O impacto do uso de métodos contraceptivos orais na função sexual de mulheres em idade reprodutiva / The impact of the use of oral contraceptive methods on the sexual function of women of reproductive age

Objetivo: Investigar o impacto dos contraceptivos orais hormonais na função sexual de mulheres. Métodos: Estudo transversal realizado por meio do questionário traduzido e validado "Índice da Função Sexual Feminina", capaz de estimar o risco de disfunção sexual feminina. Dados sociodemográficos, ginecológicos, medicamentosos e outros foram avaliados e correlacionados estatisticamente a esse escore, estimando possíveis causas da disfunção sexual, com destaque para o uso de anticoncepcional oral. O estudo foi baseado em uma amostragem por conveniência, incluindo mulheres > 18 anos em idade reprodutiva, de 04/01/2021 a 04/01/2022, obedecendo aos critérios de inclusão e exclusão. Resultados: Participaram deste estudo 105 mulheres com média e desvio-padrão de idade de 23,4 ± 3,8 anos, predominantemente heterossexuais (84,0%) e bissexuais (13,2%). A maioria delas (93,4%) utiliza métodos contraceptivos, sendo esses anticoncepcional oral (45,3%), DIU hormonal (19,8%) e camisinha (17,0%). A composição hormonal mais utilizada foi levonorgestrel (26,4%) e etinilestradiol (25,5%). Oitenta por cento das mulheres são sexualmente ativas, 69,3% delas têm parceria fixa, 42,5% tinham relações quase sempre e 33,0% referiam que as relações sexuais eram sempre satisfatórias. Houve boa adequação da amostra (0,865) e significância estatística (p < 0,0001). Utilizar ou não método contraceptivo apresentou diferença nos domínios desejo, satisfação e dor. Contudo, as questões do histórico sexual foram as que mais apresentaram relevância estatística em relação aos domínios. Conclusão: Apesar de outros estudos serem necessários para provar a hipótese de que os contraceptivos orais têm impacto negativo na função sexual feminina, é clara a importância de os profissionais de saúde já estarem cientes dessa possibilidade e saberem como abordá-la.

Objective: To investigate the impact of hormonal oral contraceptives on women's sexual function. Methods: Cross-sectional study carried out using the translated and validated questionnaire "Index of Female Sexual Function", capable of estimating the risk of female sexual dysfunction. Sociodemographic, gynecological, medication and other data were evaluated and statistically correlated to this score, estimating possible causes of sexual dysfunction, with emphasis on the use of oral contraceptives. The study was based on a convenience sample, including women > 18 years of reproductive age, from 01/04/2021 to 01/04/2022, following inclusion and exclusion criteria. Results: The study included 105 women with a mean and standard deviation of (23.4 ± 3.8) years old, predominantly heterosexual (84.0%) and bisexual (13.2%). Most of them (93.4%) use contraceptive methods, these being (45.3%) oral contraceptives, (19.8%) hormonal IUDs and (17.0%) condoms. The most used hormonal composition was levonorgestrel (26.4%) and ethinylestradiol (25.5%). Eighty percent of the women are sexually active, 69.3% of them have a steady partner, 42.5% almost always had sex and 33.0% said that sex was always satisfactory. There was good sample adequacy (0.865) and statistical significance (p < 0.0001). Using or not using a contraceptive method showed a difference in the desire, satisfaction and pain domains. However, sexual history questions were the ones that showed the most statistical relevance in relation to the domains. Conclusion: Although further studies are needed to prove the hypothesis that oral contraceptives have a negative impact on female sexual function, it is clear that health professionals are already aware of this possibility and know how to approach it.

Glutamine restores testicular glutathione-dependent antioxidant defense and upregulates NO/cGMP signaling in sleep deprivation-induced reproductive dysfunction in rats.

