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Effects of hyperthyroidism, hypothyroidism and thyroid autoimmunity on female sexual function

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Abstract

Thyroid hormones affect male and female sexual functions, but data in hypo- and hyperthyroid women are scanty. To investigate sexual function in hypo- and hyperthyroid women before and immediately after restoration of euthyroidism and in women with euthyroid Hashimoto's thyroiditis (HT). Fifty-six women with thyroid diseases (age 19-50 yr; 22 with hyperthyroidism, 17 with hypothyroidism, and 17 with euthyroid HT) and 30 age-matched healthy women. Hypoactive sexual desire, disorders of sexual arousal, vaginal lubrication, orgasm, satisfaction, and sexual pain (SPD) were assessed by Female Sexual Function Index. Serum TSH, free T4 (FT4) and thyroid autoantibodies (anti-thyroglobulin, anti-thyroperoxidase, and TSH-receptor antibodies) were assessed at the diagnosis; FT4 and TSH were repeated after treatment to confirm normalization of thyroid function. All sexual domains scores were significantly reduced (p ranging <0.0001-<0.05) in both hypo- and hyperthyroid women. Correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged. In hyperthyroid women therapy normalized sexual desire, arousal/lubrication, satisfaction, and pain, while orgasm remained significantly impaired. Interestingly, euthyroid HT women displayed a significant decrease in sexual desire (p<0.0005), with no changes in the other sexual domains. Both hypo- and hyperthyroidism markedly impair female sexual function. A rapid improvement is observed with the restoration of euthyroidism, although a longer period of time may be needed for full normalization. Preliminary data suggest that thyroid autoimmunity may selectively impair sexual desire, independently from thyroid function.

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... An increase in the prevalence of sexual dysfunction as a consequence of this pathology has also been found in both sexes [3][4][5][6][7]. In the specific case of women, hypothyroidism has been related to disorders in desire, arousal, lubrication, satisfaction and orgasm, as well as dyspareunia [5,8,9]. Different mechanisms have been proposed in order to explain the relationship between hypothyroidism and sexual dysfunction, some direct mechanism (hyperprolactinemia, alteration of other hormonal axes [10]) but also indirect mechanisms (classic symptoms of hypothyroidism [3,5], mood disorders [3,4], autoimmune processes, changes in blood circulation in the genital area [3,4]); however, the exact causes have not been precisely defined. ...
... However, not all the patients seem to obtain the same benefit from the treatment, and occasionally, some symptoms persist even after reaching euthyroidism [5,11,12]. Pasquali et al. (2013) found that arousal and orgasm dysfunction persisted, whereas Oppo et al. (2011) reported the presence of disorders in orgasm even with an appropriate treatment. ...
... Although, in last years, some research has been conducted with larger samples of women with subclinical hypothyroidism [13,14], little attention has been paid to sexuality in women with primary hypothyroidism treated with levothyroxine [4,5]. Furthermore, the studies use small samples and the patients are not always euthyroid women [5,8,9,15]. In Spain, to the best of our knowledge, there are no previous studies on this topic. ...
Article
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Background: Levothyroxine is the most common treatment to normalize thyroid hormones levels and to reduce primary hypothyroidism symptoms. Aim: To assess sexual function in women with levothyroxine-treated hypothyroidism and women without hypothyroidism. Methods: A case-control study was performed with 152 women with levothyroxine-treated hypothyroidism and 238 women without hypothyroidism. An online survey was used to collect socio-demographic data and the answers to the Women Sexual Function (WSF) questionnaire. Results: Women with levothyroxine-treated hypothyroidism showed a higher prevalence of sexual dysfunction than women in the control group (31.60% vs. 16.40%), furthermore the presence of hypothyroidism increased the risk of sexual dysfunction (p = 0.002, OR: 2.29 (1.36−3.88)). The most affected domains were 'desire' (p < 0.001), 'arousal' (p = 0.003) and 'penetration pain' (p = 0.020). In hypothyroid women, age increased the risk of sexual dysfunctions (p = 0.009, OR: 1.07 (1.01−1.12)), however when age was adjusted (ANCOVA) the sexual dysfunction remained in women with hypothyroidism in all domains. Conclusions: Hypothyroidism is associated with an increase in the prevalence of sexual dysfunction even if treated with levothyroxine and thyroid-stimulating hormone (TSH) levels are normalized. Relevance to clinical practice: Sexual function in hypothyroid women should be assessed before and after starting the treatment.
... Thyroid patients also experience changes of appearance, most prominently in patients with Graves' orbitopathy (6,7). Impairment of sex life in women with hypothyroidism and hyperthyroidism and in euthyroid patients with Hashimoto's thyroiditis has been reported in a few studies investigating relatively small samples (8)(9)(10)(11)(12)(13). All relevant domains of female sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain) have been reported to be impaired in hypo-and hyperthyroidism and chronic autoimmune thyroiditis. ...
... All relevant domains of female sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain) have been reported to be impaired in hypo-and hyperthyroidism and chronic autoimmune thyroiditis. Sexual dysfunction has been reported to be associated with abnormal serum levels of thyrotropin (TSH), free thyroid hormones, and thyroperoxidase antibodies (TPO-Ab) (8,9,12). Even mild thyroid abnormality may lead to deterioration in sex life quality (12). ...
... More women with nodular goiter had sexual dysfunction than those with hyper-or hypothyroidism, or Hashimoto's thyroiditis (9). Also, only a few studies have addressed whether therapy restores sex life in thyroid patients (8,14). Sexual function improved but was not normalized after restoration of thyroid function in females with hypo-and hyperthyroidism (8). ...
Article
Background: This study aimed to describe the frequency of self-reported thyroid-related impaired sex life in patients with thyroid diseases, to examine its clinical correlates and relationship with overall quality of life (QOL), and to investigate the effect of treatment. Patients and methods: Two separate patient samples with benign thyroid diseases were investigated: a cross-sectional sample (759 women and 118 men) treated at two Danish university hospital outpatient clinics, in 2007-2008, and a longitudinal sample (358 women and 74 men) undergoing treatment at the abovementioned centers, during 2008-2012, evaluated before and 6 months after therapy. The thyroid-specific QOL questionnaire ThyPRO was used to measure patient-evaluated thyroid-related sex life impairment. Biochemical and clinical variables were analyzed, i.e. age, education, degree of thyroid dysfunction, co-morbidity, serum thyrotropin, total thyroxine and triiodothyronine, as well as thyroperoxidase and thyrotropin receptor antibody concentrations. The SF-36 Health Survey was used to analyze the effect of impaired sex life on overall QOL. Results: In the cross-sectional sample, 36% of women and 31% of men reported what they perceived to be thyroid-attributable impaired sex life. Women with autoimmune thyroid diseases reported more impairment than those with non-autoimmune thyroid diseases. In patients with Graves' disease lower levels of educational attainment and in patients with toxic nodular goiter co-morbidities were associated with impaired sex life. Overall QOL was lower in patients with thyroid-related sex life impairment. In the longitudinal sample, 42% of women and 33% of men had impaired sex life at baseline, which improved at six months follow-up only in women and, when analyzing individual diagnoses separately, statistically significantly among those with autoimmune hypothyroidism. Sexual impairment was associated with low education in patients with toxic nodular goiter and with high plasma triiodothyronine concentrations in patients with Graves' disease. In autoimmune hypothyroidism, a younger age was associated with sex life impairment. Conclusion: We found a high frequency of self-reported, thyroid-related sex life impairment in patients with benign thyroid diseases, especially in young women with autoimmune thyroid diseases. Self-perceived impaired sex life persisted in women treated for Graves' disease, suggesting that normalization of thyroid function was not sufficient to restore sexual function. .
