Zlatko Pastor

The influence of combined oral contraceptives on female sexual desire: A systematic review

ABSTRACT Objectives To determine the relationship between the use of combined oral contraceptives (COCs) and sexual desire based on a systematic review of the literature. Methods MEDLINE Complete, Google Scholar and the Cochrane Library were searched for articles published between 1975 and 2011, reporting the effects of oral contraceptives on sexual desire. Reports fully meeting all the predefined criteria were analysed and included in a final reference list. In addition, a review of the reference list of selected articles was carried out. Results We evaluated 36 studies (1978–2011; 13,673 women). Of the COC users (n = 8,422), 85% reported an increase (n = 1,826) or no change (n = 5,358) in libido and 15% reported a decrease (n = 1,238). We found no significant difference in sexual desire in the case of COCs with 20–35 μg ethinylestradiol; libido decreased only with pills containing 15 μg ethinylestradiol. Conclusions The majority of COC users report no significant change in libido although in most studies a decline in plasma levels of free testosterone and an increase in those of sex hormone binding globulin were observed.

Female Ejaculation Orgasm vs. Coital Incontinence: A Systematic Review

INTRODUCTION Women may expel various kinds of fluids during sexual arousal and at orgasm. Their origins, quantity, compositions, and expulsion mechanisms depend on anatomical and pathophysiological dispositions and the degree of sexual arousal. These are natural sexual responses but may also represent symptoms of urinary incontinence. AIM The study aims to clarify the etiology of fluid leakage at orgasm, distinguish between associated physiological sexual responses, and differentiate these phenomena from symptoms of illness. METHODS A systematic literature review was performed. EMBASE (OvidSP) and Web of Science databases were searched for the articles on various phenomena of fluid expulsions in women during sexual arousal and at orgasm. MAIN OUTCOME MEASURES Articles included focused on female ejaculation and its variations, coital incontinence (CI), and vaginal lubrication. RESULTS Female ejaculation orgasm manifests as either a female ejaculation (FE) of a smaller quantity of whitish secretions from the female prostate or a squirting of a larger amount of diluted and changed urine. Both phenomena may occur simultaneously. The prevalence of FE is 10-54%. CI is divided into penetration and orgasmic forms. The prevalence of CI is 0.2-66%. Penetration incontinence occurs more frequently and is usually caused by stress urinary incontinence (SUI). Urodynamic diagnoses of detrusor overactivity (DOA) and SUI are observed in orgasmic incontinence. CONCLUSIONS Fluid expulsions are not typically a part of female orgasm. FE and squirting are two different physiological components of female sexuality. FE was objectively evidenced only in tens of cases but its reported high prevalence is based mostly on subjective questionnaire research. Pathophysiology of squirting is rarely documented. CI is a pathological sign caused by urethral disorder, DOA, or a combination of both, and requires treatment. An in-depth appreciation of these similar but pathophysiologically distinct phenomena is essential for distinguishing normal, physiological sexual responses from signs of illness.

The Prevalence and Risk Factors of Sexual Dysfunction Among Czech Women

ABSTRACT. This article presents the results of a representative national study highlighting the risk factors of female sexual dysfunction in the Czech Republic. The study design is a representative quota survey of 1,000 Czech women aged 15 years and older. The questionnaire is a part of wider long-term survey of sexual behavior within the Czech population, which started in 1993. Besides the various aspects of sexual behavior, the questionnaire included a specific section on sexual dysfunction. The prevalence of sexual dysfunction among women in the Czech Republic is 20%. Risk factors that increase the likelihood of sexual dysfunction are: sexual abuse during childhood and having been forced to engage in sex during their lifetime, having sexually transmitted diseases, and having positive attitudes toward casual sex. Sexual characteristics that strongly associate with sexual dysfunction are: not being satisfied with sex and having faked orgasm “often and almost always.” These results indicate that there are risk factors for developing female sexual dysfunction, which can be identified, and there are other related characteristics that can have a negative impact on sexual behavior.

The Interest of Women with Mayer–Rokitansky–Küster–Hauser Syndrome and Laparoscopic Vecchietti Neovagina in Uterus Transplantation

STUDY OBJECTIVE The goal of this study was to assess a group of women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with surgically created neovaginas in the interest of uterus transplantation (UTx) and to recruit the first group of applicants for a UTx trial. DESIGN AND SETTING This was an original prospective study using semistructured interviews. PARTICIPANTS A study group of 50 women with MRKH syndrome with Vecchietti neovaginas was recruited via letter of invitation. INTERVENTIONS AND MAIN OUTCOME MEASURES Interest of MRKH women in obtaining experimental UTx for the treatment of absolute uterine factor infertility. RESULTS A total of 50 women responded via e-mail and 31 (62% [31 of 50] of the study group) expressed serious interest in UTx after complete information about its risks and benefits was provided during the first semistructured interview. They subsequently agreed to participate in additional interviews and further examinations. Because of various reasons, only 9 women were prepared to enter our UTx trial (18% [9 of 50] of the study group). Three recipients/donors were accepted into the living donor arm and 6 into the deceased brain donor arm of the trial. CONCLUSION Nearly two-thirds of our MRKH syndrome study group women with surgically created neovaginas were interested in UTx and motivated to undergo this method of absolute uterine factor infertility treatment. Therefore, this group of women might be approached to participate in ongoing and future UTx trials. Future studies of women with MRKH syndrome might confirm or disprove the results of our survey.