Oxidative stress has been linked with sleep deprivation (SD)-induced pathological conditions and reproductive dysfunction. On the other hand, glutamine has been established to have antioxidant property. However, the impact of SD, with or without glutamine, on male reproductive function is yet to be elucidated. Thus, this study was designed to investigate the role of SD, with or without glutamine, on male reproductive function and possible associated mechanisms. Ten-week old male Wistar rats weighing 175.6 g± 0.42 were randomly assigned into vehicle that received per os (p.o.) distilled water, glutamine (1 g/kg; po), SD, and SD + glutamine that received treatments as glutamine and SD. Treatment/exposure lasted for 72 h. The results showed that SD led to reduced body weight, seminiferous luminal and epididymal sperm density, low sperm quality, increased testicular and epididymal malondialdehyde, uric acid, DNA fragmentation, and testicular injury markers. In addition, SD caused a reduction in reduced glutathione level and activities of superoxide dismutase, catalase, glucose-6-phosphate dehydrogenase, glutathione peroxidase, and glutathione-S-transferase. Also, SD increased tumor necrotic factor-α, interleukin-1ß, and nuclear factor-kappa B levels. Furthermore SD led to impaired libido and erectile dysfunction, and suppression of circulatory nitric oxide, gonadotropins and testosterone, and penile cGMP. However, glutamine attenuated the effects induced by SD. Taken together, the findings of this study demonstrate that SD induces reproductive dysfunction via glutathione-dependent defense depletion and down-regulation of NO/cGMP signaling, which was abolished by glutamine supplementation.

Men Converting from Clomiphene Citrate to Natesto with a Desire to Maintain Spermatogenesis Should Be Followed Closely.

OBJECTIVE: To report a case of a testosterone deficient man desiring maintenance of spermatogenesis converting from clomiphene citrate (CC) to Natesto, who had a decrease in gonadotropins and semen parameter values after making this medication change. The data on men maintaining gonadotropins and semen parameter values after converting from CC to Natesto is also reported. METHODS: A retrospective chart review was performed. Baseline hormones prior to treatment, and again on CC and Natesto, as well as semen parameters on CC and on Natesto were assessed. RESULTS: A 32-year-old testosterone deficient man desiring to maintain future fertility potential who had a poor symptomatic response to CC despite an adequate serum testosterone response was converted to Natesto 11 mg twice daily. His gonadotropins diminished as did his semen parameter values but with dose titration of Natesto to 11 mg in the morning and 5.5 mg in the evening he had normalization of gonadotropins and a rise in semen parameter values back towards his values on CC with a continued satisfactory symptomatic response. The remainder of the 49 men to date converting from CC to Natesto revealed stability in gonadotropins and semen parameter values. CONCLUSION: Testosterone deficient men interested in maintaining spermatogenesis who convert from CC to Natesto seeking a more robust symptomatic response should be followed closely with repeat serum gonadotropins and semen parameters to confirm that spermatogenesis is not being suppressed. Dose titration of Natesto may be effective at optimizing gonadotropins, semen parameter values, testosterone levels, and symptomatic response to treatment.

Benzodiazepines related sexual dysfunctions: A critical review on pharmacology and mechanism of action / Disfunciones sexuales relacionadas con las benzodiazepinas: una revisión crítica sobre farmacología y mecanismo de acción

INTRODUCTION: Normal sexual functioning of both men and women, being a very complex process, is affected by numerous issues besides aging. Many factors affect the sexual function and lifestyle of the young population. In this article, we tried to review the literature to update the knowledge on benzodiazepine-related (BZD) sexual dysfunction (SD) and involved mechanisms of actions based on animal and human studies. METHODS: Different standard websites such as PubMed were used to review the literature and keywords including benzodiazepines, sexual dysfunction, gammaaminobutyric acid A (GABAA) receptor and erectile dysfunction were used. RESULTS: SD is one of the most common disorders in males and females which has recently been demonstrated to be associated with psychotropic medications such as antihypertensive agents, tranquilizers, antihistamines, appetite suppressants, antidepressants and anxiolytics. BZDs are among the most common psychotropic agents worldwide. SD including decreased libido, erectile dysfunction (ED) and other undesired sexual urges were observed in the patients receiving BZDs. DISCUSSION: The mechanisms of action of BZDs to induce SD mainly relate to enhanced GABAA receptor function which reduces penile erection