... Since the incidence of hypothyroidism also peaks at the age of menopause and perimenopausal symptoms could overlap with symptoms of hypothyroidism, screening for hypothyroidism in women at this age is generally recommended (Shifren and Gass, 2014). Indeed, persistent primary hypothyroidism is occasionally associated with hyperprolactinaemia, due to the stimulatory effect of the thyrotropin-releasing hormone (TRH) on the production of prolactin (Oppo et al., 2011). Thyroxine replacement therapy with a return to the euthyroid state restores menstrual and ovulatory function in most hypothyroid and hyperthyroid women, and also normalizes prolactin levels in those with coincident hyperprolactinaemia (Krassas, 2000). ...
... One study conducted by Veronelli et al. revealed that diabetic, obese, and hypothyroidic women had a reduced score in the FSFI questionnaire when compared with healthy women (Veronelli et al., 2009). The same result was found by Oppo et al. (2011), who reported that abnormal thyroid function significantly impairs female sexual function, as assessed by the FSFI questionnaire, and that restoration of the euthyroid state is associated with a rapid improvement of most FSFI domain scores (Oppo et al., 2011). In addition, Oppo showed that restoration of biochemical euthyoidism was associated with normalization of the desire, satisfaction and pain domains, while arousal/lubrication and orgasm remained significantly different from healthy euthyroid controls, in spite of some improvement in orgasm. ...
... One study conducted by Veronelli et al. revealed that diabetic, obese, and hypothyroidic women had a reduced score in the FSFI questionnaire when compared with healthy women (Veronelli et al., 2009). The same result was found by Oppo et al. (2011), who reported that abnormal thyroid function significantly impairs female sexual function, as assessed by the FSFI questionnaire, and that restoration of the euthyroid state is associated with a rapid improvement of most FSFI domain scores (Oppo et al., 2011). In addition, Oppo showed that restoration of biochemical euthyoidism was associated with normalization of the desire, satisfaction and pain domains, while arousal/lubrication and orgasm remained significantly different from healthy euthyroid controls, in spite of some improvement in orgasm. ...
... In women, studies have demonstrated that low circulating thyroid hormone concentration is the most important factor driving FSD in hypothyroidism. This is supported by a study conducted by Oppo et al, 29 which demonstrated a strong correlation among circulating free T4 levels, TSH, and degree of FSD in hypothyroid women. Interestingly, this correlation was not present in women with hyperthyroidism. ...
... Interestingly, this correlation was not present in women with hyperthyroidism. 29 Studies have also revealed that prolonged primary hypothyroidism can lead to hyper-prolactinemia, which is another potential mechanism for sexual dysfunction that applies to both men and women. Hypothyroidism-mediated elevations in TRH increases the production of PRL by the anterior pituitary. ...
... 56% of the women with clinical hypothyroidism had FSD and 54.6% of women with sub-clinical hypothyroidism had FSD, compared to only 14.6% of women experiencing FSD in the control group. 41 In 1 study conducted by Oppo et al, 29 17 patients with hypothyroidism with age-matched controls were assessed for sexual function parameters using the validated FSFI before and after treatment. In these patients, all FSFI domains (desire, arousal/lubrication, orgasm, satisfaction, and pain) were directly correlated with free T4 and inversely related to serum TSH (P < .0001). ...
Article
Background: Individually, thyroid disease and sexual dysfunction are common conditions that can have a detrimental effect on quality of life. Recent reports have documented an increased prevalence of sexual dysfunction among patients with thyroid disorders. As such, it is important for sexual medicine physicians to be primed on the presentation of patients with overlying sexual and thyroid dysfunction to allow for proper management. Aim: To review the available literature exploring the relationship between thyroid disease and sexual dysfunction in men and women. Methods: A PubMed review of existing clinical and pre-clinical studies from 1978 through 2018 was performed. Main outcome measures: The prevalence, symptomatology, pathophysiology, diagnosis and management of patients with sexual dysfunction in the setting of thyroid disease were reviewed. Results: The prevalence of sexual dysfunction in patients with hypothyroid (59-63% and 22-46% in men and women, respectively) and hyperthyroidism (48-77% and 44-60% in men and women, respectively) has been estimated in select populations. Both hypothyroidism and hyperthyroidism were strongly associated with erectile and ejaculatory dysfunction: hypothyroidism with delayed ejaculation, hyperthyroidism with pre-mature ejaculation. Hypothyroidism and hyperthyroidism have been reported to impair libido in men and women; however, evidence of hypothyroidism's impact on male libido is mixed. Hypothyroid and hyperthyroid women demonstrated impairments in desire, arousal/lubrication, orgasm, satisfaction, and pain during intercourse. Mechanistically, hypothyroidism and hyperthyroidism exert effects on circulating sex hormone levels through peripheral and central pathways and can indirectly provoke psychiatric and autonomic dysregulation that can impair sexual function. Correction to euthyroid state was associated with dramatic resolution of sexual dysfunction in both male and female patients with hypothyroidism or hyperthyroidism. Conclusion: By improving awareness of the link between thyroid disease and sexual dysfunction, sexual medicine physicians may sooner identify patients whose sexual symptoms may be remedied by treating an underlying thyroid disorder. Gabrielson AT, Sartor RA, Hellstrom WJG. The Impact of Thyroid Disease on Sexual Dysfunction in Men and Women. Sex Med Rev 2018;XX:XXX-XXX.
... Similarly, Nikoobakht et al 16 found that the International Index of Erectile Function score in male with hypothyroidism was significantly decreased. For female subjects, Oppo et al 17 suggested that all female sexual function index (FSFI) domains scores were significantly reduced in hypothyroidism women. Of note, with the restoration of the euthyroid state, a significant improvement in FSFI domain scores in women and erectile function in men when the restoration of the euthyroid state was achieved. ...
... Of note, with the restoration of the euthyroid state, a significant improvement in FSFI domain scores in women and erectile function in men when the restoration of the euthyroid state was achieved. 17,18 Despite the results of some studies indicating hypothyroidism may have an adverse effect on female and male sexual functioning, the association between hypothyroidism and the risk of SD remains controversial. Corona et al 19 found that there was no association between hypothyroidism and erectile function after adjusting for potential confounders. ...
Article
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Introduction Many investigators have found a detrimental effect on sexual functioning developed by hypothyroidism in both sexes, but a cumulative analysis has not been conducted. Aim This study aims to summarize and quantify the association between overt or subclinical hypothyroidism and the risk of sexual dysfunction (SD) through a meta-analysis. Methods 4 electronic databases were systematically searched. The quality of evidence was rated by the GRADE approach. This meta-analysis was registered on the PROSPERO (ID: CRD42020186967). Main Outcome Measure The strength of the relationship between overt/subclinical hypothyroidism and SD was quantified by presenting the relative risk (RR) with its 95% confidence interval (CI). Results 7 studies involving 460 patients with hypothyroidism and 2,143 healthy controls were included in this meta-analysis. Among the 7 included studies, 2 studies were provided the data of both overt and subclinical hypothyroidism. Pooled results from 4 included studies investigating overt hypothyroidism indicated that overt hypothyroidism led to significant SD in both sexes (RR = 2.26, 95% CI: 1.42 to 3.62, P = 0.001), while synthetic RR of 5 eligible studies reporting subclinical hypothyroidism failed to find a positive association between subclinical hypothyroidism and SD (RR = 1.3, 95% CI: 0.85 to 1.99, P = 0.229), irrespective of gender (all P > 0.05). Subgroup analyses revealed that women with overt hypothyroidism rather than men with overt hypothyroidism were correlated with a significant higher risk of SD. The quality of evidence in the study of overt hypothyroidism and subclinical hypothyroidism was considered low and moderate, respectively. Conclusion SD is a devastating problem in female patients with clinical hypothyroidism but insusceptible in either women or men with subclinical hypothyroidism. Clinicians should be aware of these phenomena and manage the sufferers accordingly in clinical practice. More rigorous studies are still needed to validate this evidence. Shen M, Li X, Wu W, et al. Is There an Association Between Hypothyroidism and Sexual Dysfunction: A Systematic Review and Cumulative Analysis. Sex Med 2021;9:100345.