Sexual Life of Women With Mayer-Rokitansky-Küster-Hauser Syndrome After Laparoscopic Vecchietti Vaginoplasty

Introduction Adequate anatomic and physiologic functions of the genitalia are fundamental prerequisites for sexual well-being and reproduction. Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) compromises female sexual life and makes reproduction impossible. Aim To assess the psychosexual effect of vaginal reconstruction using the laparoscopic Vecchietti technique in patients with MRKHS. Methods Forty-two patients with MRKHS who underwent laparoscopic Vecchietti vaginoplasty were included. Their partners also were interviewed. A control group of 45 age-matched, childless, sexually active women were examined during the same period. Main Outcome Measures A gynecologic examination was performed to determine the anatomic outcome. Psychosexual function was evaluated with the Female Sexual Distress Scale–Revised (FSDS-R), the Female Sexual Function Index (FSFI), and a semistructured interview. Genital self-image was evaluated using the Female Genital Self-Image Scale (FGSIS). Results Average neovagina length (7.0 ± 9.6 cm) in the MRKHS group was significantly shorter than the vaginal length in the control group (9.3 ± 2.5 cm). Women with a neovagina reported satisfactory sexual function (FSFI score = 29 ± 2.7) that was not significantly different from the control group (P < .05); however, they also had significantly higher levels of distress (FSDS-R score = 14.5 ± 6.5) and were not satisfied with their genitals (FGSIS score = 22.0 ± 2.4) compared with the control group. Conclusion Sexual function in women with MRKHS can be restored successfully by vaginoplasty; however, they have higher rates of distress and are less satisfied with their genitals. Pastor Z, Fronĕk J, Nováčková M, Chmel R. Sexual Life of Women With Mayer-Rokitansky-Küster-Hauser Syndrome After Laparoscopic Vecchietti Vaginoplasty. Sex Med 2017;5:e106–e113.

Revaluation and lessons learned from the first 9 cases of a Czech uterus transplantation trial: Four deceased donor and 5 living donor uterus transplantations

Although uterus transplantation is still in the experimental stage, it has promising potential as a treatment for women with absolute uterine factor infertility based on the childbirths from living donor trials conducted in Sweden and the United States. We report the main characteristics and perioperative and postoperative courses of both recipients and donors following 4 deceased donor and 5 living donor uterus transplantations. Three main priorities differentiate this study from the previously reported uterus transplantations. First, clinical experience with the largest worldwide group of deceased donor uterine transplants is described. Second, in the majority of living donor uterine recipients, only 2 ovarian veins were used for venous blood outflow. All of these recipient procedures were surgically successful, and follow‐up posttransplant ultrasound examinations revealed normal uterine blood supply and outflow. Third, in only one living and one deceased donor recipient, the transplanted uterus relied on only 2 uterine veins for venous outflow with a 50% surgical success rate. In all other recipients, 2 uterine and 2 ovarian veins were utilized. Although a successful pregnancy has not yet been achieved, the presented surgical and functional results of our trial are promising.

Trends in Sexual Behaviour in Czech Schoolchildren between 2002-2014.

OBJECTIVE The aim of this study was to report on trends in the prevalence in age at first intercourse of Czech schoolchildren and a difference between sexes. METHODS Prevalence in age at first intercourse of Czech schoolchildren was observed under the Health Behaviour in School-aged Children study in the years 2002, 2006, 2010 and 2014. In addition, a random representative sample of children attending 9th grade completed the questions related to sexual behaviour. A total of 4,804 boys and girls at the age of 15 years were included in the study. The chi-square test and analysis of variance were used for data assessment. RESULTS Experience with first sexual intercourse before 15 years was confirmed by 16% of boys and 19.4% of girls. Average age of coitarche in both sexes most often ranged between 14 and 15 years. Since 2006 boys had significantly lower age at coitarche. Only in 2010 the girls had first intercourse more frequently than boys. Since 2010 the number of Czech adolescents of both sexes having first intercourse before the age of 15 years has significantly increased. However, a rise in average age of coitarche over 15 years in both sexes occurred in 2014. CONCLUSIONS The number of Czech children having a sexual intercourse before 15 years has significantly increased since 2010.