Sexual dysfunction prevalence is high among women. However, doctors rarely ask about their patients' sexual life, because they feel uncomfortable or because their knowledge about investigation techniques is insufficient. The PLISSIT model, a useful tool to access human sexual function, is composed by four elements: permission, limited information, specific suggestions, and intensive therapy, that favor dialogue between the doctor and the patient allowing the access to the sexual complaints. The therapeutics consists of counseling measures, drug prescription, basic orientations about sexual function and interventions on anatomic and functional aspects of the sexual apparatus with positive impact in the woman's sexual life. The present review shows how to use it. In addition, many aspects of female sexual dysfunction are discussed, such as prevalence, diagnostic and treatment options for female sexual dysfunction.

There is a positive correlation between serum and peritoneal fluid values of CA-125 in women with and without endometriosis, and their levels are higher in peritoneal fluid. Advanced endometriosis is related to higher levels in both serum and peritoneal fluid.

In order to remedy the limitations due to the scarcity of strong evidence about this topic, future studies should try to clarify predictive value of markers in groups of specific diseases-related subfertility and pay special attention to propaedeutic multivariate models including anti-Müllerian hormone and antral follicle count.

Introduction Polycystic ovary syndrome (PCOS) appears to be related to sexual dysfunction, especially if associated with obesity. However, it is not clear whether obesity per se is an independent factor for sexual dysfunction. We hypothesized that obese polycystic ovary syndrome (OPCOS) patients have poorer sexual function than controls and nonobese polycystic ovary syndrome (NOPCOS) women. Aim To assess the sexual function of women (either obese or nonobese) with PCOS compared to women with regular cycles. Main Outcome Measures The main outcome measures were the Female Sexual Function Index (FSFI) and Free Androgen Index (FAI) values. Methods We used a cross-sectional study design to evaluate 83 women, including 19 nonobese women without PCOS, 24 nonobese women with PCOS, 16 obese women without PCOS, and 24 obese women with PCOS. The FSFI questionnaire was used to gather data from all women, and free testosterone levels were determined and employed to calculate FAI values. Results Higher androgen concentrations were evident in the PCOS groups compared to controls (NOC [nonobese control] 2.3 ± 0.7; OC [obese control] 2.1 ± 0.5; NOPCOS 3.1 ± 0.8; OPCOS 3.5 ± 1.2; P < 0.0001). This was also true for FAI, with the exception of obese controls and nonobese women with PCOS, in whom the levels were similar (NOC 4.9 ± 1.6; OC 6.5 ± 3.1; NOPCOS 7.5 ± 3.9; OPCOS 12.8 ± 5.2; P < 0.05). Evaluation of the total FSFI scores revealed that obese women without PCOS had below-normal sexual function scores, whereas both obese and nonobese women with PCOS had borderline scores compared to controls, who had normal FSFI findings. No association was observed between body mass index, the presence of PCOS, testosterone level, and FSFI score. Conclusions The obese women in our sample were at a higher risk for sexual dysfunction and lower FSFI scores, and women with PCOS had borderline FSFI values, regardless of their obesity status. Based on this result, larger studies using the methods described in this pilot study are warranted to elucidate if obesity can impair sexual function in PCOS women.

Purpose To detect expression of bone morphogenetic protein 15 (BMP15) and growth differentiation factor 9 (GDF9) in oocytes, and their receptor type 2 receptor for BMPs (BMPR2) in cumulus cells in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF), and determine if BMPR2, BMP15, and GDF9 expression correlate with hyperandrogenism in FF of PCOS patients. Methods Prospective case-control study. Eighteen MIIoocytes and their respective cumulus cells were obtained from 18 patients with PCOS, and 48 MII-oocytes and cumulus cells (CCs) from 35 controls, both subjected to controlled ovarian hyperstimulation (COH), and follicular fluid (FF) was collected from small (10-14 mm) and large (>18 mm) follicles. RNeasy Micro Kit (Qiagen ® ) was used for RNA extraction and gene expression was quantified in each oocyte individually and in microdissected cumulus cells from cumulus-oocyte complexes retrieved from preovulatory follicles using qRT-PCR. Chemiluminescence and RIA assays were used for hormone assays. Results BMP15 and GDF9 expression per oocyte was higher among women with PCOS than the control group. A positive correlation was found between BMPR2 transcripts and hyperandrogenism in FF of PCOS patients. Progesterone values in FF were lower in the PCOS group. Conclusion We inferred that BMP15 and GDF9 transcript levels increase in mature PCOS oocytes after COH, and might inhibit the progesterone secretion by follicular cells in PCOS follicles, preventing premature luteinization in cumulus cells. BMPR2 expression in PCOS cumulus cells might be regulated by androgens.

Introduction Physical exercise including pelvic floor muscle (PFM) training seems to improve the sexual function of women with urinary incontinence. This effect in postmenopausal women who are continent has not yet been determined. Aim The aim of this study was to assess the effect of a 3-month physical exercise protocol (PEP) on the sexual function and mood of postmenopausal women. Methods Thirty-two sedentary, continent, sexually active women who had undergone menopause no more than 5 years earlier and who had follicle stimulating hormone levels of at least 40 mIU/mL were enrolled into this longitudinal study. All women had the ability to contract their PFMs, as assessed by vaginal bimanual palpation. Muscle strength was graded according to the Oxford Modified Grading Scale (OMGS). A PEP was performed under the guidance of a physiotherapist (M.M.F.) twice weekly for 3 months and at home three times per week. All women completed the Sexual Quotient-Female Version (SQ-F) and the Hospital Anxiety and Depression Scale (HADS) before and after the PEP. Main Outcome Measures SQ-F to assess sexual function, HASDS to assess mood, and OMGS to grade pelvic floor muscle strength. Results Thirty-two women (24 married women, eight women in consensual unions) completed the PEP. Following the PEP, there was a significant increase in OMGS score (2.59 ± 1.24 vs. 3.40 ± 1.32, P < 0.0001) and a significant decrease in the number of women suffering from anxiety (P < 0.01), but there was no effect on sexual function. Conclusion Implementation of our PEP seemed to reduce anxiety and improve pelvic floor muscular strength in sedentary and continent postmenopausal women. However, our PEP did not improve sexual function. Uncontrolled variables, such as participation in a long-term relationship and menopause status, may have affected our results. We suggest that a randomized controlled trial be performed to confirm our results.

Infertile couples are at higher risk of sexual dysfunction than fertile couples. We also describe several recent patents.

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