... Moreover, the mean FSFI score was lower than 23 (22.6±4.6) also in Group 4 but not significantly different from Group 1 and Group 2, suggesting a low influence of thyroxine replacement therapy in improving sexual function. Oppo et al. reported that thyroid autoimmunity may impair sexual desire independently of thyroid function (19). Our ...
... In particular, we have not found any significant differences in the single domains in patients with Hashimoto's thyroiditis in Group 3, but the total FSFI score was 22.6, lower than the cut-off value. Other authors observed that correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged (19). However, Mariotti et al. reported no data on total FSFI in patients with hypothyroidism and hyperthyroidism, before and after treatment, so that it is difficult to draw more general assumptions regarding the efficacy of normalization of thyroid hormones values on women's sexual health. ...
... Moreover, the mean FSFI score was lower than 23 (22.6±4.6) also in Group 4 but not significantly different from Group 1 and Group 2, suggesting a low influence of thyroxine replacement therapy in improving sexual function. Oppo et al. reported that thyroid autoimmunity may impair sexual desire independently of thyroid function (19). Our ...
... In particular, we have not found any significant differences in the single domains in patients with Hashimoto's thyroiditis in Group 3, but the total FSFI score was 22.6, lower than the cut-off value. Other authors observed that correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged (19). However, Mariotti et al. reported no data on total FSFI in patients with hypothyroidism and hyperthyroidism, before and after treatment, so that it is difficult to draw more general assumptions regarding the efficacy of normalization of thyroid hormones values on women's sexual health. ...
... Moreover, the mean FSFI score was lower than 23 (22.6±4.6) also in Group 4 but not significantly different from Group 1 and Group 2, suggesting a low influence of thyroxine replacement therapy in improving sexual function. Oppo et al. reported that thyroid autoimmunity may impair sexual desire independently of thyroid function (19). Our data showed an impairment of sexual function in patients with thyroid diseases independently of thyroid autoimmunity. ...
... In particular, we have not found any significant differences in the single domains in patients with Hashimoto's thyroiditis in Group 3, but the total FSFI score was 22.6, lower than the cut-off value. Other authors observed that correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged (19). However, Mariotti et al. reported no data on total FSFI in patients with hypothyroidism and hyperthyroidism, before and after treatment, so that it is difficult to draw more general assumptions regarding the efficacy of normalization of thyroid hormones values on women's sexual health. ...
... Moreover, the mean FSFI score was lower than 23 (22.6±4.6) also in Group 4 but not significantly different from Group 1 and Group 2, suggesting a low influence of thyroxine replacement therapy in improving sexual function. Oppo et al. reported that thyroid autoimmunity may impair sexual desire independently of thyroid function (19). Our ...
... In particular, we have not found any significant differences in the single domains in patients with Hashimoto's thyroiditis in Group 3, but the total FSFI score was 22.6, lower than the cut-off value. Other authors observed that correction of hypothyroidism was associated to normalization of desire, satisfaction, and pain, while arousal and orgasm remained unchanged (19). However, Mariotti et al. reported no data on total FSFI in patients with hypothyroidism and hyperthyroidism, before and after treatment, so that it is difficult to draw more general assumptions regarding the efficacy of normalization of thyroid hormones values on women's sexual health. ...
... Like diabetes and obesity, thyroid failure in women insufficiently treated with levothyroxine (the mean serum thyrotropin levels equal to 4.4 mIU/l) was accompanied by sexual dysfunction 3 . All sexual domains scores were significantly impaired in women with both thyroid hypofunction and hyperfunction 4,5 . Moreover, the presence of hypothyroidism co-existing with spinal cord injury was accompanied by female sexual dysfunction 6 . ...
Article
Objective: Even mild hypothyroidism in premenopausal women is accompanied by impaired sexual functioning. The study was aimed at comparing the effect of levothyroxine, administered alone or in combination with liothyronine, on sexual function and depressive symptoms in premenopausal women treated because of hypothyroidism. Methods: This quasi-randomized, single-blind study included 39 young women receiving levothyroxine treatment who, despite thyrotropin and thyroid hormone levels within normal limits, still experienced clinical symptoms of hypothyroidism. These patients were divided into two groups: group A (n = 20) continued levothyroxine treatment, while group B (n = 19) received levothyroxine/liothyronine combination therapy. At the beginning of the study and six months later, all participants of the study filled in questionnaires evaluating female sexual functioning (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition - BDI-II). Results: The study completed 37 women. Baseline sexual functioning and depressive symptoms did not differ between the study groups. Neither the total FSFI score nor the domain scores changed throughout the study in women who continued levothyroxine treatment. Compared to levothyroxine administered alone, levothyroxine/liothyronine combination therapy increased scores for two domains: sexual desire and arousal, tended to increase the total FSFI score, as well as tended to decrease the overall BDI-II score. The effect of the combination therapy on sexual function correlated with a treatment-induced increase in serum levels of free triiodothyronine and testosterone. Conclusions: The obtained results suggest that levothyroxine administered together with liothyronine is superior to levothyroxine administered alone in affecting female sexual functioning.
... Although the mean of the TPOab in the FSD and non-FSD group was significantly different, however, it was not an independent risk factor in the multivariate analysis. However, Oppo et al. reported that thyroid autoimmunity may selectively impair sexual desire independently of thyroid function 40 . ...
Article
Full-text available
Research on female sexual dysfunction (FSD) is limited, especially in China, due to conservative culture and beliefs. There has been a dearth of FSD screening research in China since the optimal cutoff value of the Chinese version of the Female Sexual Function Index (CVFSFI) was determined in 2014. At the same time, the relationship between thyroid hormones and FSD has seldom been explored in Chinese women. Therefore, hospital-based research was conducted to elucidate FSD frequency and risk factors. Women who underwent a check-up at the Health Promotion Center were approached to participate and, if consented, were enrolled in the study. Demographic and socioeconomic data was extracted. All participants completed the CVFSFI and Beck Depression Inventory (BDI) self-report questionnaires and underwent thyroid hormone tests. A total of 1119 participants were included in the final analysis, with a mean age of 38.6 ± 7.6 years and average CVFSFI score of 25.7 ± 3.9. The frequency of FSD among the participants in this hospital-based cross-sectional study was 26.5%. In addition to age, menopause, parity and depression status as risk factor, and annual income (40,000–100,000 RMB/year) and educational background (≥university) as protective factor, elevated free triiodothyronine (fT3) was identified as an independent risk factor of FSD.
... The lower reported FSD prevalence in our study could be due to sociocultural barriers that are challenging to address, especially in cross-sectional surveys. We observed a [16] endocrinopathies, and use of illicit drugs, e.g. antidepressant drugs 6. ...
