Showing papers on "Female Sexual Arousal Disorder published in 2012"

Sexual Dysfunction in Women

Abstract: Female sexual dysfunction is prevalent but remains a mysterious field in psychiatry. In this book Dr Marta Meana, a renowned sex researcher and therapist, enlightens us on the world of female sexual difficulties. The author guides us from basic descriptions to the theories, giving us a panoramic view of the spectrum of sexual dysfunction in women. She then brings us back to the practical aspects of diagnosis and treatment, which are of utmost importance to our clinical practice. The first section of this book describes the various conditions pertaining to sexual dysfunction in women. It focuses on the 6 categories of sexual dysfunction listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. These were hypoactive sexual desire disorder (HSDD), sexual aversion disorder, female sexual arousal disorder (FSAD), female orgasmic disorder, dyspareunia, and vaginismus (the last 2 are not due to a medical condition). A brief introduction of the traditional models of sexual response is given. However, the author points out that these models may not adequately depict the diverse experiences of women, and thus new models are being proposed to suggest a more complex process, e.g. the incentive-motivation model and Basson’s model. She moves on to a meticulous review of the diagnostic descriptions of each of these disorders of interest. It is inspiring to note that sexual interest / arousal disorder is the new diagnostic category proposed for the coming Diagnostic and Statistical Manual of Mental Disorders. This category would subsume the current diagnoses of HSDD and FSAD with the rationale that “neither the empirical literature nor women themselves reliably distinguish desire from arousal, and the high degree of comorbidity between the two diagnoses makes their separation questionable.” This rich section also covers the epidemiology, course, prognosis, differential diagnosis, and co-morbidities of female sexual dysfunction, beautifully. The second section is a concise account of the theories and models of sexual dysfunction, namely Barlow’s cognitive-affective model, dual-control model, Sexual Tipping Point model, inter-system approach, and new view approach. All current models appreciate the diversity of sexual experience, the mind-body integration, and the multi-determined nature of sexual function. The author demonstrates the complex architecture of the aetiologies of female sexual dysfunction in the third section of this book, which sheds light on diagnoses and treatment indications. The risks and dysfunctionmaintaining factors are analysed using the biomedicalpsychological-social model. Prescription medications are common risk factors for female sexual dysfunction and present a dilemma for the clinicians. We should be inspired by the author’s innovative comment: “...sexual side effects of necessary medications can be targeted by cautious yet creative strategies on the part of the prescribing physician.” The latter part of this section presents us with numerous astonishing psychological and social factors related to female sexual dysfunction. It is worth noting that self-focus is crucial to sexual performance and can be either positive or negative. The author states that “...the way a woman feels about herself may be even more important to her sexual function than the way her partner feels about her.” This psychological factor is magically linked to a social factor, the sexless motherhood script. Psychoanalysis referred to a Madonna-whore complex and, not surprisingly, women also have a difficult experience seeing themselves fulfilling the dual roles of lover and mother. After a relaxing overview of the basics, the author takes us to the climax of this book: treatment of female sexual dysfunction. Even at the beginning of planning treatment, we may encounter many challenges including paucity of randomised controlled trials examining treatment outcomes, clinician self-efficacy, and barriers to general assessment. The author guides us through the stage 1 of treatment: assessment, education, setting goals, and reducing distress. She states that “...despite the ubiquitous presence of sexual themes in contemporary media, misinformation and myths about sex abound.” It is important for the clinicians to help the patient to clear up these misconceptions as early as possible, not to mention his or her own! In addition, the author depicts how the trans-theoretical model of Prochaska and Prochaska (1999) can aid the assessment of the patient’s stage of readiness for treatment, which can provide helpful information for treatment planning. She emphasises that “...the ultimate goal of therapy for sexual problem is sexual and relationship satisfaction...”, independent of the frequency and nature of the sexual activity. Stage 2 of treatment consists of cognitive restructuring, emotional regulation, stimulus control and behavioural activation, and building relationship skills. This stage is described in depth, resembling a manual of psychotherapy, which can be particularly helpful to our clinical practice. The treatment ends with stage 3: consolidation of gains and relapse prevention. A detailed account of the specific assessment and treatment components of each of the disorders of interest follows. Dysfunction-specific medical treatment is also discussed. The author ends this section with some useful tips in carrying out treatment. In contrast to other psychological interventions, “...perceived pressure from the therapist can create another layer of performance anxiety.” This book is a concise and detailed clinical guide. “Nearly everyone will experience sexual difficulties at some point in the course of their lives.” — to this, I totally agree. However, this field remains a relatively ‘untouchable area’ to most clinicians. This book empowers us to actively and sensitively engage in the multidisciplinary treatment of sexual disorders, and becomes a pleasure to read!

