Chiara Malandrino

Preliminary Study on the Effect of Four‐phasic Estradiol Valerate and Dienogest (E2V/DNG) Oral Contraceptive on the Quality of Sexual Life

INTRODUCTION A new oral contraceptive containing the natural estrogen estradiol and a 19-nortestosterone derivate dienogest (DNG) in a four-phasic 28-day regimen may be used by women. AIM To investigate the quality of sexual life of healthy women on estradiol valerate and DNG (E2V/DNG) oral contraceptive. METHODS Fifty-seven women (age range 18-48 years) were enrolled. The Short Form-36 (SF-36) questionnaire to assess quality of life (QoL) was administered at baseline and at the 26th day of both the 3rd and 6th cycles of oral contraceptive (OC) intake. The Short Personal Experience Questionnaire (SPEQ) to measure the change of sexual behavior was used at the 2nd, 7th, 14th, 21st, 26th, and 28th days of the baseline cycle, as well as at the same days of both the 3rd and 6th cycle of contraceptive intake. MAIN OUTCOME MEASURE The SF-36 and the SPEQ questionnaires. RESULTS Women reported QoL improvement at the 3rd (P < 0.05) and at the 6th cycles (P < 0.01). By SPEQ, improvement of sexuality during the 3rd and the 6th cycle with respect to baseline experience was observed (P < 0.05). The frequency of sexual activity remained basically unchanged (P = NS). Enjoyment and desire improved at the 6th cycle with respect to the 3rd cycle (P < 0.05). All women reported decreased dyspareunia at the 3rd and 6th cycles (P < 0.05). Interestingly, desire, arousal, orgasm, enjoyment, and sexual activity improved, reaching a peak around the 14th day of the menstrual cycle (P < 0.05). At the 3rd and 6th cycle, women on OCs were sexually cyclic, but the peak improvement of desire, arousal, orgasm, enjoyment, and sexual activity appeared around the 7th day of OC intake (P < 0.05). CONCLUSION Reduced hormone-free interval is a new concept in low-dose OC regimens. Moreover, the E2V/DNG multiphasic extended regimen has been found to positively modify the sexuality of users.

Conventional vs. extended-cycle oral contraceptives on the quality of sexual life: comparison between two regimens containing 3 mg drospirenone and 20 µg ethinyl estradiol.

INTRODUCTION Women may use new oral contraceptives (OC) having flexible extended-cycle regimens with a reduced hormone-free interval. AIM To study the changes of the quality of sexual life in users of the traditional 21/7 or extended-cycle 24/4 OC regimens both containing 3 mg drospirenone and 20 µg ethinyl estradiol. METHODS One hundred fifteen women (age range 18-37 years) were enrolled. Fifty-four women were randomly placed on traditional OC standard regimen, administered for 21 days, followed by a 7-day hormone-free interval (group A); and 61 women were placed on extended-cycle OC regimen covering 24 days of the cycle with a 4-day hormone-free interval (group B). The Short Form-36 (SF-36) validate questionnaire to assess quality of life (QoL) and the Short Personal Experience Questionnaire (SPEQ) to measure the changes of sexual behavior were administered before starting OC intake and at the 3rd and 6th cycle follow-ups. MAIN OUTCOME MEASURE The SF-36 and the SPEQ questionnaires. RESULTS Group A women reported QoL improvement during the 6th cycle on all the scales (P < 0.05). Group B women reported QoL improvement during the 3rd and 6th cycle (P < 0.05). Satisfaction with sexual activity, arousal, orgasm, and desire increased during the 3rd cycle in women on the group B (P < 0.05). Group A women did not report any change in all SPEQ items. At the 6th cycle, group B women reported better sexual experience than baseline in all SPEQ items (P < 0.05). All subjects who were affected by dyspareunia before OC intake reported decreased genital pain associated with intercourse at the 3rd and 6th cycle of both OC regimens (P < 0.05). CONCLUSION Women could use OCs in a subjective flexible modality. The extended-cycle OC might produce positive effects on the quality of sexual life, enforcing the concept of tailoring an OC to a woman.

Do Hormones Influence Women's Sex? Sexual Activity over the Menstrual Cycle

INTRODUCTION In mammals, the effects of ovarian steroids influence sexual behavior. In humans, there are a few studies that take into account if ovulation occurs. AIM The study aims to investigate if a womans sexuality changes during the week and over the menstrual cycle, and if so, in what way. METHODS This is a prospective cohort study; 1,957 heterosexual women were involved over the period January 2004-December 2011. Two subgroups were taken into consideration, women having a partner and singles. MAIN OUTCOME MEASURE Sexual interview and the Female Sexual Function Index and Female Sexual Distress Scale questionnaires were used to exclude women with sexual dysfunction. Women with ovulation confirmed by sonography were enrolled. Women were given diary cards on which to report their daily sexual activity. Serum concentrations of estradiol, progesterone, total testosterone, sex hormone binding globulin, and free androgen index were measured during the follicular, periovular, and luteal phase of the menstrual cycle. RESULTS One thousand one hundred eighty women (age range 18-40 years) were included in the analyses. Of them, 925 had a heterosexual relationship and 255 were single. Women with a partner had more sexual activity during the weekend, while the singles had a constant sexual activity over the week. The sexual activity of singles was higher during the ovulatory phase and lower during menses than that of the women with a partner. A linear correlation between sexual activity and androgenic hormonal profile during the menstrual cycle in women with and without a partner was observed. CONCLUSIONS Ovarian steroids modulate a womans sexual activity. This aspect was more evident in singles than in women having a partner, in which a variety of nonhormonal factors can have a role.

