Validity and Reliability Evidence and Norms for the Spanish Version of the Sexual Inhibition/Sexual Excitation Scales-Short Form / Evidencias de Validez y Fiabilidad y Baremos de la Versión Española de las Sexual Inhibition/Sexual Excitation Scales-Short Form

Background: The Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES-SF) is a brief instrument for assessing the propensity for sexual excitement and inhibition in men and women. The aim of the present study was to provide evidence for the validity and reliability of the Spanish version of the SIS/SES-SF scores by examining invariance, reliability (information function and internal consistency), the relationship between the scores and sexual functioning, and presenting its standard scores. Method: A total of 2,223 Spanish heterosexuals (43.41% men and 56.59% women) aged 18 to 83 years (M = 39.94, SD = 11.95), distributed across age groups (18-34, 35-49, ≥ 50 years old) participated. Results: The three-factor structure of the Spanish version of SIS/SES-SF showed weak measurement invariance by sex and strict measurement invariance by age. The scores explained the dimensions of sexual functioning, especially sexual arousal and erection/lubrication. In addition, men and women without difficulties in sexual functioning demonstrated more propensity for sexual excitation and less sexual inhibition. The standard scores are presented by sex and age group. Conclusions: The study provides evidence of the validity and reliability of the SIS/SES-SF measures, confirming its usefulness for assessing propensity to sexual excitation and inhibition.(AU)

Antecedentes: Las Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES-SF) son un instrumento breve que evalúa, en hombres y mujeres, la propensión hacia la excitación e inhibición sexual. El objetivo fue aportar evidencias de validez y fiabilidad a las puntuaciones de la versión española de SIS/SES-SF, examinando la invarianza, la fiabilidad (función de información y consistencia interna), la relación de sus puntuaciones con el funcionamiento sexual, y presentar sus puntuaciones estandarizadas. Método: Participaron 2.223 españoles heterosexuales (43,41% hombres y 56,59% mujeres) de 18 a 83 años (M = 39,94; DT = 11,95), distribuidos en tres grupos de edad (18-34, 35-49, ≥ 50 años). Resultados: La estructura trifactorial de la versión española de SIS/SES-SF mostró nivel de invarianza débil por sexo y estricto por edad. Sus puntuaciones explicaron las dimensiones del funcionamiento sexual, especialmente excitación sexual y erección/lubricación. Además, hombres y mujeres sin dificultades en el funcionamiento sexual mostraron más propensión a la excitación sexual y menor inhibición sexual. Se presentan baremos de sus puntuaciones por sexo y grupos de edad. Conclusiones: Se aportan adecuadas evidencias de validez y fiabilidad a las medidas de SIS/SES-SF, lo que confirma la utilidad de este instrumento para evaluar la propensión a la excitación e inhibición sexual.(AU)

Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.

The yin and yang of GSM and low sexual desire.

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

Female sexual dysfunctions: an overview on the available therapeutic interventions.

INTRODUCTION: There are different types of female sexual dysfunctions (FSDs), and FSD in general has a high prevalence worldwide. Studies of FSD should consider it as a multifactorial disorder that has biological, psychological, environmental, and relational aspects. In this review we discuss the available therapeutic interventions for FSD. EVIDENCE ACQUISITION: For the current narrative review the PubMed database was searched to identify all publications up to 30 March 2021 that were systematic reviews and meta-analyses which examined therapeutic interventions for FSDs based on the diagnostic classifications of ICD-10 and ICD-11. EVIDENCE SYNTHESIS: Thirty systematic reviews and meta-analyses were included in this review. Hormone therapy (HT) and testosterone are effective to improve sexual desire in menopausal women. In these women HT and ospemiphene may improve pain during intercourse. Flibanserin may improve sexual desire and may reduce desire-related distress in premenopausal women. Bremelanotide is effective to improve desire, arousal, and orgasm scores. Evidence are still limited on the efficacy of psychoactive drugs, phosphodiesterase type 5 (PDE5), oxytocin, herbal drugs, and tibolone to treat FSDs. Psychological interventions such as cognitive-behavior therapy, mindfulness training, sensate focus, bibliotherapy are effective for the management of several different FSDs. CONCLUSIONS: The management of FSDs may require multidisciplinary and interdisciplinary approaches. Pharmacological and nonpharmacological interventions appears to have potential as a treatment for FSDs, but there are currently no gold standards regarding recommended treatment modalities, and the duration, frequency, and intensity of therapy sessions.