INTRODUCCIÓN: El funcionamiento sexual normal de los varones y las mujeres, al ser un proceso muy complejo, se ve afectado por numerosos problemas, además del envejecimiento. Muchos factores afectan a la función sexual y al estilo de vida de la población joven. En este artículo intentamos revisar la literatura para actualizar el conocimiento sobre las disfunciones sexuales (SD, por sus siglas en inglés) relacionadas con benzodiacepinas (BZD) y los mecanismos de acción involucrados en estudios con animales y humanos. MÉTODOS: Se utilizaron diferentes sitios web estándar, como PubMed, para revisar la literatura y las palabras clave que incluyen BZD, disfunciones sexuales, ácido gamma-aminobutírico A y disfunción eréctil. RESULTADOS: Las SD son uno de los trastornos más comunes en los varones y las mujeres, ya que recientemente se ha demostrado que están asociados a medicamentos psicotrópicos como agentes antihipertensivos, tranquilizantes, antihistamínicos, supresores del apetito, antidepresivos y ansiolíticos. Las BZD son uno de los agentes psicotrópicos más comunes en todo el mundo. Las SD que incluían disminución de la libido, la disfunción eréctil (DE) y otros impulsos sexuales no deseados, se observaron en los pacientes que recibieron BZD. DISCUSIÓN: Los mecanismos de acción de las BZD para inducir SD se relacionan principalmente con la función mejorada del receptor de ácido gamma-aminobutírico A (GABAA) que reduce la erección del pene

Tribulus terrestris and female reproductive system health: A comprehensive review.

BACKGROUND: Tribulus terrestris L. (T. terrestris) positive performance on the male sexual system has been confirmed, but little is known about its effects on the female reproductive system. PURPOSE: This review discussed in detail the beneficial impact of T. terrestris and its secondary metabolites on the female reproductive system. STUDY DESIGN AND METHODS: In this review, the scientific Databases of Science direct, Pubmed, Web of Science, Google, Google Scholar, Researchgate, EMBASE, Scientific Information (SID), and Elsevier were searched profoundly. Studies about the pharmacological activities of T. terrestris on the female reproductive system in each aspect of investigations: human, in vivo, and in vitro studies, in the period from 1998 to 2020 were admitted. Our study was not limited by the language of publications. RESULTS: 23 articles about the effects of T. terrestris on the female reproductive system were found. These studies approved the T. terrestris efficacy on improvements in histological features of the ovary and uterus of polycystic ovary syndrome patients as well as the well-working of normal ovaries, enhancements in the sexual desire of postmenopausal syndrome, improve ovarian and breast cancers. CONCLUSION: These studies showed that the positive effect of T. terrestris on the female reproductive system was due to the presence of a secondary metabolite called protodioscin; a steroidal saponin compound, as the dominant active component of this plant.

Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome.

OBJECTIVE: To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function. DESIGN: Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS. SETTING: Two academic medical centers. PATIENTS: Women with PCOS (N = 114) defined by the Rotterdam criteria. INTERVENTIONS: Continuous oral contraceptive pill (OCP) or intensive lifestyle modification (Lifestyle) or the combination (Combined) for 16 weeks. MAIN OUTCOME MEASURES: Change in Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores after 16 weeks. RESULTS: There was no change in total FSFI or FSDS-R score in any treatment group; however, an increase in the FSFI desire domain subscore was observed in the Lifestyle and Combined treatments, indicating improved sexual desire over the 16-week period. Overall, 33 participants (28.9%) met criteria for sexual dysfunction by FSFI criteria (baseline score ≤26.55). Among this group, FSFI score improved after 16 weeks of Lifestyle and Combined treatments. There was no change in prevalence of sexual dysfunction in treatment groups at 16 weeks. Use of OCPs did not alter FSFI scores. CONCLUSION(S): Female sexual dysfunction is highly prevalent among women with PCOS. Our findings suggest that common treatments for PCOS, including intensive lifestyle modification and the combination of intensive lifestyle modification and OCPs, have the potential to improve sexual function in these women; the mechanism for these improvements is likely multifactorial. CLINICAL TRIAL REGISTRATION NUMBER: NCT00704912.

