36) questionnaire to assess quality of life (QoL) was administered at baseline and at the 26th day of both the 3rd and 6th cycles of oral contraceptive (OC) intake. The Short Personal Experience Questionnaire (SPEQ) to measure the change of sexual behavior was used at the 2nd, 7th, 14th, 21st, 26th, and 28th days of the baseline cycle, as well as at the same days of both the 3rd and 6th cycle of contraceptive intake. MAIN OUTCOME MEASURE: The SF-36 and the SPEQ questionnaires. RESULTS: Women reported QoL improvement at the 3rd (P < 0.05) and at the 6th cycles (P < 0.01). By SPEQ, improvement of sexuality during the 3rd and the 6th cycle with respect to baseline experience was observed (P < 0.05). The frequency of sexual activity remained basically unchanged (P = NS). Enjoyment and desire improved at the 6th cycle with respect to the 3rd cycle (P < 0.05). All women reported decreased dyspareunia at the 3rd and 6th cycles (P < 0.05). Interestingly, desire, arousal, orgasm, enjoyment, and sexual activity improved, reaching a peak around the 14th day of the menstrual cycle (P < 0.05). At the 3rd and 6th cycle, women on OCs were sexually cyclic, but the peak improvement of desire, arousal, orgasm, enjoyment, and sexual activity appeared around the 7th day of OC intake (P < 0.05). CONCLUSION: Reduced hormone-free interval is a new concept in low-dose OC regimens. Moreover, the E2V/DNG multiphasic extended regimen has been found to positively modify the sexuality of users.

Ultrastructural and quantitative study of clitoral cavernous tissue from living subjects.

INTRODUCTION: There has never been an investigation about the in vivo clitoral structure. AIM: To study the "in vivo" age-related structural changes of the clitoris in healthy women and in those affected by metabolic disorders. METHODS: Forty-three women subgrouping in (i) five teenagers, aged 14-18; (ii) eight young premenopausal women, aged 23-32; (iii) 10 premenopausal women, aged 38-47; (iv) nine diabetic premenopausal women, aged 27-43; and (v) 11 naturally postmenopausal women aged 51-55. Each woman underwent microbiopsy of the clitoral body by means of an 18G needle, length 100 mm, using a semiautomatic gun during total anesthesia for a benign gynecological pathology. The tissue removed was processed for electron microscopy. A morphometric procedure was used on electron micrographs. MAIN OUTCOME MEASURE: Micro ultrastructure observation of clitoral tissue. RESULTS: The cavernous tissue from the teenagers and young women showed large amounts of smooth muscle cells (SMCs). The intercellular connective tissue showed scanty, small isometric collagen fibers and amorphous extracellular matrix. In the premenopausal diabetic women, ultrastructural abnormalities of SMCs were observed, consisting of increase of glycogen deposits, infolding cell borders, and cytoplasmic vacuoles. Moreover, the intercellular connective tissue was increased by densely packed collagen fibers. Finally, in the healthy, natural postmenopausal women, the SMCs were moderately reduced in number. We observed age-related structural changes of the vascular spaces and of the vascular lacunae. The SMC mean thickness was reduced with age; vascular abnormalities appeared to be correlated with the presence of metabolic diseases, such as diabetes. CONCLUSION: Our "in vivo" study could help to understand some aspects of the physiology of the clitoris and its role in sexual response. Apart from data obtained by studying healthy women and women affected by diabetes, other investigations are needed to study subgroups of otherwise healthy sexually dysfunctional women.

Conventional vs. extended-cycle oral contraceptives on the quality of sexual life: comparison between two regimens containing 3 mg drospirenone and 20 µg ethinyl estradiol.