Hypoactive Sexual Desire Disorder in Women: Physiology, Assessment, Diagnosis, and Treatment.

Nearly half of women in the United States report problems with sexual function. Many health care providers do not ask about sexual concerns during routine clinical encounters because of personal discomfort, lack of familiarity with treatment, or the belief that they lack adequate time to address this complex issue. This may be especially true for hypoactive sexual desire disorder (HSDD), the most commonly identified sexual problem among women. HSDD is characterized by a deficiency of sexual thoughts, feelings, or receptiveness to sexual stimulation that has been present for at least 6 months, causes personal distress, and is not due to another medical condition. This is an up-to-date overview of HSDD for clinicians, discussing its physiology, assessment, diagnosis, and treatment strategies. Although a definitive physiology of HSDD is still unknown, multiple hormones and neurotransmitters likely participate in a dual-control model to balance excitation and inhibition of sexual desire. For assessment and diagnosis, validated screening tools are discussed, and the importance of a biopsychosocial assessment is emphasized, with guidance on how this can be implemented in clinical encounters. The 2 recently approved medications for HSDD, flibanserin and bremelanotide, are reviewed as well as off-label treatments. Overall, HSDD represents a common yet likely underrecognized disorder that midwives and other health care providers who care for women across the life span are in a unique position to address.

Introducing sexual dysfunction in mental care.

Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.

Lumping, Splitting, and Treating: Therapies Are Needed for Women With Overlapping Sexual Dysfunctions.

INTRODUCTION: Phase-specific diagnoses, such as hypoactive sexual desire disorder, are the norm in sexual medicine. Epidemiologic surveys and clinical trials show the value of this structure for understanding and treating premenopausal sexual dysfunction; however, postmenopausal women have sexual dysfunction in >1 phase, for example, in desire and arousal. OBJECTIVE: To evaluate the evidence for mixed or global sexual dysfunction in women, identify associated comorbidities, and determine the best available treatment. METHODS: Literature review of epidemiologic surveys and clinical trials to quantitate overlap in sexual dysfunction and render conclusions about treatments. MAIN OUTCOME MEASURES: The main outcome measures were the Changes in Sexual Functioning Questionnaire and the Female Sexual Function Index. RESULTS: Overlap of sexual dysfunction in women is low to moderate before menopause, but it is high after menopause. Data suggest that clinical trials of postmenopausal women diagnosed with hypoactive sexual desire disorder actually entered patients with mixed or global sexual dysfunction and that benefits were pan-phasic rather than concentrated on desire. Whether local/vaginal products for the genitourinary syndrome of menopause impact all phases of sexual dysfunction is under study. Women treated for breast or gynecologic cancer or taking antidepressants also have global sexual dysfunction. Treatment options are limited but support mindfulness-based cognitive behavioral therapy and others. Other strategies include adding or switching to a serotonin 1A receptor agonist (eg, buspirone, flibanserin), a serotonin 2A receptor antagonist (eg, flibanserin, trazodone), or a norepinephrine-dopamine reuptake inhibitor (eg, bupropion). Elimination of hormonal contraception in premenopausal women and adding hormonal therapies in postmenopausal women may be necessary. CONCLUSIONS: Practitioners should be alert to overlap of sexual dysfunction in women. Focusing diagnostics and treatment on individual phases of sexual function is appropriate in premenopausal patients, but global sexual dysfunction is more likely in women taking antidepressants or cancer chemotherapy or during and after the menopausal transition. More safe, broadly effective treatments for mixed sexual dysfunction are needed for these populations of women. Pyke RE, Clayton AH. Lumping, Splitting, and Treating: Therapies Are Needed for Women With Overlapping Sexual Dysfunctions. Sex Med Rev 2019;7:551-558.

The impact of training on the perioperative and intermediate functional outcomes after holmium laser enucleation of the prostate.