Converting Men From Clomiphene Citrate to Natesto for Hypogonadism Improves Libido, Maintains Semen Parameters, and Reduces Estradiol.

OBJECTIVE: To evaluate outcomes including libido, semen parameters, testosterone, estradiol (E2), follicle stimulating hormone (FSH), and luteinizing hormone when converting men with low libido on Clomiphene Citrate (CC) to Natesto. METHODS: A retrospective chart review was performed. Baseline hormones prior to treatment, and again on CC and Natesto, as well as semen parameters on CC and on Natesto were assessed. RESULTS: In 41 men, there was no difference in serum testosterone levels on CC vs Natesto, however; there was a significantly higher E2 on CC than on Natesto. Although FSH levels were significantly lower on Natesto than at baseline, the mean FSH level on Natesto remained in the normal reference range. There was no difference in luteinizing hormone levels at baseline vs on Natesto. There was not a significant difference in semen parameter values when men were on CC vs when they were on Natesto for 3 months. At 3 months after changing to Natesto, 38 of 41 (92.7%) men reported significantly improved libido on Natesto when compared to CC. CONCLUSION: Men on CC and Natesto reach eugonadal testosterone levels, however; on CC the E2 level nearly doubled from baseline, and converting men from CC to Natesto returned E2 to nearly baseline levels. There was not a detrimental effect on semen parameters, and there was subjective reporting of improved libido after converting from CC to Natesto in this cohort, but further long-term studies are needed prior to Natesto being established as a definitive treatment for hypogonadism for men desiring to maintain fertility.

Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100 men.

An estimated 4-6% of fitness center visitors uses anabolic-androgenic steroids (AAS). Reliable data about adverse reactions of AAS are scarce. The HAARLEM study aimed to provide insight into the positive and negative effects of AAS use. One hundred men (≥18 years) who intended to start an AAS cycle on short notice were included for follow-up. Clinic visits took place before (T0 ), at the end (T1 ), and three months after the end of the AAS cycle (T2 ), and one year after the start of the cycle (T3 ), and comprised a medical history, physical examination, laboratory analysis, and psychological questionnaires. During the follow-up period, four subjects reported a serious adverse event, that is, congestive heart failure, acute pancreatitis, suicidal ideation, and exacerbation of ulcerative colitis. All subjects reported positive side effects during AAS use, mainly increased strength (100%), and every subject reported at least one negative health effect. Most common were fluid retention (56%) and agitation (36%) during the cycle, and decreased libido (58%) after the cycle. Acne and gynecomastia were observed in 28% and 19%. Mean alanine transaminase (ALT) and creatinine increased 18.7 U/l and 4.7 µmol/L, respectively. AAS dose and cycle duration were not associated with the type and severity of side effects. After one-year follow-up (T3 ), the prevalence of observed effects had returned to baseline. There was no significant change in total scores of questionnaires investigating wellbeing, quality of life, and depression. In conclusion, all subjects experienced positive effects during AAS use. Four subjects experienced a serious adverse event. Other side effects were mostly anticipated, mild, and transient.

Do high-dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study.

INTRODUCTION: High-dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high-dose progestin on sexual function among women treated for endometriosis. MATERIAL AND METHODS: In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high-dose progestins at T1: a high-dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100-mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ-5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile-de-France (Act 2004-806, 9 August 2004) approved the study. RESULTS: Among 214 women included, 25 (12%) were exposed to high-dose progestins at T1. The SAQ score of women exposed to high-dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P = .03, adjusted effect size -0.44 [95% CI -0.86 to -0.02], P = .04). High-dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P = .02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P = .02). In the overall population, dyspareunia VAS and quality of life assessed by EQ-5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P < .001; 0.78 ± 0.14 at T0 vs 0.86 ± 0.14 at T1, P < .001, respectively). At T1, the groups did not differ significantly for dyspareunia VAS (effect size 0.36 [95% CI -0.06 to 0.78], P = .10) and quality of life (EQ-5D, effect size 0.02 [95% CI -0.40 to 0.44], P = .91). CONCLUSION: In this observational study, high-dose progestins impair the sexual function of women treated for endometriosis even though they improved dyspareunia.