INTRODUCTION: Women may use new oral contraceptives (OC) having flexible extended-cycle regimens with a reduced hormone-free interval. AIM: To study the changes of the quality of sexual life in users of the traditional 21/7 or extended-cycle 24/4 OC regimens both containing 3 mg drospirenone and 20 µg ethinyl estradiol. METHODS: One hundred fifteen women (age range 18-37 years) were enrolled. Fifty-four women were randomly placed on traditional OC standard regimen, administered for 21 days, followed by a 7-day hormone-free interval (group A); and 61 women were placed on extended-cycle OC regimen covering 24 days of the cycle with a 4-day hormone-free interval (group B). The Short Form-36 (SF-36) validate questionnaire to assess quality of life (QoL) and the Short Personal Experience Questionnaire (SPEQ) to measure the changes of sexual behavior were administered before starting OC intake and at the 3rd and 6th cycle follow-ups. MAIN OUTCOME MEASURE: The SF-36 and the SPEQ questionnaires. RESULTS: Group A women reported QoL improvement during the 6th cycle on all the scales (P < 0.05). Group B women reported QoL improvement during the 3rd and 6th cycle (P < 0.05). Satisfaction with sexual activity, arousal, orgasm, and desire increased during the 3rd cycle in women on the group B (P < 0.05). Group A women did not report any change in all SPEQ items. At the 6th cycle, group B women reported better sexual experience than baseline in all SPEQ items (P < 0.05). All subjects who were affected by dyspareunia before OC intake reported decreased genital pain associated with intercourse at the 3rd and 6th cycle of both OC regimens (P < 0.05). CONCLUSION: Women could use OCs in a subjective flexible modality. The extended-cycle OC might produce positive effects on the quality of sexual life, enforcing the concept of tailoring an OC to a woman.

Quality of sexual life in hyperandrogenic women treated with an oral contraceptive containing chlormadinone acetate.

INTRODUCTION: Hyperandrogenism produces change in quality of life of women. AIM: To prespectively determine the changes of the sexual behaviour of hyperandrogenic women using an oral contraceptive containing 30 microg ethinylestradiol and 2 mg chlormadinone acetate (EE/CMA). METHODS: Seventy-two volunteer women (age range, 18-32 years), with moderate to severe hirsutim and acne were treated with EE/CMA for 9 cycles. MAIN OUTCOMES MEASURE(S): To assess hirsutism, the Ferriman-Gallwey (F-G) scoring system was used. Serum FSH, LH, estradiol, total and free testosterone, DHEAS, androstenedione, and SHBG levels were measured at baseline and at the 9th cycle of pill intake. The Short Personal Experience Questionnaire (SPEQ), the Short Form-36 (SF-36), and a visual analog scales questionnaires were used to assess the QoL, at baseline and after 3, 6 and 9 cycles of pill use. RESULT(S): A reduction of 65% and 81% in the total mean F-G score was observed after the 6th cycle and the 9th cycle, respectively. The serum Androstenedione, and total and free testosterone levels decreased, and SHBG levels increased after the 9th cycle (p < 0.05). The SF-36 score was higher after 6 (p < 0.05) 9 cycles (p < 0.001) with respect to baseline. Frequency of sexual intercourse and of orgasm by intercourse increased, and the frequency of masturbation decreased during the 6th (p < 0.05) and the 9th cycle (p < 0.001). CONCLUSION(S): The EE/CMA pill has anti-androgenic properties reducing the anti-aesthetic effect of hyperandrogenism and improving female sexual and social self-esteem.

Prospective study evaluating olfactometric and rhinomanometric outcomes in postmenopausal women on 1 mg 17beta-estradiol and 2 mg drospirenone HT.

OBJECTIVE: To evaluate the effects of drospirenone on the olfactory sensitivity in postmenopausal women treated with hormone therapy (HT). DESIGN: Forty-seven naturally postmenopausal women participated in the prospective study. The women underwent continuous combined HT containing 1 mg 17beta-estradiol and 2 mg drospirenone (DRSP). Airflow resistance values and olfactometric thresholds were measured by using rhinomanomety and olfactometry, respectively, performed at baseline and in the third and sixth cycle of HT. RESULTS: Rhinomanometric values were better during 17beta-estradiol/DRSP HT with respect to those observed at baseline (P < 0.001). Olfactometric threshold data indicated a higher sensitivity during both the third (P < 0.05), and sixth cycles of 17beta-estradiol/DRSP HT (P < 0.001) than at baseline. CONCLUSIONS: Our study confirmed that the nasal airflow resistance and olfactory thresholds to odors may depend on steroid hormones. We believe that estrogens could influence neuronal plasticity and the neuronal conduction time in the olfactory system. The antimineralocorticoid activity of DRSP may produce a decrease in nasal edema, inducing a better interaction between odorous substances with receptors.