INTRODUCTION: To systemically measure the impact of trainees' participation on the perioperative and functional outcomes after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: Benign prostatic hyperplasia patients who underwent HoLEP at our department between January 2007 and January 2013 were classified based on trainee's level. Perioperative outcomes and complications were collected. Functional outcomes were assessed using the Sexual Health Inventory for Men (SHIM), International Prostate Symptom Score (IPSS), and International Continence Society-Short Form (ICSmaleSF) questionnaires. Voiding and incontinence domains of ICSmaleSF were assessed separately. Patients were divided into group 1 if no trainee participated in the operation, group 2 if a senior trainee performed the operation, and group 3 if a junior trainee participated in the operation. The patient's baseline characteristics, complications, and perioperative outcomes were compared. RESULTS: There were no differences in the baseline characteristics. There were significant differences in overall operative and enucleation time (p = 0.0186, p = 0.0047, respectively) with shorter times noticed with more experienced operators. There were no differences in resected tissue weight, hemoglobin change, and transfusion rates. Postoperatively, all patients had a similar length of stay and catheterization. Complications (graded by Clavien grading system) were not different. All patients were followed up at regular intervals starting at 6 weeks, 3 months , 6 months, 1 year, and every year after that and there were no differences in flow rates or post void residual volumes at any time point. There were no differences in SHIM, IPSS, and ICSmale voiding scale among the groups. However, ICSmale continence scale was significantly different where the highest score seen in group 2. CONCLUSION: Trainee participation in HoLEP in a controlled training environment does not compromise the safety of the procedure.

Development of the Sexual Five-Facet Mindfulness Questionnaire (FFMQ-S): Validation Among a Community Sample of French-Speaking Women.

It has been recently demonstrated that mindfulness-based intervention may be particularly suitable for addressing sexual difficulties in women. Although the Five-Facet Mindfulness Questionnaire (FFMQ) is currently one of the most widely used scales to assess mindfulness, no adaptation and validation of the FFMQ to measure female sexual functioning has been published. The main aim of this study was to develop and validate a sexual version of the Five Facets Mindfulness Questionnaire (FFMQ-S) to specifically measure mindfulness in the context of sexual encounters. A total of 251 healthy, French-speaking female volunteers were administered the FFMQ-S, the original FFMQ, and the Female Sexual Distress Scale (FSDS-R). Confirmatory factor analyses indicated that the FFMQ-S exhibits a five-factor model, as implied by the original FFMQ. Good scale reliability was observed. The FFMQ-S showed significant correlations with the FSDS-R and the usual FFMQ. Scores on the FFMQ-S correlated significantly more negatively with the total FSDS-R score than with the total score of the original version of the FFMQ. These findings clearly support the relevance of developing a version of the FFMQ tailored to sexual functioning.

Electroejaculation in psychogenic anejaculation.

OBJECTIVE: To evaluate the results of treatment with electroejaculation (EEJ), intrauterine insemination (IUI), and IVF/intracytoplasmic sperm injection (IVF/ICSI) in patients with psychogenic anejaculation (PAE). DESIGN: Retrospective clinical study. SETTING: Academic tertiary referral fertility center. PATIENT(S): Eleven male patients diagnosed with psychogenic anejaculation (PAE) were included. Median age at the time of first treatment with EEJ was 33.0 (interquartile range, 29.0-36.0) years. INTERVENTION(S): Electroejaculation, IUI, and IVF/ICSI. MAIN OUTCOME MEASURE(S): Semen analysis, fertilization rate, implantation rate, pregnancy rate, and delivery rate. RESULT(S): A total of 60 EEJs were performed in 11 patients. Mean VCM (volume [mL] × concentration [sperm cells/mL] × percentage progressive motile cells) of the retrieved sperm of all EEJs was 17.5 × 10(6) (SD 16.5 × 10(6)). Yielded semen was used in a total of 26 ICSI procedures in seven couples. The fertilization rate was 65.6% (80 of 122). The ICSI cycles resulted in five pregnancies; of these, one resulted in a spontaneous abortion in the first trimester. Three couples were treated with 34 IUI cycles, which resulted in live births in four pregnancies. CONCLUSION(S): Electroejaculation is a suitable and effective treatment that can be used in men with psychogenic anejaculation. The retrieved semen can be used successfully in assisted reproductive technology treatment. In this study EEJ resulted in pregnancies and the birth of eight healthy children.

Sexual dysfunction in women with cancer.