Pharmacological treatment of lower urinary tract symptoms in benign prostatic hyperplasia: consequences on sexual function and possible endocrine effects.

INTRODUCTION: Benign prostate hyperplasia (BPH) is one of the most prevalent diseases in aging men. It may adversely affect quality-of-life due to the presence of low urinary tract symptoms (LUTS) and its effects on sexuality. AREAS COVERED: The impact of α1-blockers, 5α-reductase inhibitors (5-ARI), and phosphodiesterase 5 inhibitors (PDE-5i) on erectile and ejaculatory functions in men with BPH are covered. Endocrinological aspects have also been addressed, including the management of hypogonadism, which affects many patients with BPH, and the impact of the use of 5-ARI use on bone health. EXPERT OPINION: The adverse-event profile of α1-blockers depends on their affinity for the α1-adrenoceptors rather than selectivity. The probability of ejaculatory dysfunction is highest with silodosin than other nonselective drugs (tamsulosin, alfuzosin, doxazosin, and terazosin). Concerning the impact of finasteride and dutasteride on sexual desire, erectile function, and ejaculation, the vast majority of the studies have shown a low prevalence of treatment-related adverse events. Due to the benefits of erection, PDE5i represents the perfect class of drugs for the treatment of LUTS-BPH in patients with erectile dysfunction. Testosterone replacement therapy could be considered in some hypogonadal patients with BPH. Finally, current evidence support the safety of 5-ARI on bone tissue.

Acute caffeine reverses the disruptive effects of chronic fluoxetine on the sexual behavior of female and male rats.

RATIONALE: Sexual side effects of chronic treatment with selective serotonin reuptake inhibitors (SSRIs) in humans include anorgasmia and loss of sexual desire and/or arousal which interferes with treatment compliance. There are few options at present to reduce these effects. Because orgasm and desire are mediated in part by activation of sympathetic arousal, we asked whether the sympathomimetic effects of acute caffeine treatment could reverse these effects. OBJECTIVE: The present study examined whether acute treatment with caffeine (CAF; 10 or 20 mg/kg, ip) versus vehicle could ameliorate the disruption of appetitive and consummatory measures of copulatory behavior produced by chronic fluoxetine (10 mg/kg, sc) in adult, sexually active female or male rats. METHODS: Sexually experienced female or male rats received daily injections of FLU over a 24-day period and were tested for sexual behaviors five times at 4-day intervals during this period in bilevel pacing chambers. Females had been ovariectomized and given hormone replacement with estradiol benzoate and progesterone prior to each test. Males were left gonadally intact. Four days after the final FLU test, rats were randomly assigned to one of the three doses of CAF and received ip injections of CAF or the saline vehicle 60 min before testing. RESULTS: Chronic FLU reduced solicitations and lordosis over time in females and reduced the number of ejaculations in males. Both doses of CAF restored solicitations and lordosis in females and ejaculations in males. On their own, both doses of CAF increased females' pacing behavior and the number of mounts and intromissions in the males. CONCLUSIONS: Stimulation of sympathetic outflow by CAF may constitute a readily accessible on-demand treatment for the sexual side-effects of SSRIs.

Vitamin E and ginseng supplementation to enhance female sexual function: a randomized, double-blind, placebo-controlled, clinical trial.