Characteristics of nasal epithelial cells in naturally postmenopausal women receiving hormone therapy with 1 mg 17beta-estradiol and 2 mg drospirenone: a prospective study.

OBJECTIVE: To investigate the effects of drospirenone on nasal respiratory epithelium in postmenopausal women who are treated with hormone therapy (HT). DESIGN: Thirty-five naturally postmenopausal women participated in the prospective study. Women received continuous-combined HT containing 1 mg 17beta-estradiol and 2 mg drospirenone. Cytological changes of nasal middle and inferior turbinate respiratory epithelium were evaluated by using the maturation index, performed at baseline and on the sixth cycle of HT. RESULTS: Hematoxylin-eosin staining for the maturation index of the epithelial nasal cells of women reached better trophic aspects during 17beta-estradiol/drospirenone intake with respect to those observed at baseline (P < 0.001). The smears during HT emphasized the superficial and the intermediate types of cells, with a ratio index greater than 2. The parabasal cell content was less than 20%, and the karyopyknotic index showed degenerative changes in superficial and intermediate cells. CONCLUSIONS: Our study confirmed that the nasal respiratory epithelium is an ovarian steroid target. Drospirenone acts on nasal cells similarly to other progestogens.

Prospective study on the cytological aspects of the nasal respiratory epithelium in premenopausal women taking 30 mcg ethinylestradiol and 3 mg drospirenone oral contraceptive.

BACKGROUND: This study was conducted to determine the effects of the monophasic oral contraceptive (OC) containing 30 mcg ethinylestradiol (EE) and 3 mg drospirenone (DRSP) on the nasal respiratory epithelium in premenopausal women. STUDY DESIGN: Fifty premenopausal women participated in the prospective study. Baseline endovaginal ultrasound examination and blood test to measure serum progesterone to confirm an ovulatory cycle were performed. The cytologic changes on the nasal respiratory epithelium were evaluated with the maturation index, performed during the follicular, periovular and luteal phases of the menstrual cycle, and on the sixth cycle of pill intake. RESULTS: The maturation indexes of the nasal smears were higher during both the follicular and periovular phases than during the luteal phase of the menstrual cycle (p<.05). Women on the OC pill had similar changes in the nasal epithelium as those seen during the follicular phase (p NS), and less than the periovular phase (p<.05) and higher than the luteal phase (p<.05). The maturation index of the nasal respiratory epithelium seems to depend on the variation of the ovarian steroids during the menstrual cycle and on the iatrogenic effects of oral contraception. CONCLUSIONS: DRSP+EE seems to provoke cytological changes that are different from previously shown gestodene plus EE.

Changes in visual evoked potentials during the menstrual cycle in young women.

PURPOSE: Since, during the menstrual cycle, changes in neuronal activity and in auditory, olfactory, and taste thresholds were found, visual evoked potentials were investigated. MATERIALS & METHODS: In 50 healthy women the latency and the amplitude of P100 wave of pattern reversal visual evoked potentials were measured during the different menstrual phases (follicular, periovular, and luteal), as determined by sonography and serum progesterone level. RESULTS: Compared with the follicular phase, during the luteal phase significant reduction in latency (101.29+/-4.42 vs. 104.76+/-5.02 ms, P<0.01) and increase in amplitude (10.44+/-3.15 vs. 8.62+/-3.09 microV, P<0.05) were recorded. CONCLUSIONS: Fluctuations in ovarian steroid hormones affect the excitability of the visual system.

Sildenafil improves sexual functioning in premenopausal women with type 1 diabetes who are affected by sexual arousal disorder: a double-blind, crossover, placebo-controlled pilot study.