Article
Introduction: There is a dearth of studies evaluating sexual dysfunction in women with Type 2 Diabetes Mellitus (T2DM), despite anecdotal evidence suggesting an association between glycemic control and female sexual health. Materials and Methods: An observational cross-sectional study was carried out in 100 women with T2DM under follow-up at a regional diabetes center. Validated questionnaires, Female Sexual Function Index (FSFI), and Female Sexual Distress Scale (FSDS) were used to collate the prevalence and severity of female sexual dysfunction (FSD) in the subjects. Anthropometric and metabolic parameters were recorded by clinical examination and blood tests, respectively. Results: FSD was reported in 18% (95% CI: 10.5–25.5%) of the women enrolled in the study. The women with FSD were significantly older (50 ± 9.3 years vs. 43.9 ± 8.2 years, P = 0.006). In addition, the mean body mass index (BMI) (31.96 ± 5.5 Kg/m2 vs. 28.98 ± 4.63Kg/m2, P = 0.02) and waist circumference (38.88 ± 6.6 inches vs. 35.54 ± 5.62 inches, P = 0.03) were higher in the women with FSD compared with those without FSD. However, we observed no statistically significant association between FSD and the duration of diabetes, level of glycemic control, and serum testosterone level. Conclusion: Advanced age, higher BMI, and central adiposity were related with the development of FSD, whereas the duration of diabetes and level of HbA1c did not increase FSD risk.
... In women, hyperprolactinemia is closely related to hypoactive sexual desire disorder. 17 Hyperprolactinemia may be a factor of sexual dysfunction in women with clinical hypothyroidism and SCH. 7 Increased TSH may lead to hyperprolactinemia, which can lead to decreased libido, lubrication, and orgasm failure by reducing gonadotropin-releasing hormone production. ...
Article
Full-text available
Introduction Hypothyroidism and subclinical hypothyroidism (SCH) are common metabolic diseases with severe psychological and physiological effects, which may be the risk factors of sexual dysfunction. Aim The purpose of this study is to explore the influence of hypothyroidism and SCH on female sexual function through systematic literature review. Methods Until February 2020, systematic searches were conducted on Pubmed, Web of Science, EMBASE, and Clinicalkey to obtain eligible studies to report the mean and standard deviation of Female Sexual Function Index (FSFI) in various fields in women with clinical hypothyroidism, SCH, and healthy controls. In accordance with the results of heterogeneity test, a random effect model or fixed effect model was selected to aggregate the scores of each field. The scores of female patients with hypothyroidism and healthy controls were compared using forest plot. Stata (version 15.1) uses meta-analysis. Main Outcome Measure Evaluation values of various fields of FSFI in clinical hypothyroidism, SCH, and healthy controls. Results This study included 7 studies, including 88 women with clinical hypothyroidism, 337 women with SCH, and 2056 healthy controls. Compared with healthy controls, patients with hypothyroidism scored lower in all FSFI dimensions (desire, arousal, lubrication, orgasm, satisfaction, and pain), especially in lubrication. And, only arousal and orgasm decreased in patients with SCH. Hypothyroidism (odds ratio = 3.912, P = .002) rather than SCH (odds ratio = 1.036, P = .886) was a risk factor for female sexual dysfunction. Conclusion Hypothyroidism does impair female sexual function to varying degrees. SCH has little effect on female sexual function. It is essential to measure and evaluate the thyroid function of women with sexual dysfunction regularly, which can help clinicians improve sexual function and sexual quality of life. Wang Y and Wang H. Effects of Hypothyroidism and Subclinical Hypothyroidism on Sexual Function: A Meta-Analysis of Studies Using the Female Sexual Function Index. Sex Med 2020;XX:XXX–XXX.
... Besides, it is believed that the thyroid hormone level can influence reproductive hormone levels as well as sexual and reproductive function. [52][53][54] Although the efficacies and positive treatment experiences of TA procedures have been determined in recent researches, still randomized controlled studies involving large numbers of patients and longer follow-up periods are required to further confirm this conclusion. ...
Article
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Purpose: Thermal ablation (TA), as one of the most currently remarkable technologies, has achieved great success in many malignant diseases including but not limited to hepatic and renal carcinoma. In recent years, this technology was gradually introduced to the treatment of papillary thyroid microcarcinoma (PTMC) and even papillary thyroid carcinoma (PTC). Thereby, we summarized the current progress of TA development in the treatment of PTMC. Methods: The latest relevant literature from the PubMed database with keywords "thermal ablation", "papillary thyroid microcarcinoma", "microwave ablation", "radio-frequency ablation", and "laser ablation", among others, were comprehensively reviewed in this article. The follow-up outcomes of patients in these articles were analyzed. Results: The efficacy and safety of TA including microwave ablation (MWA), laser ablation (LA), and radiofrequency ablation (RFA) in the treatment of PTC and PTC have been intensively studied. Based on existing clinical trials, the relatively long-term follow-up (range, from 6 to 64.2 months) results in MWA, LA, and RFA were satisfactory that tumor volume reduction rate (VRR) reached and even surpass 99%. Compared with routine surgery methods (total thyroidectomy and lobectomy), the incidence rate of complications was relatively lower and the recurrence rate of TA techniques was not statistically significant, whereas the operative time, blood loss, length of hospital stay, and hospital cost were significantly decreased. Conclusion: TA presents the same satisfactory therapeutic effects but minimal postoperative trauma can significantly improve the patients' quality of life. However, future larger sample, multicenter, and prospective randomized controlled trials are urgently needed to validate the feasibility of TA in dealing with PTMC.
Chapter
Female orgasm disorder, the second most reported sexual problem among women, is characterized by a persistent or recurrent distressing compromise of orgasm frequency, intensity, timing, and/or pleasure. Multiple diagnostic procedures may be used to help resolve the various aspects of the underlying female orgasm disorder. Risk factors include psychosocial issues, psychiatric disorders, certain medications, central nervous system neurotransmitter imbalances associated with pelvic floor dysfunction, high‐ or low‐tone pelvic floor dysfunction, male partner sexual dysfunctions, genital medical conditions, or endocrine, neurologic or vascular disorders or debilitating disease. There has been limited research on the physiology of orgasm in women and the pathophysiologies, diagnoses, and treatments of the multiple female orgasm disorders. Therapeutic strategies include treatment considered disease modification aimed to cure the female orgasm disorder condition or symptomatic treatment aimed to reduce the female orgasm disorder symptoms so that the orgasm function is improved. More research is needed.
Article
Introduction: Use of systemic hormone therapy has been positively associated with development of dementia. Little is known about the dose-dependent effect of vaginal estradiol on dementia risk. Methods: We assessed associations between cumulative dose of vaginal estradiol tablets and dementia in a case-control study nested in a nationwide Danish cohort of women aged 50 to 60 years at study initiation, who did not use systemic hormone therapy. Each case was age-matched to 10 female controls. Results: A total of 4574 dementia cases were matched to 45,740 controls. Cumulative use of vaginal estradiol tablets was not associated with all-cause dementia; adjusted hazard ratio 1.02 (95% confidence interval [CI] 0.89-1.18) for low dose (< 750 mcg), 1.07 (0.94-1.21) for medium dose (750-2000 mcg), and 0.93 (0.84-1.03) for high dose (> 2000 mcg). Similarly, Alzheimer's disease (AD) only was not associated with vaginal estradiol. Discussion: Exposure to vaginal estradiol tablets was not associated with all-cause dementia or AD only.