Female sexual disorders (FSD) are a spectrum of disorders common among women, especially in their middle age, which can reduce the female quality of life substantially. We aimed to evaluate the effects of a combined vitamin E and ginseng supplement on amelioration of female sexual dysfunction. In a 6-week, double-blind, randomized, placebo-controlled clinical trial, participants, suffering from sexual dysfunction based on the female sexual function index (FSFI) questionnaire, were randomly allocated to receive the supplement (100 IU vitamin E, 67 mg Korean ginseng, and 40 mg Siberian ginseng) or placebo daily. The primary outcome in our trial was the change in the FSFI total score. Sixty-nine participants were enrolled, but only 31 in each group completed the trial. Changes in the FSFI total score and its domain scores were significant during the trial course within each group. However, the supplement only ameliorated desire and satisfaction domains superior to the placebo. In case of the total score and other domains, the changes were insignificantly different between the treatment groups. Although our study could not find additional benefits for the vitamin E and ginseng supplement over placebo in enhancing sexual function overall, the supplement worked better in enhancing sexual desire and satisfaction.

Quality of life in women treated with chemotherapy for breast cancer in Cali, Colombia / [Calidad de vida en mujeres con cáncer de mama sometidas a quimioterapia en Cali, Colombia].

Introduction: Breast cancer is a serious neoplasm that originates in mammary tissues whose treatment with chemotherapy seems to generate significant changes in the quality of life. Objective: To determine the risk factors associated with health-related quality of life in women with breast cancer under chemotherapy in Cali, Colombia. Materials and methods: We conducted an observational, cross-sectional study with analytical components in a sample of 80 female patients using the QLQ-C30 questionnaire for cancer, and the QLQ-BR23 for breast cancer, as well as sociodemographic and clinical information. We performed a logistic regression analysis to determine associated risk factors through adjusted OR and 95% CI; the quality of life was classified using the QLQ-BR23. Results: The most relevant symptoms were fatigue, insomnia, and hair loss. Physical functionality, feelings of pleasure, and sexual activity were reduced. The factors associated with low quality of life were mammary symptoms (adjusted OR= 5.5; 95% CI: 1.2-24.8; p = 0.038), systemic therapy side effects (adjusted OR = 7.3; IC95%: 2.6-22.1; p = 0.012), lower sexual pleasure (adjusted OR = 1.8; IC95%: 1.2-11.8; p = 0.027) and reduction of expectations about the future (adjusted OR = 4.2; IC95%: 1.1-17.8; p = 0.045). Conclusions: The quality of life in women with breast cancer and under chemotherapy was mainly affected by the side effects of the therapy; the most relevant signs and symptoms identified were hair loss, insomnia, and fatigue besides breast symptoms, lower physical functionality, and decreased sensation of sexual pleasure. We recommend intervention strategies aimed at improving the quality of life and the physical and emotional care of these patients.

Introducción. El cáncer de mama es una neoplasia grave que se origina en los tejidos mamarios y cuyo tratamiento demanda quimioterapia, con los consecuentes cambios en la calidad de vida. Objetivo. Determinar los factores de riesgo asociados con la calidad de vida relacionada con la salud en mujeres con cáncer de mama sometidas a quimioterapia en Cali, Colombia. Materiales y métodos. Se hizo un estudio observacional y transversal con componente analítico en una muestra de 80 mujeres, utilizando los cuestionarios QLQ-C30 para cáncer y QLQ-BR23 para cáncer de mama, así como información sociodemográfica y clínica. Se hizo un análisis de regresión logística para determinar los factores asociados con las razones de momios (odd ratios, OR) ajustadas y un intervalo de confianza (IC) de 95 %; la calidad de vida se clasificó mediante el cuestionario QLQ-BR23. Resultados. Los síntomas más relevantes fueron fatiga, insomnio y pérdida de cabello. Se redujeron la funcionalidad física, las sensaciones de placer y la actividad sexual. Los factores asociados con la baja calidad de vida fueron los síntomas mamarios (OR ajustada=5,5; IC95% 1,2-24,8; p=0,038), los efectos secundarios del tratamiento sistémico (OR ajustada=7,3; IC95% 2,6-22,1; p=0,012), un menor placer sexual (OR ajustada=1,8; IC95% 1,2-11,8; p=0,027) y la reducción de expectativas para el futuro (OR ajustada=4,2; IC95% 1,1-17,8; p=0,045). Conclusiones. En las mujeres con cáncer de mama sometidas a quimioterapia, la calidad de vida se vio afectada principalmente por los efectos secundarios del tratamiento, en tanto que los signos y los síntomas más relevantes fueron la pérdida del cabello, el insomnio y la fatiga, además de los síntomas mamarios, la menor funcionalidad física y la menor sensación de placer sexual. Se recomienda la implementación de estrategias de intervención destinadas a mejorar la calidad de vida, y el cuidado físico y emocional de las pacientes.