OBJECTIVE: To verify whether sildenafil is effective in type 1 premenopausal women affected by sexual arousal disorder (SAD). DESIGN: Double-blind, crossover, placebo-controlled study. SETTING: Gynecological diabetic outpatient clinic and sexual clinic. PATIENT(S): Thirty-six type 1 premenopausal diabetic women affected by SAD. INTERVENTION(S): Two 8-week periods of sildenafil 100 mg, washout, and placebo, by two possible sequences. MAIN OUTCOMES MEASURE(S): Each woman submitted blood samples to measure HbA(1c), and T, free T (FT), and PRL. Efficacy was assessed [1] subjectively by the Personal Experiences Questionnaire based on the 5-point Likert scale, quantifying arousal, desire, orgasm, enjoyment of sexual activities, and frequency of sexual relationships; and [2] objectively by translabial color Doppler ultrasound to measure the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end diastolic velocity of clitoral arteries. RESULT(S): Thirty-two women completed the study. The mean HbA(1c) value was 8.0% +/- 1.8%, and plasma concentrations of T, FT, and PRL were normal. Sildenafil seems to improve arousal, orgasm and sexual enjoyment, and dyspareunia in women affected by type 1 diabetes. However, by flowmetric measurements, the mean RI was significantly lower and both the mean PI and PSV of the clitoral arteries were significantly higher compared with baseline and placebo. CONCLUSION(S): Sildenafil seems to improve subjective sexual aspects and can be used to treat objectively genital arousal disorder of premenopausal women with type 1 diabetes.

Cytological aspects of the nasal respiratory epithelium in reproductive-age women taking oral contraceptives.

OBJECTIVE: To determine the effects of monophasic oral contraceptives on the nasal respiratory epithelium in premenopausal women. DESIGN: Prospective open clinical trial. SETTING: Outpatient Family Planning Centre. PATIENT(S): Eighty-eight premenopausal women, with ovulatory cycle, who were planning to take oral contraceptives. INTERVENTION(S): Baseline endovaginal ultrasound examination and blood test to measure serum progesterone to confirm ovulatory cycle. Thirty-eight women on pill containing 30 microg ethinylestradiol (EE) plus 75 microg gestodene, and 35 women on pill containing 15 microg ethinylestradiol plus 60 microg gestodene. MAIN OUTCOMES/MEASURE(S): Cytological changes on the nasal respiratory epithelium evaluated with the maturation index performed during the follicular, periovular, and luteal phases of the menstrual cycle, and on the sixth cycle of pill intake. RESULT(S): Hematoxylin-eosin staining for the maturation index showed similar trophic cytological aspects between the nasal and vaginal epithelium during the menstrual cycle and pill usage. Both the nasal and vaginal cytological samples showed higher maturation indexes during both the follicular and the periovular phases than during the luteal phase. Women on pill containing 15 microg EE showed lower trophic aspects in the nasal cytological samples compared with those on pill with 30 microg EE. CONCLUSION(S): Along with the vaginal cells, the nasal respiratory epithelium is an ovarian steroid target. The maturation index of the nasal respiratory epithelium seems to depend on the variation of the ovarian steroids during the menstrual cycle and on the iatrogenic effects of oral contraceptives.

Prospective study on sexual behavior of women using 30 microg ethinylestradiol and 3 mg drospirenone oral contraceptive.

The aim of the study was to determine the changes, if any, on the sexual behavior of women using an oral contraceptive containing 30 microg ethinylestradiol (EE) and 3 mg drospirenone (DRSP). Eighty healthy volunteer women (age range, 19-31 years), with regular menstrual cycle length (mean 27.6+/-3.1) and ovulation, participated in this prospective study. Sexual behavior was assessed using the self-administered Personal Experience Questionnaire, at baseline and at 3, 6 and 9 cycles of pill use. Women reported increased (i) sexual enjoyment (p < .001), (ii) orgasm frequency (p < .05) and (iii) satisfaction with sexual activity (p < .05) during all periods of pill intake with respect to baseline. Both arousal and frequency of sexual activity improved at the sixth and ninth cycle of pill use (p < .05) with respect to baseline. Moreover, women reported decreased genital pain associated with intercourse during pill intake (p < .05). Desire did not change during the use of the pill (p = NS). The mild dose of EE may have improved vaginal lubrication, sexual arousal and decreased dyspareunia. Consequently, women may have experienced increased sexual performance. In addition, improved sexual activity could have been the result of the effects of DRSP, with its antimineralocorticoid effects which could improve pill compliance, with a more satisfied sexual life.

