RESUMO
BACKGROUND: Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. OBJECTIVE: To evaluate the effects of group CBT on women with HSDD. METHOD: Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. MAIN OUTCOME MEASURES: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. RESULTS: Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87â23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43â1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). CONCLUSION: Group CBT was shown to be an effective tool for treating HSDD.
Assuntos
Terapia Cognitivo-Comportamental , Psicoterapia de Grupo , Disfunções Sexuais Psicogênicas , Cognição , Feminino , Humanos , Libido , Projetos PilotoRESUMO
Hypoactive sexual desire disorder (HSDD) is a common female sexual dysfunction and is estimated to affect approximately 10% of women in the United States. It has been suggested that HSDD is associated with an imbalance of hormone and neurotransmitter levels in the brain, resulting in decreased excitation, increased inhibition, or a combination of both. Evidence suggests neurotransmitters, including dopamine (DA), norepinephrine, and serotonin, as well as hormones such as estradiol and testosterone, contribute to female sexual desire and response. Current treatments for HSDD include psychotherapy, and two US Food and Drug Administration-approved medications for premenopausal women: flibanserin, a serotonin mixed agonist and antagonist, and bremelanotide, a melanocortin receptor (MCR) agonist. Melanocortins are endogenous neuropeptides associated with the excitatory pathway of the female sexual response system. MCRs are found throughout the body, including the brain. Bremelanotide is an MCR agonist that nonselectively activates several of the receptor subtypes, of which subtype 4 (MC4R) is the most relevant at therapeutic doses. MC4R is predominantly expressed in the medial preoptic area (mPOA) of the hypothalamus in the brain, and is important for female sexual function. Animal studies suggest that bremelanotide may affect female sexual desire by activating presynaptic MC4Rs on neurons in the mPOA of the hypothalamus, leading to increased release of DA, an excitatory neurotransmitter that increases sexual desire. This review presents what is known about the mechanism of action of bremelanotide in the context of treating HSDD.
Assuntos
Serotonina , Disfunções Sexuais Psicogênicas , Animais , Dopamina/metabolismo , Feminino , Humanos , Neurotransmissores/uso terapêutico , Peptídeos Cíclicos , Serotonina/metabolismo , Disfunções Sexuais Psicogênicas/tratamento farmacológico , alfa-MSH/uso terapêuticoRESUMO
Abstract Background: Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. Objective: To evaluate the effects of group CBT on women with HSDD. Method: Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. Main Outcome Measures: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. Results: Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). Conclusion: Group CBT was shown to be an effective tool for treating HSDD.
RESUMO
INTRODUCCIÓN Y OBJETIVO: El rol de la testosterona exógena en la función sexual femenina ha sido estudiado durante muchos años, con resultados contradictorios. En el último tiempo se ha promovido el uso de pellets de testosterona como una solución para mejorar la libido femenina, la cognición, la fuerza muscular y los sistemas cardiovascular y óseo, e incluso evitar el envejecimiento. Por ello, revisamos las publicaciones para tratar de responder si esto es una moda o el tratamiento más innovador del último tiempo. MÉTODO: Se analizaron las bases de datos PubMed/Medline, Trip Database, Cochrane, SciELO, Scopus, UpToDate, Ovid, ProQuest, Science Direct y ResearchGate. RESULTADOS: De acuerdo con la evidencia, la mejor testosterona disponible es la transdérmica y debe ser usada solo en el trastorno del deseo sexual hipoactivo (TDSH). Los trabajos que evalúan los pellets de testosterona tienen sesgos metodológicos importantes. Si bien son útiles para mejorar la función sexual femenina, producen concentraciones plasmáticas suprafisiológicas de testosterona, por lo que no se puede establecer su seguridad a largo plazo. Tampoco hay datos suficientes que avalen su uso para mejorar el rendimiento cognitivo y el bienestar general, en el tratamiento de enfermedades cardiovasculares o en la prevención de enfermedad ósea. CONCLUSIONES: La testosterona solo se recomienda en el tratamiento del TDSH por vía transdérmica. No recomendamos el uso de pellets de testosterona para el tratamiento de la disfunción sexual ni como hormona antienvejecimiento, ya que no hay estudios consistentes sobre su seguridad, eficacia y efectos adversos a largo plazo.