A focused review on the genital and sexual affection of COVID-19 patients.

The pandemic of coronavirus disease-2019 (COVID-19) could harm the reproductive and sexual health of both males and females. This could be through psychological, immunological, or systemic effects. In this article, we tried to elucidate the mechanisms that could explain the current and future genital affection of COVID-19 patients.

Exogenous melatonin advances the ram breeding season and increases testicular function.

Governed by melatonin, ovine reproductive seasonality limits production outcomes due to periods of decreased reproductive efficiency. Though it is established that slow-release melatonin implants improve out of season reproductive performance in the ewe, the comprehensive effects of exogenous melatonin in the ram remain inconclusive. This study aimed to ultimately clarify the ability of exogenous melatonin to alter ram reproductive function during the non-breeding season and the subsequent breeding season. Hence, we investigated the effect of exogenous melatonin on reproductive endocrinology, semen quality and production, testicular size and libido in Merino and Poll Dorset rams (n = 31, using a subset of 18 rams for analysis of semen production and quality). Melatonin treatment resulted in elevation of melatonin in seminal plasma from 1-8 weeks post-implantation and in blood plasma at 6 weeks post-implantation. The blood plasma testosterone of implanted rams was greater than controls at both 6 weeks post-implantation and during the following breeding season. Implanted rams exhibited increased testicular size and number of sperm per ejaculate from 3-12 weeks post-implantation but did not demonstrate any change in sperm motility or morphology in response to treatment. Compared to their control counterparts, melatonin-treated Poll Dorset rams exhibited a lower percentage of sperm DNA fragmentation during several weeks of the non-breeding season. Though melatonin increased the likelihood of ejaculate collection in Poll Dorset rams (P < 0.05), libido was otherwise unaffected by treatment. Melatonin did not alter seminal plasma concentrations of inhibin A or Anti-Mullerian hormone, however, for the first time in the ram we have shown Anti-Mullerian hormone to be positively correlated with the number of sperm per ejaculate and sperm motility (r = 0.464 and 0.3242 respectively, P < 0.001), and inhibin A to be correlated to the number of sperm per ejaculate (r = 0.1786, P = 0.0135). These results indicate that melatonin is able to both systemically upregulate reproduction and act directly upon testicular function in the ram.

[The use of "virado" as a harm reduction strategy among crack users in the State of Pernambuco, Brazil]. / El uso de "virado" como estrategia de reducción de daños entre los usuarios de crack del estado de Pernambuco, Brasil.

The aim of the study is to discuss the use of crack in the form of "virado" as a harm reduction strategy in Pernambuco, Brazil. This is a cross-sectional study with a qualitative approach in which semi-structured interviews were conducted regarding aspects related to the culture of crack use with 39 crack users between March and August 2016. Participants were recruited using saturation criteria and data were analyzed through content analysis. Respondents discussed the use of "virado" and compared its effects in relation to crack, addressing improvement in interpersonal relationships, libido, and non-compulsive drug use, which can all be understood as harm reduction strategies. On the other hand, equipment sharing for the use of "virado" was identified as a high-risk practice with regards to the transmission of infectious diseases. Knowing about the culture of crack use in different contexts is essential in order to plan and develop health care actions.

