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Definitions for female sexual dysfunctions that reflect current science provide useful nomenclature for current and future management of women with sexual disorders and development of new therapies.

Background:The Global Consensus Position Statement on the Use of Testosterone Therapy for Women (Global Position Statement) recommended testosterone therapy for postmenopausal women with hypoactive sexual desire disorder (HSDD). Aim: To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with HSDD. Methods: The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. Outcomes: A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. Results: Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed

Introduction The existence of female ejaculation and the female prostate is controversial; however, most scientists are not aware that historians of medicine and psychology described the phenomenon of female ejaculation approximately 2,000 years ago. Aim To review historical literature in which female ejaculation is described. Methods A comprehensive systematic literature review. Main Outcome Measure Emission of fluid at the acme of orgasm and/or sexual pleasure in females was considered as a description of female ejaculation and therefore all documents referring to this phenomenon are included. Results Physicians, anatomists, and psychologists in both eastern and western culture have described intellectual concepts of female ejaculation during orgasm. In ancient Asia female ejaculation was very well known and mentioned in several Chinese Taoist texts starting in the 4th century. The ancient Chinese concept of female ejaculation as independent of reproduction was supported by ancient Indian writings. First mentioned in a 7th century poem, female ejaculation and the Gräfenberg spot (G-spot) are described in detail in most works of the Kāmaśāstra. In ancient Western writings the emission of female fluid is mentioned even earlier, depicted about 300 B.C. by Aristotle and in the 2nd century by Galen. Reinjier De Graaf in the 16th century provided the first scientific description of female ejaculation and was the first to refer to the periurethral glands as the female prostate. This concept was held by other scientists during the following centuries through 1952 A.D. when Ernst Gräfenberg reported on “The role of the urethra in female orgasm. Current research provides insight into the anatomy of the female prostate and describes female ejaculation as one of its functions. Conclusions Credible evidence exists among different cultures that the female prostate and female ejaculation have been discovered, described and then forgotten over the last 2,000 years.

Aim: To provide a clinical practice guideline for the use of testosterone including identification of patients, laboratory testing, dosing, post-treatment monitoring, and follow-up care in women with hypoactive sexual desire disorder (HSDD). Methods: The International Society for the Study of Women's Sexual Health appointed a multidisciplinary panel of experts who performed a literature review of original research, meta-analyses, review papers, and consensus guidelines regarding testosterone use in women. Consensus was reached using a modified Delphi method. Outcomes: A clinically useful guideline following a biopsychosocial assessment and treatment approach for the safe and efficacious use of testosterone in women with HSDD was developed including measurement, indications, formulations, prescribing, dosing, monitoring, and follow-up. Results: Although the Global Position Statement endorses testosterone therapy for only postmenopausal women, limited data also support the use in late reproductive age premenopausal women, consistent with the International Society for the Study of Women's Sexual Health Process of Care for the Management of HSDD. Systemic transdermal testosterone is recommended for women with HSDD not primarily related to modifiable factors or comorbidities such as relationship or mental health problems. Current available research supports a moderate therapeutic benefit. Safety data show no serious adverse events with physiologic testosterone use, but long-term safety has not been established. Before initiation of therapy, clinicians should provide an informed consent. Shared decision-making involves a comprehensive discussion of off-label use, as well as benefits and risks. A total testosterone level should not be used to diagnose HSDD, but as a baseline for monitoring. Government-approved transdermal male formulations can be used cautiously with dosing appropriate for women. Patients should be assessed for signs of androgen excess and total testosterone levels monitored to maintain concentrations in the physiologic premenopausal range. Compounded products cannot be recommended because of the lack of efficacy and safety data. Clinical implications: This clinical practice guideline provides standards for safely prescribing testosterone to women with HSDD, including identification of appropriate patients, dosing, and monitoring. Strengths and limitations: This evidence-based guideline builds on a recently published comprehensive meta-analysis and the Global Position Statement endorsed by numerous societies. The limitation is that testosterone therapy is not approved for women by most regulatory agencies, thereby making prescribing and proper dosing challenging.