Tadalafil 5 mg daily treatment for type 1 diabetic premenopausal women affected by sexual genital arousal disorder.

INTRODUCTION: Type 1 diabetic women may be affected by sexual dysfunction, mainly due to peripheral vascular disease. AIM: To determine whether daily tadalafil 5 mg is effective in type 1 premenopausal women affected by sexual genital arousal disorder. METHOD: Thirty-three volunteers were enrolled in a 12-week daily tadalafil 5 mg prospective study. MAIN OUTCOME MEASURES: The efficacy of daily tadalafil 5 mg on sexual genital arousal (primary end point), and desire, orgasm, enjoyment and frequency of sexual activity, and genital pain (secondary end points) were assessed (i) subjectively by the Short Personal Experiences Questionnaire; and (ii) objectively by translabial color Doppler sonography of clitoral blood flow. Moreover, the Short Form-36 questionnaire was used to assess Quality of Life (QoL). RESULTS: Thirty-two women completed the study. Women reported a QoL improvement at the 12th week follow-up (P<0.05). Tadalafil improved the experience of sexual genital arousal, and orgasm, sexual enjoyment, satisfaction by frequency of sexual activity, and frequency of sexual thoughts or fantasies (P<0.05). Finally, dyspareunia decreased with respect to baseline (P<0.001). After tadalafil administration, the mean peak systolic velocity increased and the mean diastolic velocity decreased from baseline (P<0.001). Moreover, the mean resistance index and the mean pulsatility index were significantly higher compared with baseline values (P<0.001). CONCLUSIONS: Daily tadalafil 5 mg treatment seems to improve subjective sexual aspects and could be used to treat genital arousal disorder of premenopausal women with type 1 diabetes. The limits of the study were the small sample and the lack of a placebo control group.

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.

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.

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.

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.

Postpartum period: three distinct but continuous phases.

Postpartum period is distinct in three phases. The third phase is the delayed postpartum period, which can last up to 6 months. Some changes to the genitourinary system are much longer in resolving, and some may never fully revert to the prepregnant state. A burgeoning volume of literature on pelvic floor support implicates childbirth as the initiation of a whole host of conditions including stress urinary incontinence, incontinence of flatus or feces, uterine prolapse, cystocele, and rectocele. The duration and severity of these conditions affect many variables, including the patient's intrinsic collagen support, the size of the infant, the route of delivery, and the degree of perineal trauma occurring either naturally (lacerations) or iatrogenically (episiotomy).

Putative protective effects of cesarean section on pelvic floor disorders.

Pregnancy can affect the lower genitourinary tract through physiologic changes, or traumatic injury tissue stretching and tearing, besides neurologic and vascular compression and compromise, and muscle strain are inevitable during childbirth.The levator ani complex of the pubococcygeus, puborectalis, and iliococcygeus muscles must allow passage of the fetus. The perineal body and external anal sphincter may become injured, with or without episiotomy, but sometimes as a necessary maneuver to allow passage of the fetal head or shoulders. The traumatic insults may lead to permanent damage on pelvic floor and subsequent urinary or anal incontinence.In this article we aim to review the literature regarding the impact of pregnancy or childbirth on pelvic floor changes.

Antepartum haemorrhage.

OBJECTIVE: Antepartum haemorrhage (APH) defined as bleeding from the genital tract in the second half of pregnancy, remains a major cause of perinatal mortality and maternal morbidity in the developed world. RESULTS: In approximately half of all women presenting with APH, a diagnosis of placental abruption or placenta praevia will be made; no firm diagnosis will be made in the other half even after investigations. CONCLUSION: In cases presenting with APH, the evaluation consists of history, clinical signs and symptoms and once the mother is stabilized, a speculum examination and an ultrasound scan.A revision of the literature was mode only larger prospective tials or case-control study were taken into account.

Obesity and fetal-maternal outcomes.

In women Obesity has a significant impact on every aspect of female reproductive life both in terms of infertility and early pregnancy complications. It is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, post-dates pregangy with increased rates of induction of labour, caesarian section and complications during and following operative procedures, post-partum haemorrhage, shoulder dystocia, infection, venous thromboembolism and increased hospital day. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity.

Uterine artery Doppler flow studies in obstetric practice.

In women who develop preeclampsia there is a pathological increase in placental vascular resistance should be detectable by abnormal Dopplerf low studies of the maternal uterine vessels. In women considered at low risk with abnormal early pregnancy uterine artery Doppler studies are needed. Until such time as these are available, routine uterine artery Doppler screening of women considered at low risk is not recommended. Uterine artery Doppler screening of high-risk women appears to identify those at substantially increased risk for adverse pregnancy outcomes and interventions that might improve clinical outcomes.Abnormal testing in these women could potentially lead to increased surveillance and interventions that might improve clinical outcomes.

Post partum pelvic floor changes.

Pelvic-perineal dysfunctions, are the most common diseases in women after pregnancy. Urinary incontinence and genital prolapsy, often associated, are the most important consequences of childbirth and are determined by specific alterations in the structure of neurological and musculo-fascial pelvic support.Causation is difficult to prove because symptom occur remote from delivery.Furthermore it is unclear whether changes are secondary to the method of childbirth or to the pregnancy itself.This controversy fuels the debate about whether or not women should be offered the choice of elective caesarean delivery to avoid the development of subsequent pelvic floor disfunction.But it has been demonstrated that pregnancy itself, by means of mechanical changes of pelvic statics and changes in hormones, can be a significant risk factor for these diseases. Especially is the first child to be decisive for the stability of the pelvic floor.During pregnancy, the progressive increase in volume of the uterus subject perineal structures to a major overload. During delivery, the parties present and passes through the urogenital hiatus leading to growing pressure on the tissues causing the stretching of the pelvic floor with possible muscle damage, connective tissue and / or nervous.In this article we aim to describe genitourinary post partum changes with particular attention to the impact of pregnancy or childbirth on these changes.