El objetivo del estudio es discutir uno de los usos del crack denominado "virado", como estrategia de reducción de daños entre las personas que usan crack en Pernambuco, Brasil. Se realizó una investigación cualitativa y transversal. Desde marzo hasta agosto de 2016, se realizaron entrevistas semiestructuradas sobre la cultura del uso de crack a 39 personas que usan esta substancia. El límite de participantes se estableció por el criterio de saturación. Los datos se analizaron con la técnica de análisis de contenido. Las personas que participaron relataron que el virado es una manera distinta de utilizar el crack y, al comparar su efecto con el uso fumado o inhalado, mencionaron que el virado produce menos impacto en las relaciones interpersonales y en la libido, además de reducir el uso compulsivo de crack, cuestiones que se podrían considerar como estrategias de reducción de daños. Un aspecto negativo es que comparten los canutos para aspirar el virado, lo cual es una situación de riesgo para la transmisión de enfermedades infecciosas. Conocer la cultura del uso del crack en distintas formas y situaciones es imprescindible para la planificación y desarrollo de acciones de atención a la salud.

Dose-Response Relationships Between Gonadal Steroids and Bone, Body Composition, and Sexual Function in Aging Men.

CONTEXT: Most labs set the lower limit of normal for testosterone at the 2.5th percentile of values in young or age-matched men, an approach that does not consider the physiologic changes associated with various testosterone concentrations. OBJECTIVE: To characterize the dose-response relationships between gonadal steroid concentrations and measures regulated by gonadal steroids in older men. DESIGN, PARTICIPANTS, AND INTERVENTION: 177 men aged 60 to 80 were randomly assigned to receive goserelin acetate plus either 0 (placebo), 1.25, 2.5, 5, or 10 grams of a 1% testosterone gel daily for 16 weeks or placebos for both medications (controls). PRIMARY OUTCOMES: Changes in serum C-telopeptide (CTX), total body fat by dual energy X-ray absorptiometry, and self-reported sexual desire. RESULTS: Clear relationships between the testosterone dosage (or the resulting testosterone levels) and a variety of outcome measures were observed. Changes in serum CTX exceeded changes in the controls in men whose testosterone levels were 0 to 99, 100 to 199, 200 to 299, or 300 to 499 ng/dL, whereas increases in total body fat, subcutaneous fat, and thigh fat exceeded controls when testosterone levels were 0 to 99 or 100 to 199 ng/dL. Sexual desire and erectile function were indistinguishable from controls until testosterone levels were <100 ng/dL. CONCLUSION: Changes in measures of bone resorption, body fat, and sexual function begin at a variety of testosterone concentrations with many outcome measures remaining stable until testosterone levels are well below the stated normal ranges. In light of this variation, novel approaches for establishing the normal range for testosterone are needed.

The consequences of regular methamphetamine use in Tehran: qualitative content analysis.

BACKGROUND: In recent years, methamphetamine use has increased noticeably in Iran, and this can make harmful consequences for the health of individuals and society. Therefore, the study aimed to investigate the consequences of regular methamphetamine use in Tehran. METHODS: This study was conducted based on a conventional content analysis approach. Data were collected through observation and in-depth interviews with 20 regular adult users of methamphetamine in Tehran (including 15 males and 5 females). Participants were selected using snowball sampling and purposeful sampling, which continued until data saturation. Guba and Lincoln's criteria were used to assess the strength of the study. RESULTS: The extraction of the codes resulted in three main categories: (1)the short-term consequences, consisting of the sub-categories of individual and social consequences, (2) the long-term consequences, consisting of the sub-categories of psychological and physical consequences, high-risk behaviors, severely decayed memory and changes in the eating pattern, and (3) hallucinations and delusions including the sub-categories of visual and auditory hallucinations, persecutory delusions and delusion of having supernatural power. CONCLUSION: Regular methamphetamine use may have serious adverse effects on the overall health of individuals. It is therefore highly recommended that educational programs must implement with the use of methamphetamine in the high- risk groups in order to raise awareness and change attitudes about the short and long term consequences. is highly recommended.