Article
Introduction: Sexual dysfunction affects many people, with 33‒60% of women reporting sexual dysfunction and 8‒52% of men with erectile dysfunction or premature ejaculation. In an effort to determine the constellation of factors responsible for sexual dysfunction, the effect of thyroid hormone derangements has been of recent interest. Aim: To investigate the associations between thyroid hormones and sexual dysfunction in women and men. Methods: Literature was reviewed to examine the effects of hypo- and hyperthyroidism on sexual function. Main outcome measure: We present a summary of the effects of thyroid dysfunction on domains of sexual functioning. Results: Most studies demonstrate that men with hypo- and hyperthyroidism have increased rates of sexual dysfunction, including erectile dysfunction in men with hypothyroidism. However, studies vary on the strength of correlation between hormonal derangement and level of sexual dysfunction. In both men with hyper- and hypothyroidism, treating the thyroid disorder at least partially reverses sexual dysfunction. In contrast, the current literature provides no consensus on the effect of hypothyroidism, hyperthyroidism, or Hashimoto's thyroiditis on female sexual function. In studies that observed increased rates of sexual dysfunction in women with thyroid disorders, correction of the thyroid derangement resulted in resolution of some sexual dysfunction. Studies are also conflicted on whether there is a relationship between the degree of sexual dysfunction and the degree of hormone derangement in women. However, prior work has demonstrated a relationship between thyroid autoantibodies and sexual dysfunction in women. Conclusion: Thyroid dysfunction is an important factor in the pathogenesis of sexual dysfunction in men and possibly women. Evidence suggests a reversibility of sexual dysfunction with correction of thyroid dysfunction, although the exact pathophysiology of thyroid-mediated sexual dysfunction remains unknown. However, current evidence supports thyroid derangements rather than autoantibodies as the causative factor in men, whereas autoantibodies appear to play a more prominent role in women. Bates JN, Kohn TP, Pastuszak AW. Effect of Thyroid Hormone Derangements on Sexual Function in Men and Women. Sex Med Rev 2018;XX:XXX-XXX.
Article
Objective Despite high prevalence in a female population, surprisingly little is known about sexual functioning of women with thyroid hyperfunction. This study was aimed at assessing female sexual function and depressive symptoms in women with overt hyperthyroidism of autoimmune and non-autoimmune origin. Study design The study included three age-matched groups of young women inhabiting the Upper Silesia (a selenium-deficient and iodine-sufficient area): individuals with overt hyperthyroidism induced by Graves’ disease (group A, n = 31), women with overt hyperthyroidism caused by toxic multinodular goiter or toxic adenoma (group B, n = 30) and women with normal thyroid function (group C, n = 34). Apart from measuring serum hormone levels, serum antibody titers and determining calculated parameters of thyroid homeostasis, all women completed questionnaires evaluating femalesexual function (FSFI) and depressive symptoms (BDI-II). Results The mean total FSFI score and all domain scores were lower while the overall BDI-II score was higher in both groups of women with overt hyperthyroidism than in the control group, and correlated with thyrotropin and free thyroid hormone levels, as well as with the SPINA-GT index. The FSFI score as well as domain scores for desire, arousal and sexual satisfaction were lower, while the BDI-II score was higher in group A than in group B. In group A, the total FSFI score, desire, arousal, sexual satisfaction and severity of depressive symptoms correlated with TRAb and TPOAb titers. Conclusion The obtained results suggest that excessive thyroid hormone production and thyroid autoimmunity have an additive effect on sexual functioning and mood.
Article
Objective The results of few studies conducted to date suggest an increased prevalence of sexual dysfunction in patients with thyroid disorders. DesignThe aim of this study was to compare female sexual function and depressive symptoms between women with autoimmune thyroid disease and with mild thyroid failure. PatientsThe study included four groups of young women: euthyroid women with Hashimoto's thyroiditis (Group 1), women with nonautoimmune subclinical hypothyroidism (Group 2), women with autoimmune subclinical hypothyroidism (Group 3) and healthy euthyroid females without thyroid autoimmunity (Group 4). MeasurementsBeyond measuring serum hormone levels and thyroid antibody titres, all enrolled women completed questionnaires evaluating female sexual function (Female Sexual Function Index - FSFI) and the presence and severity of depressive symptoms (Beck Depression Inventory-Second Edition - BDI-II). ResultsThe mean total FSFI score was lower in women with autoimmune hypothyroidism than in the remaining groups of women, as well as lower in Groups 1 and 2 than in Group 4. Compared to Group 4, three domains (sexual desire, lubrication and sexual satisfaction) were lower in Group 1, four domains (desire, arousal, lubrication and dyspareunia) in Group 2 and all FSFI domain scores in Group 3. The total BDI-II score was higher in Groups 1 and 2 than in Group 4, as well as higher in Group 3 than in the other groups of women. Conclusions The obtained results suggest that both thyroid autoimmunity and mild thyroid failure, particularly if they occur together, may negatively affect female sexual function and depressive symptoms.
Article
Background Numerous studies have shown the detrimental effects of overt hyperthyroidism on sexual functioning but a quantitative result has not yet been synthesized. Aim To conduct a systematic review and meta-analysis that quantifies the association between overt hyperthyroidism and the risk of sexual dysfunction (SD). Methods A meta-analysis of studies in the literature published prior to February 1, 2020, from 4 electronic databases (MEDLINE, Embase, Cochrane Library databases, and PsychINFO) was conducted. All analyses were performed using the random-effects model comparing individuals with and without overt hyperthyroidism. Outcomes The strength of the association between overt hyperthyroidism and risk of SD was quantified by calculating the relative risk (RR) and the standard mean difierences with 95% CI. The quality of evidence for the reported outcome was based on the Grading of Recommendations Assessment, Development, and Evaluation approach. Results Of 571 publications, a total of 7 studies involving 323,257 individuals were included. Synthetic results from 7 eligible studies indicated that overt hyperthyroidism led to significant SD in both sexes (pooled RR = 2.59, 95% CI: 1.3–5.17, P = .007; heterogeneity: I² = 98.8%, P < .001). When we analyzed the data of men and women independently, the pooled results consistently showed that men and women with overt hyperthyroidism were at over 2-fold higher risk of SD than the general populations (RR for males = 2.59, 95% CI: 1.03–6.52, P = .044; RR for females = 2.51, 95% CI: 1.47–4.28, P = .001). Combined standard mean diffierences from those studies providing the Female Sexual Function Index (FSFI) suggested that women with overt hyperthyroidism were associated with a significantly lower FSFI value in FSFI total scores, subscale sexual arousal, lubrication, orgasm, and satisfaction domain (all P < .05). The overall quality of evidence in our study was considered to be moderate. Clinical Implications Clinicians should know the detrimental effects of overt hyperthyroidism on sexual functioning in clinical practice. Measurement of thyroid hormones should be included in the assessment of patients presenting with SD when they show symptoms of clinical hyperthyroidism. Strengths & Limitations This is the first meta-analysis quantifying the relationship between overt hyperthyroidism and the risks of SD. However, the combined results were derived from limited retrospective studies along with substantial heterogeneities. Conclusion Our study has confirmed the potentially devastating sexual health consequences caused by overt hyperthyroidism. However, additional rigorous studies with sizable samples are still needed to better elucidate this evidence. Pan Y, Xie Q, Zhang Z, et al. Association Between Overt Hyperthyroidism and Risk of Sexual Dysfunction in Both Sexes: A Systematic Review and Meta-Analysis. J Sex Med 2020;XX:XXX–XXX.