Approximately 14 million people have a history of cancer in the United States alone, and the number is expected to increase with time. This has prompted an appreciation of the quality of life for survivors. Women treated for cancer identify gynecologic issues as a major concern for both general health and the negative impact on sexual function that follow the cancer diagnosis and subsequent treatment. Unfortunately, issues related to sexual health continue to be underappreciated. Although comprehensive cancer centers have adopted specialized centers for survivorship issues, including those involving sexual health, consultations are not widely available in most communities. We provide background information on female sexual health, examine the impact of cancer treatment on sexual function, and discuss some of the major sexual health issues of women who have received a cancer diagnosis and been subsequently treated.

Hypoactive sexual desire disorder in women: treatment options beyond testosterone and approaches to communicating with patients on sexual health.

Hypoactive sexual desire disorder (HSDD) affects nearly 1 in 10 women. Thus, it is essential for pharmacists and other health care providers to be comfortable when discussing a patient's sexual health to ensure appropriate triage so that the specific causes of HSDD can be identified and potential recommendations provided. HSDD is defined as the absence or deficiency of sexual interest and/or desire, leading to significant distress and interpersonal difficulties. As health care providers, pharmacists have a critical role in assessing the presence of HSDD and providing education on available treatment options. This article will review the potential causes of HSDD and low sexual desire, the screening tools available, and the significant role of health care professionals in communicating with patients about their sexual health. An overview of the importance of behavioral modifications, the current pharmacologic options being investigated, and the use of complementary and alternative therapies will also be explored. Currently, buproprion is the primary pharmacologic agent that has shown positive results in treating patients with HSDD. The use of testosterone therapy will not be addressed in this article, as this therapy is described in greater detail elsewhere.

Changes in sexual functioning in women after neuromodulation for voiding dysfunction.

INTRODUCTION: Sacral neuromodulation is a well-established treatment for urinary and bowel disorders with potential use for other disorders such as sexual dysfunction. AIM: To evaluate changes in sexual functioning in women undergoing neuromodulation for voiding symptoms. METHODS: Patients enrolled in our prospective, observational neuromodulation database study were evaluated. Data were collected from medical records, and patient-completed Female Sexual Function Index (FSFI) and Interstitial Cystitis Symptom-Problem Indices (ICSI-PI) at baseline, 3, 6, and 12 months post-implant. Patients rated overall change in sexual functioning on scaled global response assessments (GRA) at 3, 6, and 12 months post-implant. We grouped women by baseline FSFI scores: less (score<26) and more sexually functional (score≥26). Data were analyzed with Pearson's Chi-square or Fisher's Exact test and repeated measures. MAIN OUTCOMES MEASURES: Changes in FSFI and ICSI-PI scores in women grouped by baseline FSFI score<26 and ≥26. RESULTS: Of 167 women evaluated, FSFI scores improved overall from preimplant (mean 13.5±8.5) to 12 months (N=72; mean 15.9±8.9, P=0.004). At baseline and each follow-up point, ICSI-PI scores were similar between groups and improved through time. For patients in the FSFI<26 group there was improvement from baseline to 12-month scores (N=63; 11.9±6.9 to 14.8±8.7; P=0.0006). Improved FSFI domains included desire, orgasm, satisfaction, and pain. Furthermore, of the 74 subjects in this group not sexually active at baseline, 10 became sexually active during follow-up. In the FSFI≥26 group there was slight but statistically significant decline in mean scores between baseline and 12 months (N=9; 27.4±1.1 to 24.5±3.4; P=0.0302); however one had become sexually inactive. A significant decrease was seen in the satisfaction domain. CONCLUSIONS: Many factors affect sexual functioning in women; however sexual function may improve along with urinary symptoms after neuromodulation.

Persistent genital arousal disorder: characterization, etiology, and management.