Olfactometric and rhinomanometric outcomes in post-menopausal women treated with hormone therapy: a prospective study.

BACKGROUND: The aim of this prospective study was to evaluate the effects of hormone therapy (HT) on olfactory sensitivity in post-menopausal women. METHODS: Forty-six naturally post-menopausal women underwent rhinomanometric and olfactometric measurements to compare nasal airflow resistance values and olfactometric thresholds during the eighth month of HT treatment with baseline levels prior to starting HT. Eighteen women used an oral HT regimen, and twenty-eight women used transdermal patch HT. RESULTS: Rhinomanometric values during HT were statistically differ from those at baseline (P < 0.001). Olfactometric threshold data indicated a higher sensitivity during the HT treatment than at baseline (P < 0.001). Finally, no statistically significant difference was observed among women using oral or patch HT administration on rhinomanometric and olfactometric values. CONCLUSIONS: Our study demonstrates that 8 months of treatment with estrogen and progestogens in HT preparations has an effect on nasal airflow resistance and the olfactory thresholds to odours. We believe that estrogens could influence neuronal plasticity, and the neuronal conduction time into the olfactory system. Our findings confirm that gonadal steroids such as estrogen have an influence on non-genital targets; this relationship might have a beneficial impact on sensorineural communication and emotional behaviour.

Placebo-controlled study on efficacy and safety of daily apomorphine SL intake in premenopausal women affected by hypoactive sexual desire disorder and sexual arousal disorder.

OBJECTIVES: To verify whether apomorphine SL is effective in premenopausal women affected by arousal disorder with hypoactive sexual desire disorder. METHODS: Sixty-two volunteer women, aged 26 to 45 years, affected by arousal disorders and hypoactive sexual desire disorder participated in the study, which consisted of two parts. The first was 4 weeks of a taken-as-needed, open-label, dose-escalation regimen starting at 2 or 3 mg of apomorphine SL. The second part of the study was for the nonresponders, who were randomly allocated to treatment in one of six possible sequences of three 2-week double-blind, crossover study periods with apomorphine 2 mg or 3 mg, washout, and placebo. Efficacy was assessed with the Personal Experiences Questionnaire using the 5-point Likert scale. The Personal Experiences Questionnaire quantified subjective arousal, desire, orgasm, enjoyment, and frequency of sexual relationships. RESULTS: Fifty women completed the 4-week "as required" drug regimen, and 6 of them benefited from this treatment regimen (P <0.05). The 44 women who reported no change with respect to baseline participated in the double-blind crossover part of the study. Six women stopped taking the drug because of a fear of problems (two each during the 2-mg apomorphine, 3-mg apomorphine, and placebo periods). Adverse events were mild or moderate, both occurred during the "as required" part (10 patients) and during daily usage (6 patients) and were mainly nausea, vomiting, dizziness, or headache. However, during the placebo period, 2 women had adverse events, mainly headache. The daily intake of the drug was effective with both the 2-mg and 3-mg dosages compared with placebo for arousal and desire (P <0.05). The effects of 3 mg of apomorphine were better than those obtained with 2 mg (P <0.05). The orgasm, enjoyment, and satisfied by frequency scores improved during treatment with daily apomorphine compared with baseline and placebo. CONCLUSIONS: The results of our study suggest that daily apomorphine SL may improve the sexual life of women affected by sexual difficulties. Additional studies are needed to define the daily use of apomorphine SL in large subgroups of women on the basis of etiology and the severity of sexual dysfunction.

Sexual behavior of women taking low-dose oral contraceptive containing 15 microg ethinylestradiol/60 microg gestodene.

