[Show abstract][Hide abstract] ABSTRACT: IntroductionThe Food and Drug Administration defines an aphrodisiac drug product as “any product that bears labeling claims that it will arouse or increase sexual desire, or that it will improve sexual performance.” Presently, there are no approved medications for the treatment of lowered desire for women, and many opt for “natural” products.AimThe aim of this article was to review the most popular and currently used aphrodisiac products marketed in the United States. The safety and efficacy of animal- and plant-based aphrodisiacs, vitamins and minerals, and popular over-the-counter combination supplements have been reviewed.Methods
An English PubMed literature search was performed using the key words “sexuality,” “sex,” “aphrodisiac,” and “sexual enhancer.” Approximately 50 articles were reviewed by the authors. The authors used relevant case series, case-controlled, and randomized clinical trial data.Main Outcome MeasuresProducts were evaluated based on the quality of research, and their known efficacy and safety considerations. Products with low risk and potential benefit for sexual response based on prior research studies were highlighted.ResultsResearch has demonstrated that the risks of yohimbine, Spanish fly, mad honey, and Bufo toad may outweigh any benefit, and these products should be avoided. Other products, such as Maca, Tribulus, Ginkgo, and ginseng, have limited but emerging data. Randomized clinical trial data are often lacking, but future research should be performed to further elucidate the efficacy and safety of these products.Conclusion
Future randomized clinical trials are warranted before health care practitioners can recommend most aphrodisiac products. There remain some medical concerns with drug interactions, purity, reliability, and safety. West E and Krychman M. Natural aphrodisiacs—A review of selected sexual enhancers. Sex Med Rev **;**:**–**.
[Show abstract][Hide abstract] ABSTRACT: IntroductionSexual health is an integral part of the multifaceted human experience that is driven both by biological factors and psychological facets. Religion may provide a moral code of conduct or a sexual compass as to sexual norms and behaviors.AimThe aim of this study was to summarize the integration of sexuality and religion.MethodA review of published literature and religious texts was conducted.ResultsThe integration of religion with country or state politics and laws is a complicated dilemma and will not be discussed in the scope of this article. The extent to which an individual incorporates their religious doctrine into their sexual life is a personal and individualized choice. The sexual medicine health professional will likely encounter a diverse patient population of distinct religious backgrounds, and a primer on religion and sexuality is a much needed adjunctive tool for the clinician.Conclusion
Because religion can influence sexuality and dictate, in part, the behavioral and medical treatments for sexual complaints, the clinician should be familiar with religious guidelines regarding sexuality, and treatment should be customized and individualized. Failure to do so can impact compliance with the therapeutic interventions. Religious awareness also solidifies the therapeutic alliance between clinician and patient as it demonstrates respect and acknowledgment for patient's beliefs and autonomy. Kellogg Spadt S, Rosenbaum TY, Dweck A, Millheiser L, Pillai-Friedman S, and Krychman M. Sexual health and religion: A primer for the sexual health clinician. J Sex Med 2014;11:1606–1619.
Full-text · Article · Jul 2014 · Journal of Sexual Medicine
[Show abstract][Hide abstract] ABSTRACT: Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA.
[Show abstract][Hide abstract] ABSTRACT: Bremelanotide is a novel heptapeptide melanocortin receptor-4 agonist. This study examined its subcutaneous self-administration by premenopausal patients with hypoactive sexual desire disorder, female sexual arousal disorder, or both and included exploratory analyses specifically in patients with hypoactive sexual desire disorder.
Premenopausal women with hypoactive sexual desire disorder, female sexual arousal disorder, or both underwent a no-treatment diagnosis-confirmation month followed by 4 weeks of single-blind, at-home placebo self-dosing (baseline). Patients were then randomized to double-blind placebo or bremelanotide at 0.75, 1.25, or 1.75 mg self-administered for 12 weeks. Outcomes included changes from baseline to end of study in the number of satisfying sexual events, Female Sexual Function Index scores, and Female Sexual Distress Scale-Desire/Arousal/Orgasm scores.