Tadalafil 5 mg Daily Treatment for Type 1 Diabetic Premenopausal Women Affected by Sexual Genital Arousal Disorder

INTRODUCTION Type 1 diabetic women may be affected by sexual dysfunction, mainly due to peripheral vascular disease. AIM To determine whether daily tadalafil 5 mg is effective in type 1 premenopausal women affected by sexual genital arousal disorder. METHOD Thirty-three volunteers were enrolled in a 12-week daily tadalafil 5 mg prospective study. MAIN OUTCOME MEASURES The efficacy of daily tadalafil 5 mg on sexual genital arousal (primary end point), and desire, orgasm, enjoyment and frequency of sexual activity, and genital pain (secondary end points) were assessed (i) subjectively by the Short Personal Experiences Questionnaire; and (ii) objectively by translabial color Doppler sonography of clitoral blood flow. Moreover, the Short Form-36 questionnaire was used to assess Quality of Life (QoL). RESULTS Thirty-two women completed the study. Women reported a QoL improvement at the 12th week follow-up (P<0.05). Tadalafil improved the experience of sexual genital arousal, and orgasm, sexual enjoyment, satisfaction by frequency of sexual activity, and frequency of sexual thoughts or fantasies (P<0.05). Finally, dyspareunia decreased with respect to baseline (P<0.001). After tadalafil administration, the mean peak systolic velocity increased and the mean diastolic velocity decreased from baseline (P<0.001). Moreover, the mean resistance index and the mean pulsatility index were significantly higher compared with baseline values (P<0.001). CONCLUSIONS Daily tadalafil 5 mg treatment seems to improve subjective sexual aspects and could be used to treat genital arousal disorder of premenopausal women with type 1 diabetes. The limits of the study were the small sample and the lack of a placebo control group.

Quality of Sexual Life of Women on Oral Contraceptive Continued-Regimen: Pilot Study

INTRODUCTION To date, women may use flexible oral contraceptive (OC) regimens. AIM The aim of this study was to evaluate the quality of sexual life of healthy women on continued-regimen OCs. METHODS Fifty women (age range 18-38) were enrolled. The Female Sexual Function Index (FSFI) and the Short Form-36 (SF-36) questionnaires were used to investigate, respectively, sexual behavior and the quality of life (QoL) of women on OC for 72 days with a 4-day hormone-free interval, for two cycles. Both the FSFI and the SF-36 were administered before starting OC intake, at the first (72-82 days) and the second (144-154 days) follow-ups. MAIN OUTCOME MEASURE The main outcomes are the FSFI and the SF-36 questionnaires. RESULTS The FSFI score obtained at the first follow-up detected a worsening with respect to baseline score (P < 0.05). The score obtained at the second follow-up detected an improvement with respect to both the baseline and the first follow-up total scores (P < 0.05). QoL improved at the first follow-up only as regards body pain (P < 0.05), and at the second follow-up as regards: physical role, body pain, general health, vitality, and social function (P < 0.05). CONCLUSIONS The use of continued-regimen OCs is able to improve the sexual behavior and the QoL of women.

Hyperandrogenic women treated with a continuous-regimen oral contraceptive

OBJECTIVES To investigate the effects of a continuous-regimen combined oral contraceptive (COC) on hyperandrogenic women. STUDY DESIGN This prospective study enrolled 52 women with moderate to severe hirsutism, as well as acne and seborrhea. Women were placed on a 192-day continuous regimen. To assess hirsutism, the modified Ferriman-Gallwey (mF-G) scoring system was used. Acne and seborrhea were defined by the Cremoncini scale. Serum FSH, LH, estradiol, total testosterone, FAI, DHEAS, androstenedione, SHBG and fasting insulin were measured at baseline and at the endpoint. One-way ANOVA was used to compare serum hormone levels and hirsutism scores at baseline with those obtained at the endpoint. RESULTS A reduction of 78.5% in the mF-G scores was observed at the endpoint (p<0.001). Women underwent improvement of acne and seborrhea, -58.7% and -56%, respectively (p<0.001). An evident decrease in both total testosterone and FAI, and an increase in SHBG were shown (p<0.001). CONCLUSIONS A COC continuous-regimen improved the esthetic effect of hyperandrogenism.