The objective of this prospective study was to assess the effects of a low-dose oral contraceptive (OC) containing 15 microg ethinylestradiol and 60 microg gestodene on sexuality. Forty-eight healthy volunteers (age range, 18-35 years), having regular menstrual cycles with ovulation, participated in the study. Sexual behavior was assessed using the self-administered Personal Experience Questionnaire, at baseline, and at 3, 6 and 9 months of pill use. Women reported decreased sexual desire (p < 0.005) and sexual activity (p < 0.05) at the 9th month of pill use, and diminished sexual arousal at the 3rd month of pill intake (p < 0.05), with respect to baseline. The frequency of orgasm did not change during OC use (p = NS). Moreover, sexual enjoyment was worse at the 3rd, 6th and 9th month with respect to baseline (p < 0.001). The low dose of ethinylestradiol could cause decreased vaginal lubrication, and diminished sexual arousal could be due to hypoandrogenism. Women may expect increased sexual performance when they take the pill, as compared to before starting contraception. Consequently, they could have an unexpected effect with pill use, though sexuality may remain the same.

Efficacy and safety of daily intake of apomorphine SL in men affected by erectile dysfunction and mild hyperprolactinemia: a prospective, open-label, pilot study.

OBJECTIVES: To evaluate the efficacy of the "daily" use of apomorphine SL compared with the "on demand" administration of the drug in patients with mild to moderate erectile dysfunction (ED) and mild hyperprolactinemia who were nonresponders to apomorphine administered "on demand." METHODS: In this open-label prospective study, 34 patients with mild-to-moderate ED and mild hyperprolactinemia were screened. The subjects answered the International Index of Erectile Function (IIEF) questionnaire and underwent follicle-stimulating hormone, luteinizing hormone, testosterone, free testosterone, and prolactin plasma testing, and Doppler sonography at the 2-week screening period to define the ED severity and etiology, at the end of a 4-week "as required" dose-escalation regimen of 2 mg/3 mg apomorphine SL, and at the end of a 4-week period of daily administration of the drug to assess the efficacy of each treatment modality. RESULTS: Twenty patients (age range 27 to 46 years) were included in the study. Eighteen subjects completed the 4-week "as required" drug intake period, and three (16.7%) benefited from this modality of treatment (P <0.05). Fifteen nonresponder patients participated in the 4-week daily apomorphine SL use, and 13 (86%) reported satisfaction with the treatment (P <0.05). The 3-mg daily administration was more effective than the 2-mg daily administration for erectile function (P <0.02) but not for other sexual domains scored with IIEF. Adverse events were of mild or moderate severity, either during the "as required" drug intake (4 patients) or during daily use (3 subjects) and were mainly nausea, dizziness, or headache. CONCLUSIONS: Data from the clinical evaluation of symptomatic apomorphine SL use have always shown a poor success rate, probably because it is used "as sildenafil." Using apomorphine SL as a treatment of ED, we observed a significant improvement in both subjective and objective aspects scored with the IIEF. The increase of prolactin could influence the erective mechanisms, and it cannot be excluded that a subgroup of men with ED may have an impairment of central dopaminergic function. Moreover, additional studies need to define the daily use of apomorphine SL in large subgroups of men on the basis of ED etiology and severity.

The function of sildenafil on female sexual pathways: a double-blind, cross-over, placebo-controlled study.

OBJECTIVES: To determine the changes, if any, on female sexual pathways using sildenafil (primary outcome), and to verify the safety of this drug (second outcome). STUDY DESIGN: Following previous research on symptomatic women, we wanted to study the effects of sildenafil on asymptomatic women. We would like to make it clear from the outset that this study is part of an ongoing line of research and this drug, and others of its type, should be used under strict medical supervision only on symptomatic patients. A randomized double-blind cross-over, placebo-controlled study was conducted at the Family Planning Centre of the Group for Sexological Research, Department of Microbiological and Gynecological Science, School of Medicine, University of Catania, Italy. Sixty-eight healthy volunteer women aged 19-38 years, asymptomatic for sexual disorders, were enrolled. The study consisted of 4 weeks sildenafil, 2 weeks washout, and 4 weeks placebo, by two possible sequences: sildenafil 50 mg, washout, placebo; or placebo, washout, sildenafil 50 mg. Efficacy of sildenafil was assessed by the Personal Experiences Questionnaire (PEQ) based on the 5-point Likert scale. The questionnaire quantified subjective sexual aspects at baseline, during washout, after treatments, and at the follow-ups. Statistical analysis was done with the Wilcoxon's rank-sum test and Student's t-test. RESULTS: 50/68 women completed the study at the first follow-up, and 38 women reached the second follow-up. Six women withdrew because of adverse events. Sildenafil improved arousal (P<0.001), orgasm (P<0.05), and enjoyment (P<0.001) with respect to placebo. Significant differences were noted during sildenafil usage with respect to the baseline for arousal (P<0.01), orgasm (P<0.001), and sexual enjoyment (P<0.001). The adverse events were transient and mild or moderate. CONCLUSIONS: Our study suggests that sildenafil acts on the different sexual pathways in healthy women, improving their sexual experience. This study could help to understand the physiologic and pathophysiologic aspects of female sexuality. In comparison with current psychosexual therapies, which are long-term, compliance would be improved with use of this drug. Additional studies are required to define the use of sildenafil in a clinical setting.