Of 327 at-home study-drug users, 281 either had mixed hypoactive sexual desire disorder and female sexual arousal disorder with a primary diagnosis of hypoactive sexual desire disorder (n=206) or had solely hypoactive sexual desire disorder (n=75). Among all 281 women, mean satisfying sexual events change (per 4 weeks) was +0.2 for placebo compared with +0.8 for 0.75 mg, +0.7 for 1.25 mg, and +0.7 for 1.75 mg. Mean Female Sexual Function Index change was +1.55 compared with +1.45, +3.11, and +4.24 for total score and +0.37 compared with +0.33, +0.58, and +0.97 respectively for desire subscore. Mean Female Sexual Distress Scale-Desire/Arousal/Orgasm change was -6.6 compared with -8.0, -9.6, and -12.7 for total score and -0.6 compared with -0.5, -0.7, and -1.0 for question 13 ("bothered by low desire"). On all outcomes, bremelanotide benefit was statistically significant (P<.05, Van Elteren test) at 1.75 mg.
In premenopausal hypoactive sexual desire disorder, subcutaneous bremelanotide yielded improvements across all key hypoactive sexual desire disorder measures with robust dose-dependence attaining statistical significance at 1.75 mg.
No preview · Article · May 2014 · Obstetrics and Gynecology
[Show abstract][Hide abstract] ABSTRACT: Bremelanotide is a novel heptapeptide melanocortin receptor-4 agonist. This study examined its subcutaneous self-administration on an at-home, as-needed basis by premenopausal patients with female sexual dysfunctions. Efficacy measures included the 15-item, Female Sexual Distress Scale-Desire/Arousal/Orgasm questionnaire.
Premenopausal women with hypoactive sexual desire disorder, female sexual arousal disorder, or both received an in-clinic placebo dose followed by 1-week monitoring and then 4 weeks of at-home placebo self-dosing (baseline period). Participants then were randomized to placebo or bremelanotide at 0.75, 1.25, or 1.75 mg, self-administered twice in-clinic and then for 12 weeks at home. Female Sexual Distress Scale-Desire/Arousal/Organism score changes from baseline to end of study were analyzed by the Van Elteren test.
Among 327 at-home study-drug users, mean (standard deviation) baseline Female Sexual Distress Scale-Desire/Arousal/Orgasm total score was 30.5-33.3, depending on treatment group. On Female Sexual Distress Scale-Desire/Arousal/Orgasm item 13 ("feeling bothered by low sexual desire"), mean baseline scores were 2.4-2.7. Mean (standard deviation) changes in total score were -6.8 (13.57) for placebo compared with -7.4 (13.47) for 0.75 mg, -9.2 (10.79) for 1.25 mg, -13.1 (12.93) for 1.75 mg, and -11.1 (12.02) for 1.25 and 1.75 mg pooled. Bremelanotide benefit was statistically significant (P<.05) at 1.75 mg and for 1.25 and 1.75 mg pooled. On item 13, mean changes were -0.6 (1.25) compared with 0.5 (1.07), -0.7 (1.03), -1.1 (1.16), and -0.9 (1.11) with statistical significance for 1.75 mg individually and 1.75 and 1.25 mg pooled.
In premenopausal women with female sexual dysfunctions, subcutaneous bremelanotide reduced sexually related distress, including distress regarding feeling bothered by low sexual desire, with statistical significance at 1.75 mg.
No preview · Article · May 2014 · Obstetrics and Gynecology
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Vaginal childbirth may result in vaginal introital laxity, altered genital sensation during sexual intercourse, and reduced sexual satisfaction. We report the long-term effectiveness of a single nonsurgical procedure with radiofrequency (RF) energy for laxity at the vaginal introitus.
Materials and methods:
Prospective single-arm study of 30 premenopausal women (21-52 year) with one 30-minute office procedure using RF applied to the vaginal introitus; 12-month outcome assessments included the linguistic validated Japanese versions of the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) and the Vaginal Laxity and Sexual Satisfaction Questionnaires.
Sexual function improved significantly throughout 6 months (30 subjects); mean FSFI total score was 22.4±6.7 before treatment and then improved to mean 26.0±5.8 at month 6 (P=0.002), inclusive of improved scores in five of six FSFI domains except desire (P<0.001 -<0.01). In the 22 of 30 subjects remaining evaluable at 12 months, the mean was 26.0±5.2 (P=0.08). Distress related to sexual activity decreased significantly; baseline FSDS-R mean score of 15.8±11.7 improved to 9.8±8.0 at one month and was sustained throughout 12 months (P<0.001 - 0.002). Subjects reported decreased vaginal laxity within the first month after the procedure (P<0.001); responses peaked, and effectiveness was sustained through 12 months (P<0.001).