INTRODUCTION: Persistent genital arousal disorder (PGAD) is a potentially debilitating disorder of unwanted genital sensation and arousal that is generally spontaneous and unrelenting. Since its first description in 2001, many potential etiologies and management strategies have been suggested. AIM: To review the literature on PGAD, identify possible causes of the disorder, and provide approaches to the assessment and treatment of the disorder based on the authors' experience and recent literature. METHODS: PubMed searches through July 2012 were conducted to identify articles relevant to persistent sexual arousal syndrome and PGAD. MAIN OUTCOME MEASURES: Expert opinion was based on review of the medical literature related to this subject matter. RESULTS: PGAD is characterized by persistent sensations of genital arousal in the absence of sexual stimulation or emotion, which are considered unwanted and cause the patient at least moderate distress. The proposed etiologies of PGAD are plentiful and may involve a range of psychologic, pharmacologic, neurologic, and vascular causes. PGAD has been associated with other conditions including overactive bladder and restless leg syndrome. Assessment should include a through history and physical exam and tailored radiologic studies. Treatment should be aimed at reversible causes, whether physiologic or pharmacologic. All patients should be considered for cognitive therapy including mindfullness meditation and acceptance therapy. CONCLUSIONS: PGAD likely represents a range of conditions manifesting in unwanted genital sensations. Successful treatment requires a multidisciplinary approach and consideration of all reversible causes as well as cognitive therapy.

Summary of the recommendations on sexual dysfunctions in women.

INTRODUCTION: Women's sexual dysfunction includes reduced interest/incentives for sexual engagement, difficulties with becoming subjectively and/or genitally aroused, difficulties in triggering desire during sexual engagement, orgasm disorder, and sexual pain. AIM: To update the recommendations published in 2004, from the 2nd International Consultation on Sexual Medicine (ICSM) pertaining to the diagnosis and treatment of women's sexual dysfunctions. METHODS: A third international consultation in collaboration with the major sexual medicine associations assembled over 186 multidisciplinary experts from 33 countries into 25 committees. Twenty one experts from six countries contributed to the Recommendations on Sexual Dysfunctions in Women. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: A comprehensive assessment of medical, sexual, and psychosocial history is recommended for diagnosis and management. Indications for general and focused pelvic genital examination are identified. Evidence based recommendations for further revisions of definitions for sexual disorders are given. An evidence based approach to management is provided. Extensive references are provided in the full ICSM reports. CONCLUSIONS: There remains a need for more research and scientific reporting on the optimal management of women's sexual dysfunctions including multidisciplinary approaches.

What's new in sex therapy (CME).

INTRODUCTION: "Is there anything new in sex therapy?" Has the field of sex therapy been stagnating and failing to develop new treatments? Clearly, the important pharmaceutical advances of the past 11 years have overshadowed the developments in the field of sex therapy. AIM: The goal of this manuscript is to call attention to the recent innovations in the field of sex therapy. METHOD: Review of the literature. RESULTS: There are four candidates to consider: (i) combination medical and psychological therapy; (ii) the technique of mindfulness for women with complaints of arousal disorder and low sexual desire; (iii) Internet sexual therapy and; and (iv) reconceptualization of genital pain and psychological interventions for women with these complaints. This article reviews the literature in these areas and offers commentary regarding the benefits and limitations of the research. Finally, future directions for research in these four areas are discussed. CONCLUSIONS: Psychological innovation and intervention remains a vital aspect in the field of sexual medicine. New methods continue to be developed and appraised and the methodology, design, and sophistication of sex therapy outcome research have significantly advanced.

Sexual functions and depressive symptoms after photodynamic therapy for vulvar lichen sclerosus in postmenopausal women from the Upper Silesian Region of Poland.

INTRODUCTION: Although lichen sclerosus (LS) may affect women's physical functioning, mood, and quality of life, restricting their physical activities, sexual, and non-sexual contacts, there are limited data on the sexual functioning of women diagnosed with LS. AIMS: The aim of the study was to evaluate the influence of photodynamic therapy for vulvar LS on sexual functions and depressive symptoms in postmenopausal women from the Upper Silesian Region of Poland. METHODS: A total of 65 women aged 50-70 visiting an outpatient clinic for assessment of vulvar dermatoses were screened for the clinical trial. Finally, 37 women who met all the inclusion/exclusion criteria were included in the study. All the subjects were treated by topical laser therapy (photodynamic therapy). Sexual functions and depressive symptoms were assessed before and after the therapy using Female Sexual Function Index and Beck Depression Inventory, respectively. MAIN OUTCOME MEASURES: Sexual behaviors, sexual functions, and depressive symptoms in females after photodynamic therapy for vulvar LS. RESULTS: The total FSFI score was significantly lower after the treatment of vulvar LS as compared with the baseline (median 24.6 vs. 15.9). However, the prevalence of clinically significant FSD was stable throughout the medical intervention except lubrication disorders (higher prevalence after the treatment: 40% vs. 68.57%). Although the scores of BDI at the baseline dropped significantly after the photodynamic therapy (median 12.0 and 9.0, respectively), there were no significant differences in the prevalence of depressive symptoms (48.65% vs. 45.94%). CONCLUSIONS: Topical laser therapy for vulvar LS has a good clinical outcome, especially in the context of no major negative effects on sexual functioning and the positive impact on the severity of depressive symptoms in postmenopausal women. However, patients should be informed about the possible lubrication disorders following the treatment.