Controlled release nasal testosterone gels, methods and pre-filled multi-dose applicator systems for pernasal administration

Abstract: The present invention relates to intranasal testosterone gels for the controlled release of testosterone into the systemic circulation of males and females for providing constant effective testosterone blood levels, without inducing undesired testosterone spike in blood levels, following pernasal administration. The intranasal testosterone gels of the present invention are safe, convenient to use, well tolerated, stable and easily and reproducibly manufactured on scale up. Moreover, because supra- normal and sub-normal testosterone blood levels are believed to be essentially kept to a minimum or avoided and the testosterone serum levels are believed to remain essentially constant during dose life, i.e., the intranasal testosterone gels of the present invention mimic or restore testosterone blood levels to normal physiologic daily rhythmic testosterone levels, the novel intranasal testosterone gels of the present invention are uniquely suited for testosterone replacement or supplemental therapy and effective for treating males diagnosed with, for example, male testosterone deficiency, such as, low sexual libido, low sexual drive, low sexual activity, low fertility, low spermatogenesis, aspermatogenesis, depression and/or hypogonadism, and females who are diagnosed with, for example, female sexual dysfunction, such as, low sexual libido, low sexual drive, low sexual activity, low amygdala reactivity, low sexual stimulation, hypoactive sexual desire disease ("HSDD"), female sexual arousal disorder and/or anorgasmia. The present invention also relates to methods and pre- filled multi-dose airless applicator systems for pernasal administration of the nasal testosterone gels of the present invention.

Acupuncture and Female Sexual Dysfunction: A Time-Series Study of Symptom Relief

Abstract: Background: Female sexual dysfunction (FSD) includes disturbances in the sexual response cycle resulting in marked distress and interpersonal difficulty capable of altering quality of life adversely. FSD is a common phenomenon affecting up to 26%–71% of the general female population worldwide. The umbrella term FSD subsumes four disorders: (1) hypoactive sexual desire disorder; (2) female sexual arousal disorder; (3) orgasmic disorder; and (4) sexual pain disorder. Objective: The aim of this pilot study was to assess immediate and longer-term effects of acupuncture quantitatively on symptoms related to female sexual dysfunction, using global- and specific-symptom instruments. Design: This was a time series study in a self-selected population of nonrandomized patients. Setting: The pilot study was conducted at a private women's health clinic in Reno, NV. Patients: Seventeen sequential subjects between ages 40 and 66 and clinically diagnosed with FSD were assessed at baseline and followed through t...

Psychometric Validation of the Sexual Function Questionnaire in Poland

Abstract: Questionnaires diagnosing sexual dysfunctions in women are important tools which can facilitate the diagnosis and therapy of individual female patients. The study is aimed at the adaptation of the Sexual Function Questionnaire, which was designed by Frances H. Quirk and associates for the American population, to Polish conditions (Quirk et al. in J Sex Med 4:469–77, 1). The study group consisted of 143 women aged 20–68 who were receiving gynaecological care and displayed various types of sexual dysfunction (e.g. female sexual arousal disorder, female orgasmic disorder, dyspareunia), or none of those. The good psychometric quality of the Sexual Function Questionnaire has been confirmed with the following results: convergent validity rs=0.62, p<0.01, construct validity was estimated by Principal Component Analysis with the promax rotation method. The 7 factors together explained 80.7% of total variance, and a reliability of 0.97 for the whole test, with that for particular domains ranging from 0.62 to 0.96 (estimated with Cronbach’s alpha). The obtained results are mostly consistent with results from studies conducted by the authors of the Questionnaire in the United States, and with the adaptation study carried out in Iran. There are, however, some differences in the assignment of questions to particular domains, as well as in the names of the domains.

ORIGINAL RESEARCH—FSD PHARMACOTHERAPY Influence of Sildenafil on Genital Engorgement in Women with Female Sexual Arousal Disorder

Abstract: Introduction. We previously described dynamic, noncontrast magnetic resonance imaging (MRI) of the female genitalia as a reproducible, nonintrusive, objective means of quantifying sexual arousal response in women without sexual difficulties. These studies showed an increase in clitoral engorgement ranging from 50 to 300% in healthy women during sexual arousal. Aim. This study sought to evaluate the genital arousal response in women with female sexual arousal disorder (FSAD) after administration of sildenafil and placebo. We performed a multicenter, double-blind, placebo- controlled, cross-over study to assess the clitoral engorgement response using dynamic MRI in women with FSAD after administering sildenafil and placebo followed by audiovisual sexual stimulation (AVSS). Methods. Nineteen premenopausal women with FSAD underwent two MRI sessions. Subjects were randomized to receive either (i) sildenafil 100 mg during the first session followed by placebo during the second session, or (ii) placebo followed by sildenafil. During each session, baseline MR images were obtained while subjects viewed a neutral video. Subjects then ingested sildenafil or placebo. After 30 minutes, a series of MRIs were obtained at 3-minute intervals for 10 time points while subjects viewed AVSS. Main Outcome Measures. A positive sexual arousal response was achieved if clitoral volume increased 50% from baseline. Results. Thirteen of 19 (68%) subjects achieved a 50% increase in clitoral engorgement from baseline when administered sildenafil or placebo 30 minutes after dose administration. At 60 minutes after administration, 17/19 (89%) subjects receiving sildenafil and 16/19 (84%) subjects receiving placebo had responded (P value 0.3173). Conclusions. Sildenafil did not augment the genital response in women with FSAD. Secondarily, a majority of women in this study did not have impaired clitoral engorgement as measured by MRI, suggesting that FSAD is not predominantly a disorder of genital engorgement. Leddy LS, Yang CC, Stuckey BG, Sudworth M, Haughie S, Sultana S, and Maravilla KR. Influence of sildenafil on genital engorgement in women with female sexual arousal disorder. J Sex Med 2012;9:2693-2697.