Article
Von der mit fortschreitendem Lebensalter zunehmenden Prävalenz von Schilddrüsenerkrankungen sind Frauen deutlich häufiger betroffen als Männer. Symptome einer Schilddrüsenerkrankung sind oft unspezifisch und damit nicht ohne Weiteres von Symptomen des physiologischen Alterns und auch der Peri‑/Postmenopause abzugrenzen. Eine korrekte Diagnosestellung ist nicht zuletzt im Hinblick auf das in Peri‑/Postmenopause ohnehin erhöhte Osteoporose- und kardiovaskuläre Risiko relevant. Diskutiert werden (Differenzial‑)Diagnostik einschließlich zu berücksichtigender beeinflussender Faktoren sowie Therapie und Therapie-Monitoring auch in besonderen situativen Konstellationen.
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Background: Few data exist on the prevalence of female sexual dysfunction (FSD) in thyroid disorders. Aim: We evaluated FSD in women with thyroid diseases and in control age-matched healthy women to investigate the relationship between sexual function and thyroid hormones. Methods: One hundred and four women with thyroid diseases and 53 controls participated in the study. Eighteen with hyperthyroidism (Group 1), 22 hypothyroidism (Group 2), 45 Hashimoto's thyroiditis (Group 3), 19 nodular goiter (Group 4) underwent thyroid function evaluation and sonography. The Female Sexual Function Index (FSFI) assessed sexual function. Results: The prevalence of FSD was 46.1% in thyroid diseases and 20.7% in controls. Only in Group 4, the prevalence (68.4%) was significantly higher than in controls (p<0.005). The mean total FSFI score was 20.1 ± 7.1 in women with thyroid diseases and 25.6 ± 4.7 in the controls (p<0.001). Compared with controls, there was a significant decrease of desire in Group 2; desire, arousal and lubrication in Group 3; desire, arousal, lubrication, orgasm and satisfaction in Group 4. In thyroid diseases the prevalence of FSD was 53% and 42%, while in the controls was 55% and 20%, in menopausal and pre-menopausal groups, respectively. We found a significant inverse correlation between TSH and FSFI (r=-0.7, p=0.01) in Group 4, which showed the lowest FSFI score (17.8 ± 5.7) and the highest body mass index (28.4 ± 7.1 kg/m(2)). Conclusions: Women with thyroid diseases present a higher prevalence of FSD than controls. Although our findings suggest a higher impairment of sexual function in Group 4 and a role for TSH in FSD, further researches are needed.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
Article
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While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.
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This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
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To report a series of newly diagnosed thyrotoxic patients with concurrent acute psychosis, and to assess the association between the two disorders. Retrospective study of thyrotoxic patients with associated psychosis ('thyrotoxic psychosis'; TP) requiring inpatient psychiatric care. New Zealand thyrotoxicosis annual incidence figures and first psychiatric admission rates for affective psychosis were utilised to statistically assess the co-occurrence of thyrotoxicosis and affective psychosis. During the 20-year study period, 18 inpatients (16 women and 2 men), mean age 54 years, with TP were identified. No patient had a past history of thyrotoxicosis, but four had required psychiatric inpatient care many years earlier. Thyrotoxicosis was documented by radioimmunoassay of thyroid hormone levels, and thyroid scintiscan. Psychiatric manifestations were classified using ICD9 criteria. Thyroid hormone levels were markedly elevated in more than half of our TP patients. All younger patients had Graves' disease, and most older patients toxic nodular goitre. All patients were treated with antithyroid drugs, and all but one subsequently received (131)I therapy. Two patients were not mentally ill when thyrotoxicosis was diagnosed, but suffered major mood swings when thyroid hormone levels were falling. There was no specific psychiatric clinical picture but affective psychoses were commonest - seven depression, seven mania. The other diagnoses were two schizophreniform, one paranoid, and one delirium. Initially, neuroleptic medication was used in all but one patient, and during long-term follow-up (median 11 years) more than half our series had remained well with no further psychiatric problems. Statistical analysis was restricted to thyrotoxic patients with first psychiatric hospital admission for affective psychosis. During the 20-year period, there were nine thyrotoxic patients (95% confidence interval 4.5-17.1) with concurrent affective psychosis requiring first admission, and the calculated expected number was only 0.36. These findings indicate a clear association well above chance co-occurrence. TP is not a specific clinical picture, but affective psychoses are commonest. Statistical analysis of thyrotoxic patients with concurrent affective psychoses showed an incidence well above chance co-occurrence. It appears that thyrotoxicosis may be a precipitant of acute affective psychosis.
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To evaluate the association between mood and anxiety disorders in Hashimoto disease and Euthyroid Goitre in a case control study. Cases included 19 subjects with Hashimoto disease in euthyroid phase, 19 subjects with euthyroid goitre, 2 control groups each of 76 subjects matched (4/1) according to age and sex drawn from the data base of a community based sample. Psychiatric diagnoses were formulated using the International Composite Diagnostic Interview Simplified, according to DSM-IV criteria. All subjects underwent a complete thyroid evaluation including physical examination, thyroid echography and measure of serum free T4 (FT4), free T3 (FT3), thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase autoantibodies (anti-TPO). Subjects with Hashimoto disease showed higher frequencies of lifetime Depressive Episode (OR = 6.6, C.L. 95% 1.2-25.7), Generalized Anxiety Disorders (OR = 4,9 Cl 95% 1.5-25.4) and Social Phobia (OR = 20.0, CL 95% 2.3-153.3) whilst no differences were found between subjects with goitre and controls. The study seems to confirm that risk for depressive disorders in subjects with thyroiditis is independent of the thyroid function detected by routine tests and indicates that not only mood but also anxiety disorders may be associated with Hashimoto disease.
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Erectile dysfunction (ED) is associated with numerous diseases and aging. The objective of the study was to investigate the impact of hyper- and hypothyroidism on male sexual health by using the Sexual Health Inventory for Males (SHIM). Seventy-one men, 27 hyper- and 44 hypothyroid and a similar number of controls were included in the study. A validated SHIM 5-item questionnaire was administered to all participants. Patients were asked to respond before and a year after initiation of treatment for thyroid dysfunction. A score between 25 and 22 is considered normal, between 21 and 11 diagnostic of mild to moderately severe ED, and 10 or less diagnostic of severe ED. Fifty-six men with thyroid dysfunction (78.9%; 19 hyperthyroid and 37 hypothyroid) had a SHIM score of 21 or less, compared with 24 controls (33.8%) (P < 0.0001). Twenty-one patients with ED (37.5%) had SHIM scores 10 or less, indicative of severe ED, compared with six controls (25%) (P < 0.01). ED was more prevalent in patients with hyperthyroidism and hypothyroidism, compared with controls (P < 0.001 and P < 0.0001, respectively). Positive correlation was found between SHIM scores and serum free T(4) (r = 0.413, P = 0.005) and negative for TSH (r = -0.669, P < 0.001). After treatment a significant increase of SHIM scores was noted in both hyperthyroid (P < 0.0001) and hypothyroid (P < 0.0001) patients. ED is extremely common in males with dysthyroidism. Treatment of the latter restores erectile function. Screening for thyroid dysfunction in men presenting with ED is recommended, whereas specific treatment for ED should be postponed in such patients for at least 6 months after achieving euthyroidism because the latter might be responsible for ED.
