Medical Treatment of Female Sexual Dysfunction

Nappi, Rossella E.; Tiranini, Lara; Martini, Ellis; Bosoni, David; Righi, Alessandra; Cucinella, Laura

doi:10.1016/j.ucl.2022.02.001

Cited by 21 publications

(10 citation statements)

References 68 publications

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“…Currently, there are no recommended treatments for sexual dysfunction in national guidelines, and international guidelines lack specific recommendations for addressing sexual dysfunction in women with PD, despite its negative impact on their quality of life [ 36 ]. However, treatments such as menopause hormone therapy, local estrogen therapy, and vaginal dehydroepiandrosterone are available for women with sexual dysfunctions [ 37 ]. Studies on their effectiveness in women with PD are necessary to update the guidelines and provide recommendations for both sexes.…”

Section: Discussionmentioning

confidence: 99%

Non-Motor Symptom Management: Insights into Adherence to Treatment Guidelines in Parkinson’s Disease Patients

Janz,

Timpka,

Rosqvist

et al. 2024

JPD

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Background: Non-motor symptoms (NMS) reduce quality of life in Parkinson’s disease (PD) patients, who experience three times more NMS than individuals without PD. While there are international and national NMS treatment guidelines, their implication in clinical practice remains unclear. Objective: This study aimed to investigate the adherence to pharmacological NMS treatment guidelines in patients with mild to moderately severe PD. Methods: 220 PD patients with ≥1 NMS based on the Non-Motor Symptom Questionnaire and a Hoehn and Yahr stage ≤4 were randomly selected from the Swedish Parkinson registry and screened for inclusion. NMS were evaluated using the International Parkinson and Movement Disorder Society–Non-Motor Rating Scale (MDS-NMS), Parkinson’s Disease Sleep Scale 2, Epworth Sleepiness Scale, and Hospital Anxiety and Depression Scale. Treatment was compared with Swedish national guidelines and international guidelines from the MDS Evidence-Based Medicine Committee. Results: Among 165 included patients, the median number of NMS was 14, and in median 7 symptoms were estimated to require treatment. The most common NMS requiring treatment were pain (69%) and urinary problems (56%). Treatment of depression and constipation demonstrated the highest adherence to guidelines (79% and 77%), while dysphagia and excessive daytime sleepiness exhibited the lowest adherence (0% and 4%). On average, only 32% of NMS were treated in accordance with guidelines. Conclusions: Adherence to pharmacological guidelines for NMS in patients with mild to severe PD was low. This study highlights the need for improved evaluation and treatment of NMS to enhance symptom management and quality of life among PD patients.

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Section: Discussionmentioning

confidence: 99%

Non-Motor Symptom Management: Insights into Adherence to Treatment Guidelines in Parkinson’s Disease Patients

Janz,

Timpka,

Rosqvist

et al. 2024

JPD

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“… 28 In addition, vaginal estrogen therapy plays a critical role in the management of pelvic floor dysfunction and sexual health. 29 , 30 Although the data are limited, a small US-based study suggests that hysterectomy adversely affects pelvic floor function, irrespective of menopausal status. 31 While hysterectomy alone has not been shown to worsen sexual function, rr-BSO independently and when combined with hysterectomy adversely affects sexual health because of the induced hypoestrogenic state.…”

Section: Limitations Of the Current Literature Informing Rr-hysterect...mentioning

confidence: 99%

Endometrial Cancer Risk Among Germline BRCA1/2 Pathogenic Variant Carriers: Review of Our Current Understanding and Next Steps

Sorouri,

Lynce,

Feltmate

et al. 2023

JCO Precis Oncol

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PURPOSE To review the literature exploring endometrial cancer (EC) risk among surgical candidates with germline BRCA1/2 pathogenic variants (PVs) to guide decisions around risk-reducing (rr) hysterectomy in this population. DESIGN A comprehensive review was conducted of the current literature that influences clinical practice and informs expert consensus. We present our understanding of EC risk among BRCA1/2 PV carriers, the risk-modifying factors specific to this patient population, and the available research technology that may guide clinical practice in the future. Limitations of the existing literature are outlined. RESULTS Patients with BRCA1/2 PVs, those with a personal history of tamoxifen use, those who desire long-term hormone replacement therapy, and/or have an elevated BMI are at higher risk of EC, primarily endometrioid EC and/or uterine papillary serous carcinoma, and may benefit from rr-hysterectomy. Although prescriptive clinical guidelines specific to BRCA1/2 PV carriers could inform decisions around rr-hysterectomy, limitations of the current literature prevent more definitive guidance at this time. A large population-based study of a contemporary cohort of BRCA1/2 PV carriers with lifetime follow-up compared with cancer-gene negative controls would advance this topic and facilitate care decisions. CONCLUSION This review validates a potential role for rr-hysterectomy to address EC risk among surgical candidates with BRCA1/2 PVs. Evidence-based clinical guidelines for rr-hysterectomy in BRCA1/2 PV carriers are essential to ensure equitable access to this preventive measure, supporting insurance coverage for patients with either BRCA1 or BRCA2 PVs to pursue rr-hysterectomy. Overall, this review highlights the complexity of EC risk in BRCA1/2 PV carriers and offers a comprehensive framework to shared decision making to inform rr-hysterectomy for BRCA1/2 PV carriers.

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“…Because the literature on pharmacologic therapies continues to differentiate between HSDD and FSAD, they will continue to be referred to separately in this review. Development to date has been primarily aimed at the centrally acting excitatory (dopamine, noradrenaline, melanocortin) and inhibitory (serotonin, endocannabinoid, opioid) receptors to augment the sexual desire response [35]. Although our understanding of the neurochemical basis for HSDD is poor, the prevailing hypothesis is that an interplay between the serotoninergic system and other neurochemical pathways leads to increased inhibition or decreased excitation, and pharmaceutical development has been aimed at these pathways [36].…”

Section: Hypoactive Sexual Desire Disorder and Female Sexual Arousal ...mentioning

confidence: 99%

Pharmacologic therapeutic options for sexual dysfunction

Burton¹,

Mishra

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewSexual problems are reported by up to 45% of individuals assigned female at birth. Although sexual function is a complex biopsychosocial construct, there are a number of pharmacologic treatment options aimed at addressing the changing vaginal hormonal milieu in postmenopausal individuals and moderating the excitatory and inhibitory aspects of the central nervous system in those with hypoactive sexual desire disorder.Recent findingsThe last decade has seen an increase in the number and type of pharmacologic treatment options for dysfunction primarily associated with menopause and hypoactive sexual desire disorder. Recent publications and systematic reviews have strengthened the safety data of existing FDA-approved medications as well as off-label therapies.SummaryPharmacologic treatment with local estrogen and testosterone replacement in postmenopausal individuals and with centrally-acting therapies such as flibanserin, bremelanotide, and testosterone in premenopausal individuals assigned female at birth are safe and can be used to improve sexual desire and sexual satisfaction.

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Medical Treatment of Female Sexual Dysfunction

Cited by 21 publications

References 68 publications

Non-Motor Symptom Management: Insights into Adherence to Treatment Guidelines in Parkinson’s Disease Patients

Non-Motor Symptom Management: Insights into Adherence to Treatment Guidelines in Parkinson’s Disease Patients

Endometrial Cancer Risk Among Germline BRCA1/2 Pathogenic Variant Carriers: Review of Our Current Understanding and Next Steps

Pharmacologic therapeutic options for sexual dysfunction

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