Auditory brain stem response throughout the menstrual cycle.

A prospective study was performed to evaluate the changes in the auditory brain stem response (ABR) that occur in healthy premenopausal women throughout the menstrual cycle. Ninety-four women with ovulatory menstrual cycles underwent ABR testing by auditory evoked potentials for wave I, III, and V latencies and for interpeak I-III, I-V, and III-V intervals during the follicular, periovular, and luteal phases of the menstrual cycle. The wave latencies and the interpeak intervals showed shorter values during the periovular phase than during the luteal phase (p < .05) and shorter values during the follicular phase for wave I (p < .05) and interpeak interval I-V (p < .05). The ABR seems to be influenced by the variations of ovarian steroids that occur during the menstrual cycle.

Cytologic aspects of the nasal respiratory epithelium in postmenopausal women treated with hormone therapy.

OBJECTIVE: To investigate the effects of hormone therapy (HT) on nasal respiratory epithelium in postmenopausal women. DESIGN: Prospective open clinical trial. SETTING: Outpatient menopausal clinic. PATIENT(S): One hundred three healthy postmenopausal women, of whom 55 treated with HT, and 48 untreated women (controls). INTERVENTION(S): Different regimens of HT by patch, gel, or oral administration. MAIN OUTCOME MEASURE(S): Cytologic changes of nasal, middle and inferior turbinate cells compared with vaginal cytologic findings by using the maturation index. RESULT(S): Hematoxylin-eosin staining for the maturation index confirmed similar trophic cytologic aspects between the nasal respiratory epithelium and vaginal smears in HT-treated women and controls. Women treated with sequential HT or estrogen therapy (ET) showed better trophic characteristics in the nasal cytological samples compared with women treated with continuous combined HT. CONCLUSION(S): Along with vaginal cells the nasal respiratory epithelium is an estrogen target. The activity of HT in the nasal respiratory epithelium may depend on the type of hormone regimen used.

Effects of patch or gel estrogen therapies on auditory brainstem response in surgically postmenopausal women: a prospective, randomized study.

OBJECTIVE: To study the effects of gonadal steroids on the nongenital audiological target in surgically postmenopausal women treated with patch or gel transdermal estrogen therapy (ET). DESIGN: Prospective randomized study. SETTING: Research Group for Sexology, University of Catania, Italy. PATIENT(S): One hundred twenty-two surgically postmenopausal women. INTERVENTION(S): Transdermal E(2) by patch or gel, and evaluation of auditory brainstem response by auditory-evoked potentials for waves I, III, and V latencies, and for interpeak I-III, I-V, and III-V intervals. MAIN OUTCOME MEASURE(S): Changes in auditory wave latencies and in interpeak intervals during treatment with ET with respect to baseline levels. RESULT(S): One hundred two women completed the study. Forty-eight subjects used E(2) patches and 54 E(2) gel. No significant difference was observed in plasma E(2) improvement and in auditory brainstem response values with the two estrogen (E) formulations. The wave latencies and the interpeak intervals showed lower values during the E treatment than at baseline. CONCLUSION(S): Auditory brainstem response seems to depend on the type of E given. Our data suggest that fluctuating E levels act on waves, even if the exact mechanism of the gonadal steroids is not clear. However, we believe that E could influence neuronal plasticity, the metabolic levels of neurotransmitters, and thus, the neuronal conduction time into the audiological system.