Article
Introduction: Many patients with endocrinal changes (endocrinopathy) have some degrees of sexual dysfunction that necessitate assessment and treatment. Aim: To assess the prevalence, and identify the pattern, of endocrinopathy in patients with sexual dysfunction in our community. Methods: A total of 1,248 male patients with sexual dysfunction were enrolled in this study. Patients were screened for erectile dysfunction (ED) and sexual desire by the erectile function and the sexual desire domains of the International Index of Erectile Function (IEEF). Patients underwent routine laboratory investigations as well as total testosterone and prolactin assessment. All patients were referred to an endocrinologist for clinical and biochemical assessment of their endocrine function. The evaluation consisted of comprehensive history taking, physical examination, and, as needed, laboratory investigations. Results: Mean ages+/-SD were 51.9+/-12.2 and 52.3+/-11.7 years for patients with and without endocrinopathy, respectively. Of the study population, 23.8% had endocrinopathy. The most frequent endocrinal changes were low testosterone level (15%), hyperprolactinemia (13.7%), and hypothyroidism (3.1%). There were significant associations between endocrinopathy and obesity, smoking, low desire, and premature ejaculation (P<0.05 for each). Also, significant associations were found between low desire and low testosterone level, hyperprolactinemia, and hypothyroidism (P<0.05 for each). Hyperprolactinemia was significantly associated with premature ejaculation (P<0.05) but not with low testosterone level (P>0.05). There was no significant association between endocrinopathy and age, cigarette smoking (number and duration), and ED (duration, severity, type of onset, and progression) (P>0.05 for each). Conclusion: Endocrinopathy is not a rare condition among ambulatory patients with sexual dysfunction. This study provides a quantitative estimate of endocrinopathy in ambulatory patients with sexual dysfunction.
Article
Not only the most frequent causes of endocrine sexual dysfunction, such as hypogonadism and hyperprolactinemia, but almost all extragonadal endocrinopathies (hyper- and hypothyroidism, hyper- and hypocortisolism, steroidal secreting tumors, etc.) may have a greater or lesser effect on sexual function. We analyzed scientific literature on the correlations between hormones and sexual behavior, analyzing the most important issue from a practical point of view. The aim of this review article was thus to summarize the sexual symptoms that may be observed with endocrine diseases. Hormones directly or indirectly regulate all human sexual functions (desire, erection/lubrication, ejaculation, orgasm). Some sexual symptoms may occur as a psychosomatic consequence of hormonal impairment. However, in other cases, endocrine failure may be generated by the psychosomatic involvement. The endocrinologist, as an expert in body chemistry, is ideally positioned to identify and evaluate the full range of medical, physical, and psychiatric problems disrupting sexual function.
Article
Hypothyroidism is a common hormonal disorder in women that may affect the phases of female sexual function. To investigate female sexual function in patients with clinic hypothyroidism and subclinic hypothyroidism. A total of 25 women with clinic hypothyroidism (group 4), 25 women with subclinic hypothyroidism [thyroid stimulating hormone (TSH) value <or=10 mU/L (group 2), TSH value >10 mU/L (group 3)], and 20 age matched voluntary healthy women controls (group 1) were included in the study. All the subjects were evaluated with a detailed medical and sexual history, including a female sexual function index (FSFI) questionnaire for sexual status and the Beck Depression Inventory for psychiatric assessment. The levels of serum TSH, thyroid hormones, prolactin (PRL), free testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, lipid profile, and blood glucose were measured. Female sexual dysfunction (FSD) was diagnosed in 14 of 25 patients (56%) in group 4, in 6 of 11 patients (54.6%) in group 3, in 2 of 14 patients (14.6%) in group 2, and while only 3 of 20 the control group of women (15%) had FSD (P = 0.006). The mean total FSFI scores were 23.9 in the group 4, 26.03 in the group 3, 29.2 in the group 2, and 32.30 in the control group (P < 0.0001). The mean BDI score for clinic hypothyroidic patients was significantly greater than the scores for the control group and for the group 2 (P = 0.017 and P = 0.043, respectively). The mean PRL levels for patients in group 4 and group 3 were found to be significantly higher than the level for controls (P < 0.0001), whereas other serum hormone levels were not different among groups. A significant percent of women with clinic hypothyroidism and subclinic hypothyroidism with TSH values >10 mU/L had sexual dysfunction. Hyperprolactinemia, hyperlipidemia, and depression were associated with FSD in clinic hypothyroidism. Different than clinic hypothyroidism depression was not associated with FSD in subclinic hypothyroidism with TSH values >10 mU/L.
Article
Endocrine disorders may adversely affect men's sexual function. To provide recommendations based on best evidence for diagnosis and treatment of endocrine-related male sexual dysfunctions. The Endocrine Aspects of Male Sexual Dysfunctions Committee, including 11 members from eight countries and four continents, collaborated with the Endocrine subcommittee of the Standards Committee of the International Society for Sexual Medicine. Medical literature was reviewed in detail, followed by extensive internal committee discussion over 2 years, then public presentation and discussion with the other experts before finalizing the report. Recommendations based on grading of evidence-base medical literature and interactive discussion. From animal studies, it is derived that testosterone modulates mechanisms involved in erectile machinery, including expression of enzymes that both initiate and terminate erection. In addition, testosterone is essential for sexual motivation. Whether these findings could be extrapolated to human erections is unclear. Testosterone plays a broad role in men's overall health. Recent studies have established strong associations between low testosterone and metabolic and cardiovascular imbalances. In some studies, low testosterone decreased longevity; however, longitudinal studies do not support the predictive value of low testosterone for further cardiovascular events. The article proposes a standardized process for diagnosis and treatment of endocrine-related male sexual dysfunctions, updating the knowledge on testosterone and prostate safety. There is no compelling evidence that testosterone treatment causes prostate cancer or its progression in men without severe testosterone deficiency (TD). The possible roles of prolactin and thyroid hormones are also examined. Men with erectile dysfunction, hypoactive sexual desire and retarded ejaculation, as well as those with visceral obesity and metabolic diseases, should be screened for TD and treated. Prospective interventional studies are required before screening for TD in more conditions, including cardiovascular diseases, and considering correction as preventive medicine as much data suggests.
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Unlabelled: Depending on the availability of iodine, the thyroid gland is able to enhance or limit the use of iodine for thyroid hormone production. When compensation fails, as in severely iodine-deficient populations, hypothyroidism and developmental brain damage will be the dominating disorders. This is, out of all comparison, the most serious association between disease and the level of iodine intake in a population. In less severe iodine deficiency, the normal thyroid gland is able to adapt and keep thyroid hormone production within the normal range. However, the prolonged thyroid hyperactivity associated with such adaptation leads to thyroid growth, and during follicular cell proliferation there is a tendency to mutations leading to multifocal autonomous growth and function. In populations with mild and moderate iodine deficiency, such multifocal autonomous thyroid function is a common cause of hyperthyroidism in elderly people, and the prevalence of thyroid enlargement and nodularity is high. The average serum TSH tends to decrease with age in such populations caused by the high frequency of autonomous thyroid hormone production. On the other hand, epidemiological studies have shown that hypothyroidism is more prevalent in populations with a high iodine intake. Probably, this is also a complication to thyroid adaptation to iodine intake. Many thyroid processes are inhibited when iodine intake becomes high, and the frequency of apoptosis of follicular cells becomes higher. Abnormal inhibition of thyroid function by high levels of iodine is especially common in people affected by thyroid autoimmunity (Hashimoto's thyroiditis). In populations with high iodine intake, the average serum thyroid-stimulating hormone (TSH) tends to increase with age. This phenomenon is especially pronounced in Caucasian populations with a genetically determined high tendency to thyroid autoimmunity. A small tendency to higher serum TSH may be observed already when iodine intake is brought from mildly deficient to adequate, but there is at present no evidence that slightly elevated serum TSH in elderly people leads to an increase in morbidity and mortality. Conclusion: Even minor differences in iodine intake between populations are associated with differences in the occurrence of thyroid disorders. Both iodine intake levels below and above the recommended interval are associated with an increase in the risk of disease in the population. Optimally, iodine intake of a population should be kept within a relatively narrow interval where iodine deficiency disorders are prevented, but not higher. Monitoring and adjusting of iodine intake in a population is an important part of preventive medicine.