A single nonsurgical office-based RF procedure for vaginal introital laxity achieved significant and sustainable 12-month effectiveness with respect to improved integrity at the vaginal introitus and improved sexual satisfaction. Treatment was well-tolerated with no adverse events.
No preview · Article · Aug 2013 · Journal of Women's Health
[Show abstract][Hide abstract] ABSTRACT: Several recent, large-scale studies have provided valuable insights into patient perspectives on postmenopausal vulvovaginal health. Symptoms of vulvovaginal atrophy, which include dryness, irritation, itching, dysuria, and dyspareunia, can adversely affect interpersonal relationships, quality of life, and sexual function. While approximately half of postmenopausal women report these symptoms, far fewer seek treatment, often because they are uninformed about hypoestrogenic postmenopausal vulvovaginal changes and the availability of safe, effective, and well-tolerated treatments, particularly local vaginal estrogen therapy. Because women hesitate to seek help for symptoms, a proactive approach to conversations about vulvovaginal discomfort would improve diagnosis and treatment.
Full-text · Article · Jul 2013 · International Journal of Women's Health
[Show abstract][Hide abstract] ABSTRACT: Vulvar and vaginal atrophy (VVA) is a chronic medical condition experienced by many postmenopausal women. Symptoms include dyspareunia (pain with intercourse), vaginal dryness, and irritation and may affect sexual activities, relationships, and activities of daily life.
The aim of this study is to characterize postmenopausal women's experience with and perception of VVA symptoms, interactions with healthcare professionals (HCPs), and available treatment options.
An online survey was conducted in the United States in women from KnowledgePanel®, a 56,000-member probability-selected Internet panel projectable to the overall US population. Altogether, 3,046 postmenopausal women with VVA symptoms (the largest US cohort of recent surveys) responded to questions about their knowledge of VVA, impact of symptoms on their activities, communication with HCPs, and use of available treatments.
Percent is calculated as the ratio of response over total responding for each question for all and stratified participants.
The most common VVA symptoms were dryness (55% of participants), dyspareunia (44%), and irritation (37%). VVA symptoms affected enjoyment of sex in 59% of participants. Additionally, interference with sleep, general enjoyment of life, and temperament were reported by 24%, 23%, and 23% of participants, respectively. Few women attributed symptoms to menopause (24%) or hormonal changes (12%). Of all participants, 56% had ever discussed VVA symptoms with an HCP and 40% currently used VVA-specific topical treatments (vaginal over-the-counter [OTC] products [29%] and vaginal prescription therapies [11%]). Of those who had discussed symptoms with an HCP, 62% used OTC products. Insufficient symptom relief and inconvenience were cited as major limitations of OTC products and concerns about side effects and cancer risk limited use of topical vaginal prescription therapies.
VVA symptoms are common in postmenopausal women. Significant barriers to treatment include lack of knowledge about VVA, reluctance to discuss symptoms with HCPs, safety concerns, inconvenience, and inadequate symptom relief from available treatments. Kingsberg SA, Wysocki S, Magnus L, and Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: Findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med 2013;10:1790–1799.
No preview · Article · May 2013 · Journal of Sexual Medicine
[Show abstract][Hide abstract] ABSTRACT: Vaginal atrophy results from a decrease in circulating estrogen and is experienced by approximately 50% of postmenopausal women. Its symptoms affect multiple dimensions of genitopelvic health, sexuality, and overall quality of life. Nonhormonal over-the-counter treatments may provide temporary symptom relief, but the condition is progressive, and hormonal treatment may be warranted.
The study aims to review the literature and discuss the impact of atrophic vaginitis and various treatment options, including the resistance and barriers to the use of local estrogen therapy for atrophic vaginitis. This article also aims to provide a greater awareness of the condition and the difficulties in communicating effectively with patients, and to provide strategies to help healthcare professionals acquire effective communication skills to initiate a candid dialogue with patients who may be suffering in silence and may benefit from therapy.
This review was based on peer-reviewed publications on the topic of atrophic vaginitis and local estrogen therapy identified from key word searches of PubMed, in addition to landmark studies/surveys and treatment guidelines/recommendations on menopause available in the literature and on the Internet.
The main outcomes are the impact of atrophic vaginitis and the various treatment options, including the resistance and barriers to the use of local estrogen therapy.
Minimally absorbed local vaginal estrogen therapy enables administration of estrogen doses much lower than systemic doses used for vasomotor symptoms. Local therapy is also the first-line pharmacologic treatment recommended by the North American Menopause and International Menopause Societies. Despite treatment options, the sensitive nature of the condition and embarrassment may prohibit or limit many women from openly discussing symptoms with healthcare professionals. Many are hesitant to initiate hormonal treatment because of safety concerns.