Pathways of sexual desire.

INTRODUCTION: Sexual desire is controlled by brain systems involved in sexual excitation and inhibition. Hypoactive sexual desire disorder (HSDD) may result from hypofunctional excitation, hyperfunctional inhibition, or some mix of the two. AIM: This study aimed to identify neurochemical and neuroanatomical systems involved in sexual excitation and inhibition, their role during normal, and hypoactive sexual expressions. METHODS: A comprehensive review of the human and animal literature is made, and a theory surrounding the ways that HSDD can be manifested and treated is presented. MAIN OUTCOME MEASURES: Drug effects and neural systems derived largely from rat studies that are involved in the stimulation of sexual desire (excitatory system) vs. the stimulation of sexual reward, sedation, and satiety (inhibitory system). RESULTS: Brain dopamine systems (incertohypothalamic and mesolimbic) that link the hypothalamus and limbic system appear to form the core of the excitatory system. This system also includes melanocortins, oxytocin, and norepinephrine. Brain opioid, endocannabinoid, and serotonin systems are activated during periods of sexual inhibition, and blunt the ability of excitatory systems to be activated. CONCLUSIONS: Drugs that stimulate the activation of hypothalamic dopamine or that blunt endocannabinoid or serotonin release and/or postsynaptic binding may be effective in stimulating sexual desire in animals and humans. The characterization of how those drugs work will help generate a rational approach to drug development in the treatment of HSDD.

Short- and long-term effects of Ginkgo biloba extract on sexual dysfunction in women.

Ginkgo biloba extract (GBE) facilitates blood flow, influences nitric oxide systems, and has a relaxant effect on smooth muscle tissue. These processes are important to the sexual response in women and, hence, it is feasible that GBE may have a therapeutic effect. The present study was the first to provide an empirical examination of the effects of both short- and long-term GBE administration on subjective and physiological (vaginal photoplethysmography) measures of sexual function in women with Sexual Arousal Disorder. A single dose of 300 mg GBE had a small but significant facilitatory effect on physiological, but not subjective, sexual arousal compared to placebo in 99 sexually dysfunctional women. The long-term effects of GBE on sexual function were assessed in 68 sexually dysfunctional women who were randomly assigned to 8 weeks treatment of either (1) GBE (300 mg/daily), (2) placebo, (3) sex therapy which focused on training women to attend to genital sensations, or (4) sex therapy plus GBE. When combined with sex therapy, but not alone, long-term GBE treatment significantly increased sexual desire and contentment beyond placebo. Sex therapy alone significantly enhanced orgasm function compared with placebo. Long-term GBE administration did not significantly enhance arousal responses beyond placebo. It was concluded that (1) neither short- or long-term administration of GBE alone substantially impacts sexual function in women, (2) a substantial placebo effect on sexual function exists in women with sexual concerns, and (3) teaching women to focus on genital sensations during sex enhances certain aspects of women's sexual functioning.

Sexuality assessment: 10 strategies for improvement.

Although nurses are aware that assessing sexuality, diagnosing sexuality problems, and evaluating outcomes of interventions to address patients' sexuality concerns are part of holistic care, they often do not perform sexuality assessment in practice. Understanding sexuality as patients' perceptions of body image, family roles and functions, relationships, and sexual function can help nurses improve assessment and diagnosis of actual or potential alterations in sexuality. In addition, nurses should increase their knowledge and understanding of sexuality, identify available information and resources, apply practice standards, and develop a skill set to incorporate sexuality questions routinely in clinical assessments. This article provides 10 strategies to help address and validate patients' sexuality experiences and quality-of-life concerns. By promoting sexual health, nurses can help patients regain a sense of normalcy after cancer diagnosis and treatment. Holistic care is provided when nurses acknowledge the importance of sexuality in patients' lives.