Marta Berra

The Impairment of Sexual Function Is Less Distressing for Menopausal than for Premenopausal Women

INTRODUCTION Menopause requires psychological and physical adjustments because of the occurring significant hormonal changes. Sexuality is one of the aspects that undergoes the most profound modifications. Preliminary data suggest that sometimes women do not regard sexual changes as problematic and often readjust their life and relationship according to their new physical status. AIM The aim of our study was to evaluate sexual function and the way women feel by comparing healthy postmenopausal and premenopausal women. METHODS One hundred menopausal (M) and 100 premenopausal (pM) healthy women were asked to complete anonymous questionnaires to assess sexual function and stress related to sexual activity. MAIN OUTCOME MEASURES Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS) were completed by M and pM women. Results. Medium FSFI score was 20.5 +/- 9.6 and 26.4 +/- 7.7 (P < 0.0005) and medium FSDS score was 12.1 +/- 11.7 (95% CI 9.7-14.4) and 11.3 +/- 10.2 (P = 0.917) for M and pM women, respectively. Twenty-five of the 69 M women and 20 of the 31 pM women with a pathological score in the FSFI questionnaire scored higher than 15 in the FSDS (P < 0.0005). The overall prevalence of sexual dysfunction was 20% and 25% (P = 0.5) in the M and pM women. CONCLUSIONS Our data confirm that menopause is associated with changes in sexual function that may be compatible with sexual dysfunction. However, personal distress caused by these changes in sexual life appears to be lower among menopausal women (36.2%) as compared with premenopausal women (64.5%). These data suggest that medical treatment for sexual health in menopause must be highly personalized and carefully prescribed.

Long-term influence of combined oral contraceptive use on the clinical course of relapsing–remitting multiple sclerosis

OBJECTIVE To assess the long-term effects of combined oral contraceptives (COCs) on the clinical course of relapsing-remitting multiple sclerosis (RRMS), focusing on disability progression and evolution to secondary-progressive multiple sclerosis (SPMS). DESIGN Retrospective and exploratory study. SETTING Academic medical center. PATIENT(S) A total of 174 women with clinically confirmed MS; of these, 33 had evolved to SPMS at the time of enrollment in the study, whereas 141 still had a relapsing-remitting form of disease. INTERVENTION(S) Women were interviewed to obtain gynecologic and obstetric history. MAIN OUTCOME MEASURE(S) Expanded Disability Status Scale (EDSS); Multiple Sclerosis Severity Score (MSSS); annualized relapse rate; evolution to SPMS. RESULT(S) Mean±SD duration of disease was 14.3±9.8 years. Compared with non-users of COCs, COC users had lower EDSS scores and MSSS only in the subset of the population with prior or current immunomodulatory treatment. Nonuse of COCs was a predictor of disease evolution in SPMS, whether treated or not with immunomodulatory drugs. The annualized relapse rate was not influenced by COC use. No differences in EDSS scores and evolution to SPMS depending on COC formulation were detected. CONCLUSION(S) Our results suggest that COC use is associated with a less severe disease and less severe evolution. Whether different doses or types of progestin may have different effects remains to be defined.

Safety of hormonal treatment in transgenders.

Purpose of reviewDiscussion of short and long-term issues of cross-hormone treatment of transgender individuals in the light of recent literature. Recent findingsGender nonconformity has been depathologized and replaced by gender dysphoria in the Diagnostic and Statistical Manual of Mental Disorders version V.Safety of cross-sex hormone treatment is still a matter of debate, but the latest findings in literature are quite reassuring about short-term and long-term effects. No dramatic changes in recommendations for treatment have emerged in the past years, and for the most part, clinical work is based on Endocrine Society Clinical Guidelines published in 2009. SummaryMost recent findings agreed on the importance of maintaining cross-sex hormone serum concentration within the physiological range, avoiding or limiting maximum peaks and troughs.Treatment must be highly individualized and transitioning patients need to be engaged in a ‘clinical contract’ with the physician in order to ensure compliance with prescribed treatments.Although overall mortality appears to be higher among transgender individuals, this in not attributed to hormonal treatment but to other causes mostly related to lifestyle habits.

