Audrey Serafini

HPV Infection in Women: Psychosexual Impact of Genital Warts and Intraepithelial Lesions

INTRODUCTION Genital Human Papillomavirus (HPV) infection is the most commonly occurring sexually transmitted viral infection in humans. HPV is a wide family of DNA viruses, which may cause benign skin and mucosal tumors (genital, anal, or oral warts), intraepithelial neoplasias, and/or malignant cancers in different organs. Women are more susceptible to the oncogenic effect of HPVs, mostly at the genital site on the uterine cervix. AIMS This review analyzes the impact of: (i) genital warts (GWs) and their treatment; (ii) HPV-related genital, oral, and anal precancerous lesions on womens sexual function. METHODS A Medline search was carried out. Search terms were HPV, GWs, intraepithelial neoplasia, cervical cancer, anal cancer, oral cancer, epidemiology, HPV risk factors, sexual dysfunctions, desire disorders, arousal disorders, dyspareunia, vulvar vestibulitis, vulvodynia, orgasmic difficulties, sexual repertoire, couple sexual problems, depression, anxiety, pap smear, screening program, therapy, and vaccines. MAIN OUTCOME MEASURES Sexual consequences of HPV infection in women, specifically GWs and intraepithelial HPV-related neoplasia. RESULTS Psychosexual vulnerability increases with number of recurrences of HPV infections. Depression, anxiety, and anger are the emotions most frequently reported. However, to date, there is no conclusive evidence of a specific correlation between HPV infection and a specific female sexual disorder. The relationship between HPV and vulvar vestibulitis/vulvodynia-related dyspareunia seems not to be direct. Counseling problems, the role of anti-HPV vaccine, and the concept of the high-risk partner are discussed. The reader is offered a practical approach with clinically relevant recommendations that may prove useful in his/her daily practice when dealing with HPV-infected women and couples. CONCLUSION The evidence of psychosexual consequences of HPV-related GWs and intraepithelial lesions is limited. Specific research on the sexual impact of GWs and intraepithelial HPV-related lesion in women is urgently needed.

Depression and the menopause: why antidepressants are not enough?

Background Gender differences, related to varying sexual hormone levels and hormone secretion patterns across the lifespan, contribute to womens vulnerability to mood disorders and major depression. Women are more prone than men to depression, from puberty onwards, with a specific exposure across the menopausal transition. However, controversy still exists in considering fluctuation/loss of estrogen as a specific aetiologic factor contributing to depression in perimenopause and beyond. Aims To briefly review the interaction between changes in menopausal hormone levels, mood disorders, associated neuropsychological co-morbidities and ageing, and to evaluate the currently available therapeutic options for perimenopausal mood disorders: (a) treatment of light to moderate mood disorders with hormonal therapy (HT); (b) treatment of major depression with antidepressants; (c) the synergistic effect between HT and antidepressants in treating menopausal depression. Results Depression across the menopause has a multifactorial aetiology. Predictive factors include: previous depressive episodes such as premenstrual syndrome and/or postpartum depression; co-morbidity with major menopausal symptoms, especially hot flashes, nocturnal sweating, insomnia; menopause not treated with HT; major existential stress; elevated body mass index; low socioeconomic level and ethnicity. Postmenopausal depression is more severe, has a more insidious course, is more resistant to conventional antidepressants in comparison with premenopausal women and has better outcomes when antidepressants are combined with HT. Conclusion The current evidence contributes to a re-reading of the relationship between menopause and depression. The combination of the antidepressant with HT seems to offer the best therapeutic potential in terms of efficacy, rapidity of improvement and consistency of remission in the follow-up.

Aetiology, diagnostic algorithms and prognosis of female sexual dysfunction.

OBJECTIVE The aim of this paper is to describe the aetiology, diagnosis and prognosis of female sexual dysfunction (FSD), so as to increase the physicians competence in the management of women with these problems. METHOD A literature review of the most relevant publications was undertaken evaluating each sexual dysfunction. RESULTS The aetiology of FSD is multifactorial. The most important causes include biological, psychosexual and contextual factors. When assessing FSD, the clinical history should assess if: (a) the disorder is generalized or situational; (b) the disorder is lifelong or acquired after months or years of satisfying sexual intercourse; (c) the level of distress is mild, moderate, or severe in terms of the impact of FSD on personal life; and (d) the leading aetiologies. To diagnose a sexual dysfunction, it is crucial to ask specifically about sexual function and avoid a collusion of silence that is all too common. A structured clinical history, selected investigations and physical examination are fundamental to diagnosis. CONCLUSIONS A structured multidisciplinary, integrative approach is fundamental to the evaluation and management of FSD.

Sexual Rehabilitation After Gynaecological Cancers

Women’s quality of sexual life is an urgent issue in gynecological oncology. The multifactorial etiology of gynecological cancers (GC) and the increasing prevalence of such cancers at younger ages require a comprehensive medical and psychosexual perspective, even more so when sexual rehabilitation is the ultimate goal. The high rate of long-term survival makes GC more of a chronic than a fatal disease. Premature iatrogenic menopause is an important factor to be considered.

Medical Treatments for Sexual Problems in Women

Cancer today is more of a chronic than a fatal disease: the improving survival rates increase the likelihood of long survival after the diagnosis. Unfortunately, cancer treatment is the most frequent cause of premature iatrogenic menopause and psychosexual dysfunction. Therefore, an increasing number of cancer survivors have to cope with both the consequences of cancer treatment per se, the complex physical and psychological changes secondary to a premature iatrogenic menopause, and the burden of sexual dysfunctions, more difficult to accept in the youngest patients. Female sexual identity may be variably affected by a cancer diagnosis and treatment depending on the age at diagnosis (and the age at the time of any recurrences). Age is the first biological factor that may modify the outcome of cancer diagnosis and treatment, when sexuality is considered as an independent variable in the quality of life (QOL) evaluation. The impact of cancer is increasingly worse in younger patients, especially if radical surgery, adjuvant systemic chemotherapy, and/or local radiotherapy further reduce the biological chances of a fulfilling sexual and procreative life.

Testosterone Substitution Therapy and Women’s Sexual Health

Testosterone therapy is of growing interest because of its increasingly recognised role in sexual and mental health, bone and muscle trophism and vitality.1–4 An expanding body of evidence supports the influence of testosterone on sexuality, with the focus on desire and central (mental) arousal. This is more evident in women who have undergone oophorectomy and, therefore, have a complex symptomatology (sexual and non-sexual), secondary to the loss of ovarian androgens.