Healthcare professionals should initiate and encourage frank and candid conversation about vaginal atrophy at annual visits and provide follow-up and treatment as needed.
No preview · Article · Mar 2013 · Journal of Sexual Medicine
[Show abstract][Hide abstract] ABSTRACT: Introduction. Sexual health issues for women who have cancer are an important and under-diagnosed and under-treated survivorship issue. Survivorship begins at the time a cancer is detected and addresses health-care issues beyond diagnosis and acute treatment. This includes improving access to care and quality-of-life considerations, as well as dealing with the late effects of treatment. Difficulties with sexual function are one of the more common late effects in women. Aim. This article attempted to characterize the etiology, prevalence, and treatment for sexual health concerns for women with gynecological cancer. Methods. A systematic survey of currently available relevant literature published in English was conducted. Results. The issue of sexual health for women with cancer is a prevalent medical concern that is rarely addressed in clinical practice. The development of sexual morbidity in the female cancer survivor is a multifactorial problem incorporating psychological, physiologic, and sociological elements. Treatments such as chemotherapy, radiation therapy, surgery, and hormonal manipulation appear to have the greatest influence on the development of sexual consequences. Sexual complaints include but are not limited to changes in sexual desire, arousal, and orgasmic intensity and latency. Many women suffer from debilitating vaginal dryness and painful intercourse. Conclusions. Many of the sexual health issues experienced by cancer survivors can be addressed in clinical practice. A multimodal treatment paradigm is necessary to effectively treat these sexual complaints in this special patient population. Krychman M and Millheiser LS. Sexual health issues in women with cancer. J Sex Med 2013;10(suppl 1):5–15.
No preview · Article · Feb 2013 · Journal of Sexual Medicine
[Show abstract][Hide abstract] ABSTRACT: Introduction. Sexual health is the result of a complex interplay between social, relational, intrapsychic, and medical aspects. Sexual health care professionals (SHCP) may face several ethical issues. Some SHCP prescribe Internet pornography for both diagnosis and therapy and some others directly sell vibrators and sex aids in their offices.
Methods. Five scientists, with different perspectives, debate the ethical aspects in the clinical practice of the SHCP.
Main Outcome Measure. To give to the Journal of Sexual Medicine's reader enough data to form her/his own opinion on an important ethical topic.
Results. Expert #1, who is Controversy's Section Editor, together with two coworkers, expert psycho-sexologists, reviews data from literature regarding the use of the Internet in the SHCP. Expert #2 argues that licensed professionals, who treat sexual problems, should not sell sexual aids such as vibrators, lubricants, erotica, and instructional DVDs to their clients. On the other hand, Expert #3 is in favor of the possibility, for the patient, to directly purchase sexual aids from the SHCP in order to avoid embarrassment, confusion, and non-adherence to treatment.
Conclusion. Evidence and intelligence would suggest that both the Internet (in selected subjects) and the vibrators (in the correct clinical setting), with the due efforts in counseling the patients and tailoring their therapy, are not-harmful, excellent tools in promoting sexual health. Jannini EA, Limoncin E, Ciocca G, Buehler S, and Krychman M. Ethical aspects of sexual medicine. Internet, vibrators and other sex aids: Toys or therapeutic instruments? J Sex Med 2012;9:2994–3001.
Full-text · Article · Dec 2012 · Journal of Sexual Medicine
[Show abstract][Hide abstract] ABSTRACT: Cancer survivors face a myriad of long-term effects of their disease, diagnosis, and treatment, and chief among many are problems associated with sexual dysfunction. Yet despite their frequency and the degree of distress they cause patients, sexual dysfunction is not effectively screened for or treated, and this is particularly true in female survivors. Inconsistently performed general sexual health screening at all facets of cancer care and survivorship ultimately translates into missed attempts to identify and treat dysfunction when it does arise. In this paper, we will review the current research and clinical practices addressing sexual dysfunction in female cancer survivors and propose questions in need of future research attention. This article will review the phases of sexual response and how each may be affected by the physical and emotional stress of cancer diagnosis and treatment. We will then discuss existing tools for assessment of sexual function and approaches to their treatment. Finally, we will conclude with advice to health care professionals based on current research and suggest questions for future study.
No preview · Article · May 2012 · American journal of clinical oncology