Sexuality and Psychopathological Aspects in Premenopausal Women with Metabolic Syndrome

INTRODUCTION Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that have been suggested to impact female sexual function. AIMS This study aims to assess the prevalence of female sexual dysfunction (FSD) in premenopausal women with MetS compared with healthy controls (HC). Psychopathological aspects and the relationship to FSD were also evaluated in both groups. METHODS Two hundred four premenopausal women, of whom 98 had diagnosis of MetS, were asked to complete the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), and the Middlesex Hospital Questionnaire (MHQ). Routine laboratory tests and anthropometric measurements were routinely performed. MAIN OUTCOME MEASURES FSFI and FSDS questionnaires, prevalence of FSD, and MHQ scores. RESULTS In the MetS group compared with the HC group, we found: a lower global FSFI score (P=0.005), higher prevalence of pathological scores compared with HC group, and lower scores in the desire, arousal, lubrication, and orgasm domains. An inverse correlation between the FSFI score and the number of risk factors for MetS was detected. MetS women reported significantly higher total scores in the somatization and depression domains when compared with the HC group. The logistic regression showed that high triglycerides (odds ratio [OR] 3.097; 95% confidence interval [CI] 1.272-7.542; P=0.026) and somatization (OR 7.068; CI 95% 2.291-21.812; P=0.001) are independently associated with FSD in premenopausal women. CONCLUSIONS Our results indicate a higher prevalence of sexual dysfunction in MetS women. A number of risk factors for MetS are positively associated with FSD and higher triglycerides seem to be the strongest predictors of sexual dysfunction. Psychopathological dimensions such as somatization are strongly associated with sexual dysfunction.

Changes in Vaginal Physiology of Menopausal Women with Type 2 Diabetes

INTRODUCTION Metabolic disorders, such as type 2 diabetes, have been associated with an increased risk of development of female sexual dysfunction (FSD). In experimental studies, vascular, neuronal, and hormonal responsiveness alteration at vaginal level were proposed as contributors to the onset of FSD in women with diabetes; however, conclusive data on humans are still lacking. AIMS The study aimed to assess changes in vascularization, sex steroid receptors, nitric oxide synthase, and aquaporin-2 (AQP2) expression occurring at vaginal level in women with diabetes. METHODS Vaginal biopsies were obtained from 21 postmenopausal women, 10 of whom were diagnosed as having type 2 diabetes mellitus. CD31, estrogen receptor-α (ERα) and androgen receptor (AR) expression and localization were analyzed by immunostaining. Expression of endothelial (eNOS) and neuronal (nNOS) nitric oxide synthase isoforms and AQP2 were also assessed in vaginal samples. MAIN OUTCOMES MEASURES Changes in vaginal vascularization, sex steroids receptor, eNOS, nNOS and AQP2 expression. RESULTS Vaginal samples from women with diabetes showed an increased microvessel density in the lamina propria, which were morphologically disrupted suggesting an angiogenic compensatory mechanism. While no differences were seen in ERα, AR expression was significantly reduced in the vaginal epithelium and lamina propria of women with diabetes. Similarly, the gene and protein expressions of both nNOS and eNOS were significantly reduced in patients with diabetes, while AQP2 mRNAs level did not significantly differ between the two groups. CONCLUSION Diabetes greatly impacts vaginal physiology, being associated with alterations of the vaginal lamina propria vascular network, nitrergic signaling, and AR expression. These alterations may contribute to the increased risk of FSD development in women with diabetes.

Long-term cross-sex hormone treatment is safe in transsexual subjects

The European Journal of Endocrinology recently published a paper (Asscheman et al.) presenting mortality data from more than a thousand transsexuals followed for a median time of 18 years and who had undergone previous or were currently on long term cross-sex hormonal treatment. Transsexualism is a rare condition and in scientific literature there are few reports on the long-term safety of different treatment protocols and on the physical and psychological outcomes of medical treatments. The safety of long-term high doses oestrogen or testosterone in subjects of the opposite sex has been debated and data on long term effects are scant at best. The Asscherman paper therefore represents a very important and reassuring reference for professionals working in this field suggesting that mortality is increased among transsexuals although due to causes unrelated to cross sex replacement therapy. These results will benefit the care and treatment of these subjects.