INTRODUCTION AND OBJECTIVE: The role of exogenous testosterone in female sexual function has been studied for many years with contradictory results. In recent times, the use of testosterone pellets has been promoted as a solution to improve female libido, cognition, muscle strength, cardiovascular system, bone and even prevent aging. Therefore, we will review the publications in order to answer whether this is a fad or the most innovative treatment of recent times. METHOD: The databases PubMed/Medline, Trip Database, Cochrane, SciELO, Scopus, UpToDate, Ovid, ProQuest, Science Direct and ResearchGate were analyzed. RESULTS: So far, the evidence best testosterone available is transdermal testosterone and that it should be used only in hypoactive sexual desire disorder (HSDD). Papers evaluating testosterone pellets have significant methodological biases. While they are useful in improving female sexual function, they produce supra-physiological plasma levels of testosterone, so their long-term safety cannot be established. There is also insufficient data to support their use in improving cognitive performance and general well-being, treatment of cardiovascular disease or prevention of bone disease. CONCLUSIONS: Testosterone is only recommended for the tratment of HSDD via the transdermal route. We do not recommended the use of testosterone pellets for the treatment of sexual dysfunction or as an anti aging hormone, as there are no consistent studies on its safety, efficacy, and long-term adverse effects.
Assuntos
Humanos , Feminino , Testosterona/administração & dosagem , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Implantes de Medicamento , Androgênios/biossínteseRESUMO
AIMS: To evaluate the prevalence of hypoactive sexual desire disorder (HSDD) among postmenopausal women diagnosed with metabolic syndrome (MS) and to compare it to that of a control group without MS. METHODS: This is a cross-sectional study carried out in 2 public tertiary hospitals in the state of São Paulo, Brazil, with a sample of 291 postmenopausal women aged between 40 and 65 years. Sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria and was related to the diagnosis of MS, which was determined according to the guidelines defined by the Adult Treatment Panel. MAIN OUTCOME MEASURES: Analysis of sexual function with emphasis on sexual desire (HSDD), the incidence of MS, and the components of MS. RESULTS: The prevalence of HSDD was significantly higher among women diagnosed with MS than among women without MS (P = .01). Women diagnosed with high blood pressure (P < .01) and increased triglycerides (P = .03) also had a higher prevalence of HSDD than did women without these conditions. The FSFI domain scores for desire, arousal, lubrication, orgasm, and satisfaction and the total FSFI score were significantly lower for postmenopausal women with MS, whereas the pain domain score was not significantly different between the groups (P = .913). The incidence of female sexual dysfunction was significantly higher among women with MS, regardless of the diagnostic criteria used (P < .05). CONCLUSION: Postmenopausal women diagnosed with MS have higher rates of HSDD than do women without MS. CLINICAL TRIAL REGISTRATION: ID NCT02430987. Dutra da Silva GM, Rolim Rosa Lima SM, Reis BF, et al. Prevalence of Hypoactive Sexual Desire Disorder Among Sexually Active Postmenopausal Women With Metabolic Syndrome at a Public Hospital Clinic in Brazil: A Cross-sectional Study. J Sex Med 2020;8:545-553.
