Jean L. Fourcroy

Definitions of women's sexual dysfunction reconsidered: Advocating expansion and revision

In light of various shortcomings of the traditional nosology of womens sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about womens sexual response. It is apparent that fullfillment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of womens sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Female Sexual Dysfunction Potential for Pharmacotherapy

The act of sex includes a womans sexual self and self-image, intimate relationships, family, society and culture. The complexities of her environment, sexual and partner history, past relationships, mental health status, current medical problems and hormonal status all play a role. An interdisciplinary consensus conference panel expanded the former Diagnostic and Statistical Manual of Mental Disorders-IV classifications of female sexual dysfunction to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders that cause personal distress.The US FDA Guidance paper details the recommendations for the clinical development of drugs for the treatment of female sexual dysfunction. In this document, great emphasis is placed on orgasm as a clinical trial endpoint and itwould appear that satisfactory sexual intercourse is of secondary importance to the Agency. However, there is no evidence to suggest that the majority of women correlate their sexual enjoyment and satisfaction with numbers of orgasms or even the likelihood of orgasm during a given sexual interaction. Nonetheless, any drug coming through the regulatory agency in the US will need to follow these recommendations.Currently, there are six major pharmaceutical therapeutic paths being pursued for treatment of female sexual disorders and/or postmenopausal symptoms. These include dopaminergic agonists and related substances, melanocortin-stimulating hormones, adrenoceptor antagonists, nitric oxide delivery systems, prostaglandins, and androgens. A number of compounds that target these pathways are undergoing development for female sexual dysfunction. The array of pharmacological agents that are being developed for female sexual dysfunction must prove to be efficacious and have a good safety profile at a time when there are increasing worries that hormonal replacement with estrogen and progestogens are not safe. It is unclear if any of these pharmaceutical pathways will prove to be both safe and effective for the treatment of female sexual disorders; however, studies investigating this area will provide important scientific data for the future.

Report of the International Consensus Development Conference on Female Sexual Dysfunction: Definitions and Classifications

83 Address correspondence to Rosemary Basson, Echelon Bldg., Vancouver Hospital, 855 W. 12th Avenue, Vancouver, B.C., Canada V5Z 1M9. E-mail: sexmed@interchange.ubc.ca Supported by the Sexual Function Health Council of the American Foundation for Urologic Disease through educational grants provided by Affiliated Research Centers, Eli Lilly/ICOS Pharmaceuticals, Pentech Pharmaceuticals, Pfizer Inc., Procter & Gamble, Schering-Plough, Solway Pharmaceuticals, TAP Pharmaceuticals, and Zonagen. Financial interest and/or other relationship with Affiliated Research Centers, Astra, Bayer AG, Bristol-Myers, Eli Lilly, Fournier Group, Glaxo Wellcome, Lilly/ICOS, Matrix Pharma, NexMed, NitroMed, Pentech, Pfizer Inc., Pfizer Canada Ltd., Pfizer UK, Pharmacia & Upjohn, Procter & Gamble, Scherling-Plough, Senetek, Shwarz-Pharma, Solvay Pharmaceuticals, Syntec, Syntex, TAP Pharmaceuticals, Vivus and/or Zonagen. This article originally appeared in The Journal of Urology, volume 163, pages 888–893 and is reprinted with permission of the publisher. Report of the International Consensus Development Conference on Female Sexual Dysfunction: Definitions and Classifications

Gynecomastia and Breast Cancer during Finasteride Therapy

To the Editor: From June 1992, when finasteride (Proscar) was approved for the treatment of prostatic hyperplasia, to February 1995, the Food and Drug Administration (FDA) received reports of gynec...

Fibrous Hamartoma of Infancy in the Genital Region: Findings in 15 Cases

Fibrous hamartoma of infancy is a benign myofibroblastic proliferation that typically occurs in the axillary or shoulder region of male infants. We describe 15 cases of this condition, which involved the inguinal region in 5, scrotum in 5, spermatic cord in 1, perineum in 1, labium majus in 1, the suprapubic region in 1 and the pubic area in 1. Patient median and mean ages were 10 and 6.7 months, respectively (range 2 to 24). No case was reported to be congenital. Median and mean tumor size was 3 cm. (range 0.5 to 6). The microscopic features were identical to those seen in fibrous hamartoma of infancy occurring in more typical sites and consisted of 3 components: 1) fascicles of myofibroblasts, 2) disorganized mature adipocytes and 3) small rounded primitive mesenchymal cells. Immunohistochemically, the myofibroblastic component expressed muscle specific actin and vimentin, and the primitive component expressed vimentin only. There was no evidence of increased cellular proliferation in the primitive cell component using proliferating cell nuclear antigen antibodies. Of the 15 lesions 1 recurred locally and 14 were apparently cured by local excision. Awareness of this presentation of fibrous hamartoma of infancy may avert misdiagnosis of more aggressive lesions, especially infantile fibromatosis or rhabdomyosarcoma.

A unique case of Sertoli cell only syndrome with normal gonadotropins

A 23-year-old male presented with primary infertility, normal male phenotype, and azoospermia. He had normal basal T, FSH, and LH levels and responded normally to clomiphene citrate stimulation. He also had normal androgen receptors in cultured pubic skin fibroblasts. A testis biopsy showed only Sertoli cells and no evidence of seminiferous tubule damage, lacking the fibrosis or Leydig cell hyperplasia usually seen in SCOS. This case of SCOS, combined with those previously reported, suggests that the etiology of SCOS is heterogeneous, with a single common end point, or that it is a single process that has been studied at different developmental stages by different investigators.