T09-O-02 The impairment of sexual function stresses menopausal less than premenopausal women

Objective Menopause requires psychological and physical adjustments, due to the occurring dramatic hormonal changes. Sexuality is one of the aspects that undergoes the most profound modifications. Preliminary data suggest that sometimes postmenopausal women do not regard sexual changes as being problematic often readjusting their life and relationship according to their new physical status. This underlines the evaluation of personal distress in the diagnosis of sexual dysfunction in particular in menopause. The aim of our study was to evaluate sexual function and the way women feel comparing postmenopausal and pre-menopausal women. Design and Method The Female Sexual Index Function (FSIF) and the Female Sexual Distress Scale (FSDS) were completed by 74 menopausal and 100 premenopausal women. Results Resultsare reported in postmenopausal versus premenopausal women as median + SD: • age: 56.0+4.2 versus 27.6+4.3 years; • FSFI total score: 20.2+3.5 versus 28.7+6.9 (p=0.000); • FSFI score • (p=0.000); • FSDS score >15 in women with FSFI >26.5: 17/51 • (33.3%) versus 16/24 (66.7%) (p=0.007); • sexual dysfunctional women 17/74 (23%) versus 16 /100 • (p= 0.25). Conclusions Although in menopause there is a higher incidence of potential sexual problems, personal distress caused by these problems is lower among menopausal as compared to premenopausal women. This data further supports the importance of incorporating personal distress evaluation in the diagnosis of sexual dysfunction.

T04-P-04 Effects of Testosterone Undecanoate (TU) administered alone or in combination with letrozole or dutasteride in Female to Male transsexuals (FtM)

Introduction The role of testosterone (T) and its metabolites, diidrotestosterone (DHT) and estradiol (E), on different physiological functions is not completely known. Ovariectomized FtM T treated represent an interesting model to study the effects of T and its metabolites on different physiological functions. In this study, TU 1000 mg (Nebido ® ) was injected in 15 FtM (week 0, 6,18, 30 and 42) alone (n=5; group A) or in combination with dutasteride 5 mg/d (n=5; group B) or letrozole 5 mg/d (n=5; group C). Results Hormone, bone and metabolic parameters at baseline and at week 54 were: TotalT (nmol/L) GROUP A 7.9±6.0, 13.6±2.6, GROUP B 7.1±6.3, 18.4±4.6§, GROUP C 4.8±4.8, 18.2±4.2§, baseline and wk 54 respectively. E (pmol/L) GROUP A 64.4±43.4, 89.6±36.3, GROUP B 41.4±19.4, 76.0±47.4, GROUP C 37.8±23.1, 18.0±0.0* baseline and wk 54 respectively. DHT (nmol/L) GROUP A 1.3±1.2, 2.2±0.9, GROUP B 1.0±0.7, 0.4±0.1*, GROUP C 0.9±0.7, 2.7±1.3 baseline and wk 54 respectively. *= P §= P No significant changes of any parameters occurred except for bone mass density that significantly decreased in group C and lean mass that increased significantly less in group B as compared to group A. TU injections were well tolerated by all subjects. Conclusions This data suggests that TU is an optimal formulation for replacement in FtM that is well accepted and does not cause major problems. The aromatization of TU is important for maintenance of bone density while DHT may have a role in muscle mass maintenance.

Androgens and male contraception

Purpose of reviewAt present, family planning still caters for a predominantly female clientele. The major reason for that is the shortcoming of currently available male contraceptives. Most recent clinical trials demonstrate that hormonal contraception may be feasible for men too. This chapter will discuss the efforts performed over the past decades to develop a male hormonal contraceptive analogous to the hormonal methods so successful in women, focusing in particular on the developments carried out in the last few years. Recent findingsLong-acting androgen–progestin regimens seem to be the best available choice to induce profound and reversible suppression of spermatogenesis in Caucasian men. Although more sensitive to the steroid suppressive effects on spermatogenesis, Chinese men may also benefit by the addition of a progestin to testosterone to obtain a regimen that provides optimal contraceptive protection. Larger efficacy studies are warranted to prove the efficacy and safety of these regimens. Recent surveys suggest that potential acceptability of new male hormonal contraceptives is high among both men and women. SummaryRecent studies have demonstrated that androgen–progestin regimens may represent optimal regimens for contraception in men. Effectiveness and safety of these regimens will have to be proved in large-scale, long-term trials that are currently being planned.