RESUMO
Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)
There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)
Assuntos
Humanos , Feminino , Idoso , Testosterona/uso terapêutico , Pós-Menopausa/efeitos dos fármacos , Depressores do Apetite/efeitos adversos , Fenitoína/efeitos adversos , Placebos/administração & dosagem , Psicotrópicos/efeitos adversos , Tamoxifeno/efeitos adversos , Testosterona/administração & dosagem , Testosterona/análise , Testosterona/efeitos adversos , Testosterona/farmacologia , Fármacos Cardiovasculares/efeitos adversos , Indometacina/efeitos adversos , Hormônio Liberador de Gonadotropina/efeitos adversos , Pós-Menopausa/fisiologia , Ensaios Clínicos Controlados como Assunto , Antagonistas Colinérgicos/efeitos adversos , Anticoncepcionais Orais/efeitos adversos , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/terapia , Danazol/efeitos adversos , Consenso , Inibidores da Aromatase/efeitos adversos , Uso Off-Label , Inibidores do Fator Xa/efeitos adversos , Anfetaminas/efeitos adversos , Antagonistas dos Receptores Histamínicos/efeitos adversos , Antagonistas de Androgênios/efeitos adversos , Androgênios/fisiologia , Cetoconazol/efeitos adversos , Entorpecentes/efeitos adversosRESUMO
Although hypoactive sexual desire disorder (HSDD) is the most common sexual complaint, there is no consensus for the ideal treatment. Our study aimed to evaluate the efficacy of treating premenopausal women with HSDD with Tribulus terrestris and its effect on the serum levels of testosterone. We performed a prospective, randomized, double-blind, placebo-controlled trial, with 40 premenopausal women reporting diminished libido, receiving T. terrestris or placebo. The questionnaires FSFI and the QS-F were used to evaluate sexual dysfunction before and after treatment. Patients treated with T. terrestris experienced improvement in total score of FSFI (p < .001) and domains "desire" (p < .001), "sexual arousal" (p = .005), "lubrication" (p = .001), "orgasm" (p <.001), "pain" (p = .030) and "satisfaction" (p = .001). Treatment with placebo did not improve the scores for the "lubrication" and "pain". QS-F scores showed that patients using T. terrestris had improvements in "desire" (p = .012), "sexual arousal/lubrication" (p = .002), "pain" (p = .031), "orgasm" (p = .004) and "satisfaction" (p = .001). Women treated with placebo did not score improvements. Women receiving T. terrestris had increased levels of free (p = .046) and bioavailable (p < .048) testosterone. T. terrestris might be a safe alternative for the treatment of premenopausal women with HSDD as it was effective in reducing the symptoms, probably due to an increase in the serum levels of free and bioavailable testosterone.
Assuntos
Libido/efeitos dos fármacos , Extratos Vegetais/uso terapêutico , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Tribulus , Adulto , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Extratos Vegetais/administração & dosagem , Pré-Menopausa , Comportamento Sexual/efeitos dos fármacos , Disfunções Sexuais Psicogênicas/sangue , Testosterona/sangue , Resultado do TratamentoRESUMO
Objetivo: medir la prevalencia del desorden de deseo sexual hipoactivo (DDSH) en una muestra de mujeres sexualmente activas con edades entre 15 y 59 años en Colombia, y explorar posibles factores asociados. Materiales y métodos: estudio de corte transversal. Se incluyeron mujeres colombianas entre 15 y 59 años, con vida sexualmente activa. Estas mujeres no son una muestra clínica sino de grupos de mujeres entrevistados de la población general. Criterios de exclusión: analfabetismo y enfermedad sistémica. El tamaño muestral mínimo estimado fue de 369 mujeres, para una prevalencia de 35 por ciento con un error máximo de 5 por ciento y con 95 por ciento de confianza. Muestreo por conveniencia. El cuestionario Female Sexual Function Index (FSFI), validado previamente al español, fue administrado a 567 mujeres sexual-mente activas en varios grupos focales. Se usó un valor de corte de 5 en la escala del deseo para definir DDSH. Se evaluaron además edad, nivel educativo, nivel socioecónomico, estado marital, cohabitación, sentimientos de depresión, uso de drogas antidepresivas, ciclo menstrual, número de hijos y método anticonceptivo. Se calculó la frecuencia relativa en las variables. Para evaluar la asociación entre las variables y la presencia del desorden de deseo sexual hipoactivo se utilizó la razón de Odds (OR) y su respectivo intervalo de confianza. Resultados: en el grupo de estudio 101 de 497 mujeres tuvieron un puntaje menor de 5 para una prevalencia de desorden de deseo sexual hipoactivo de 20,3 por ciento. Las variables asociadas fueron: bajo nivel educativo (OR = 2,77; IC 95 por ciento: 1,1-6,5), número de hijos (OR = 3; IC 95 por ciento: 1,8-5,1), edad mayor de 50 (OR = 3,19; IC 95 por ciento: 1-9,4), falta de cercanía emocional con la pareja (OR = 5; IC 95 por ciento: 3-8,3), sentimientos de depresión (OR = 1,9; IC 95 por ciento: 1,2-2,9) y el uso de antidepresivos (OR = 5; IC 95 por ciento: 3-8,3). Conclusiones: un importante porcentaje de la población en Colombia presenta puntajes bajos en el FSFI, sugestivos de desorden de deseo sexual hipoactivo
Objective: Measuring the prevalence of hypoactive sexual desire disorder (HSDD) in a sample of sexually-active Colombian females aged 15 to 59 years old and exploring possible associated factors. Materials and methods: This was a crosssectional study. Colombian females aged 15 to 59 years old having an active sex-life. Exclusion criteria were being illiterate and suffering systemic disease. Minimum estimated sample size was 369 females, using 35 percent prevalence, 5 percent maximum error and 95 percent confidence level. Convenience sampling was used. The Female Sexual Function Index (FSFI) questionnaire, previously validated in Spanish, was administered to 567 sexually active females in several focal groups. A cut-off value of 5 on the scale of desire was used for defining HSDD. Age, educational level, socio-economic status, marital state, cohabitation, feelings of depression, antidepressant medication use, menstrual cycle, number of children and contraceptive method were also evaluated. The variables relative frequency was calculated. The odds ratio (OR) and their confidence intervals (95 percent) was used for evaluating the association between variables and the presence of HSDD. Results: 101 of the 497 females in the study group scored less than 5, giving 20.3 percent HSDD prevalence. The associated variables were: low educational level (OR = 2.77; 1.1-6.5 95 percent CI), number of children (OR = 3; 1.8-5.1 95 percent CI), being aged over 50 (OR = 3.19; 1-9.4 95 percent CI), a lack of emotional closeness to the partner (OR = 5; 3-8.3 95 percent CI), feelings of depression (OR = 1.9; 1.2-2.9 95 percent CI) and antidepressant medication use (OR = 5; 3-8.3 95 percent CI). Conclusions: An important percentage of the Colombian population in question had low scores on the FSFI, suggestive of hypoactive sexual desire disorder
Assuntos
Adulto , Feminino , Depressão , SexualidadeRESUMO
At the Department of Psychology of the Instituto Nacional de Perinatología 'Isidro Espinosa de los Reyes' (INPERIER), a hospital specialized in reproductive problems, we have detected a high proportion of couples with sexual problems. Therefore we decided to develope a line of research on human sexuality. Ever since, several exploratory studies have taken place with the aim of assessing the prevalence and the frequency of sexual dysfunction in both women and men attending the INPERIER. Our studies showed that 52% of women had one or more sexual dysfunctions and 38.8% of men had one or more sexual dysfunctions. Objective The main purpose of the study was to identify (in women and men) the relationship and the combination between hypoactive sexual desire disorder and some intervening variables catalogued as personality factors: gender role, self-esteem and locus of control. We also analysed sexual backgrounds by indentifying: child sexual traumatic experience, sexual information available, sex fears, masturbation and couple problems; in order to propose a profile of the relationship between psychological factors and hypoactive sexual desire in women and men. Material and methods A non-experimental, retrospective, transversal, field study with a correlation-multivariate design was used, which consisted of two independent samples divided into four groups selected through intentional sampling by quotas. This study is part of a larger research study aimed to assess risk factors for feminine and masculine sexual dysfunctions, whose original sample size was 400 participants. Out of this sample only participants with hypoactive sexual desire were selected, so in the end the groups included 58 women and 55 men. However, they were compared with the same number of participants with no sexual dysfunction. The groups were organized as follows: Group 1, women or men with no sexual dysfunction; Group 2, women or men who presented hypoactive sexual desire disorder. The participants included in the study were INPERIER regular patients. Samples were handled individually. In order to have an accurate sample all participants had to cover the selection criteria. Additionally, in order to place participants in the right group we used the Codified Clinical History Form on Female Sexuality (CCHFFS) for women -which also was used to examine their sexual background information- and in the case of men, we used the Male Sexuality Questionnaire. Furthermore the measurement of personality items was done by using the Inventory of Masculinity and Femininity IMAFE, the Coppersmith Self-Esteem Inventory and the Internal-External Locus of Control Scales. Sexuality questionnaires as well as other measurement instruments were applied at the External Clinic area during a single session followed by the transcription of data. In order to analyse the results we applied measures of central tendency to describe the socio-demographic factors (such as: age, civil status and education); for the analysis of personality factors (role of gender, self-esteem and locus of control) and its relationship with hypoactive sexual desire disorder we used the Student's T-test and estimated the Eta coefficient. The analysis of sexual background (child sexual traumatic experience, sexual information, sex fears, masturbation and couple problems) and its relationship with hypoactive sexual desire disorder was calculated by χ² and Cramer's V. Data analysis was performed with the statistical and data management package SPSS version 11. Results The thrown results showed that the descriptive analysis of data from women and men had a normal distribution. Also, results indicate that women with a hypoactive sexual desire disorder present a decrease in masculinity features and in their self-esteem level, and an increase in the submissive features when compared to women with no sexual dysfunction. When we analyzed the results of the sexual background in this group, we found a relationship between hypoactive sexual desire and child sexual traumatic experience, and between sex fears and couple problems, suggesting that these variables significantly intervene in the presence of hypoactive sexual desire disorder during women's adult life. In the discriminant analysis we obtained just one factor out of the six previously isolated variables with 75% of the cases correctly classified, indicating that this proportion of women with hypoactive sexual desire disorder are related to such indicators, the variables discriminated were an approximate explanation for the disorder. The results in the other group showed that in men with hypoactive sexual desire disorder there is a decrease in masculinity and femininity features and in the levels of self-esteem, plus an increase in the submissive features when compared to men with no sexual dysfunction. When we analyzed sexual background information, we found in the group with hypoactive sexual desire disorder that sex fears and couple problems significantly intervene in men's adult life. The discriminant analysis revealed a single factor with the six variables previously isolated, with 68.6% of cases correctly classified, which shows that men with hypoactive sexual desire disorder also have a relationship with the indicators, being the discriminated variables an approximate explanation. Conclusions When we discussed the results, we observed differences in two ways. First, for both women and men there was a decrease in masculinity features, defined as conducts directed to action, with well-defined, self-affirmed and self-reflective targets. Also there was a decrease in self-esteem, defined as the personal value judgment expressed as the individual's attitudes towards himself and the subjective experience transmitted to others; when masculinity features and self-esteem are diminished they may have an impact on sexuality, becoming a risk factor. In the group of men we also observed a decrease in the femininity features, defined as the traits aimed at feelings and abstraction, the expression of affection, the desire to provide protection as well as to experience nature feelings. When these three factors predominate they turn out to be a protective factor for an adequate practice of sexuality; both masculinity and femininity features could appear together or independently. In a second way, both in women and men we observed an increase in the submissive behavior, a risk indicator for the development of sexuality, because of the presence of self-denial, dependency, conformism, shyness and the capacity to endure suffering, features all shown as particular conducts. When it comes to sexual background in women, we found a close relationship with child sexual traumatic experience, sex fears and couple problems. In the case of men, the hypoactive sexual desire disorder was related to sex fears and couple problems. In this respect, in the review made by Basson, she mentions a new body of evidence that confirms what we have found in this study. She indicates that there are psychological factors that inhibit sexuality in women, for example, a history of child sexual traumatic experience may have a major impact in their sexual development, particularly in desire.
En el Departamento de Psicología del Instituto Nacional de Perinatología <