Article
A limiting step in the evaluation of female sexual dysfunction (FSD) is the availability of a rapid screening procedure. Often, practitioners avoid investigating sexual symptoms due to concerns of insufficient time or lack of proper tools to address FSD. The purpose of this study was to prepare and validate an abridged form of the most popular psychometric diagnostic test (Female Sexual Function Index, FSFI-19) to provide a fast screener of FSD for easy use in outpatient visits, epidemiological studies, and assessment of treatment response. We interviewed and administered the FSFI-19 to 200 women attending outpatient clinics for sexual and reproductive medicine. Forty women were excluded because they had no sexual activity or failed to attend the retest visit. Patients were evaluated on two subsequent visits to validate the abridged form of the questionnaire. Overall, 105 were found to suffer from a FSD. We assessed, individually, the sensibility and sensitivity of all questions of the full-length FSFI. We then estimated the performance of each item with respect to the specific sexual domain they address. By selecting the best combination of performing items in each domain, we built an abridged, 6-item form of the FSFI. The Receiver Operating Characteristic curves of the FSFI-6 showed that women who scored <or=19 were classified as having FSD. Using the cut-off of 19, the sensitivity and specificity of the test were, 0.93 and 0.94, respectively. Reliability, internal consistency, and stability on retest were also good. The abridged FSFI-6 is a valuable tool for screening women that are likely to suffer from FSD. In six simple questions, taking no more than 3 minutes, a score of less than 19 indicates the need for further investigations, including the full-length FSFI-19 and a dedicated interview. In conclusion, this is a novel tool that can help any doctor to disclose FSD rapidly and efficiently.
Article
Female sexual dysfunction (FSD) is characterized by reduced sexual appetite and altered psychologic and physiologic response to sexual intercourse; it is reported to be frequent in diabetes mellitus, but no data have been reported in thyroid disorders. To compare the prevalence of FSD in diabetic, in obese, and in hypothyroid women vs. healthy women, and to correlate FSD with endocrine and metabolic profiles. We evaluated, through a questionnaire (Female Sexual Function Index [FSFI]), the prevalence of FSD in 91 women affected by diabetes mellitus, obesity, or hypothyroidism, and in 36 healthy women, all aged 22-51 years and in premenopausal state. FSFI score, endocrine and metabolic parameters (triglycerides, high-density lipoprotein [HDL] and low-density lipoprotein [LDL] cholesterol, free-triiodothyronine (FT3), free-thyroxine (FT4), thyroid stimulating hormone [TSH], 17-beta-estradiol, testosterone, glycated hemoglobin 1c (HbA1c), thyroid autoantibodies, E-selectin, P-selectin, intercellular adhesion molecule-1 [ICAM-1], plasminogen-activator inhibitor-1 [PAI-1]), and anthropometric parameters (body mass index, waist, blood pressure [BP]). A reduced FSFI score was more frequent in diabetic, obese, and hypothyroid women vs. healthy women (P < 0.01). In the different groups of women, FSFI score was inversely correlated (pairwise correlation) with at least one of the following: HbA1c, TSH, LDL-cholesterol, PAI-1, diastolic BP, presence of thyroid Ab, and directly correlated with HDL-cholesterol (always P < 0.05 or less). At stepwise regression analysis, HDL-cholesterol (protective) and HbA1c, LDL-cholesterol, PAI-1, and diastolic BP (negatively) predicted reduced FSFI score. These data indicate an increased prevalence of sexual dysfunction in diabetic, in obese, and in hypothyroid women, associated with markers of cardiovascular risk.
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Female sexual dysfunction is complex and its management challenging. In this review, we discuss female sexual response and the definitions of female sexual disorders. Evidence-based strategies for the evaluation and multidisciplinary treatment of female sexual dysfunction are presented in a case-oriented manner applicable to everyday clinical practice.
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The clinical usefulness of thyroid ultrasonography in the evaluation of patients with autoimmune thyroiditis has been investigated. Thyroid ultrasonography was performed in 1184 consecutive patients attending our clinic, and the echo density of the thyroid parenchyma was evaluated with respect to that of normal thyroid tissue. Diffuse thyroid hypoechogenicity was found in 44 of 238 (18.5%) patients with autoimmune thyroiditis; the degree of hypoechogenicity was significantly correlated with the levels of circulating thyroid autoantibodies. Thyroid function was normal in all 194 patients with normal thyroid echogenicity, whereas hypothyroidism was found in 28 of 44 (63.6%) with reduced thyroid echogenicity. Included in this group were 8 patients, euthyroid at the first observation, who developed hypothyroidism over an 18-month follow-up period. None of the 133 patients with autoimmune thyroiditis and normal thyroid echogenicity followed for the same period of time became hypothyroid. Evidence of diffuse lymphocytic thyroiditis was obtained by histology after thyroidectomy (n = 10) or multiple fine needle aspiration cytology (n = 15) in 25 of the 44 patients with thyroid hypoechogenicity; on the other hand, focal thyroiditis was shown at histology in 8 patients who had normal thyroid echogenicity. In conclusion, diffuse low thyroid echogenicity was found in about 20% of patients with autoimmune thyroiditis. This echographic pattern is indicative of diffuse autoimmune involvement of the gland and is associated with or may predict the development of hypothyroidism.
Article
Thyroid microsomal antibodies (anti-M Ab) have been recently proven to be directed to thyroid peroxidase (TPO). Methods to detect anti-TPO antibodies (anti-TPO Ab) employing purified antigen have been developed, but the available information on the clinical usefulness of this technique is still limited to small patient series. In the present investigation anti-TPO Ab were assayed by a newly developed monoclonal antibody-assisted RIA in a large number (n = 715) of subjects, including 119 normal controls and 596 patients with different autoimmune or nonautoimmune thyroid disease: Anti-TPO Ab were detected in 10 of 119 (8.4%; range, 11-210 U/mL) normal controls, 134 of 181 (74%; range, 11-74.000 U/mL) patients with Graves' disease, all but 1 of 144 (99.3%; range, 11-90.000 U/mL) with Hashimoto's thyroiditis (n - 98) or idiopathic myxedema (n = 46), 20 of 180 (11.1%; range, 11-6.700 U/mL) with miscellaneous nonautoimmune thyroid diseases, 16 of 83 (19.2%; range, 11-6.600 U/mL) patients with differentiated thyroid carcinoma, and in none of 8 patients with subacute thyroiditis. The highest anti-TPO Ab concentrations were found in untreated hypothyroid Hashimoto's thyroiditis, but no simple relationship between anti-TPO Ab levels and thyroid function was observed. Anti-TPO Ab significantly decreased in patients with Graves' disease after treatment with methimazole and in those with hypothyroid Hashimoto's thyroiditis or idiopathic myxedema during L-T4 administration. A highly significant positive correlation (r = 0.979; P less than 0.001) was found between anti-M Ab titers by passive hemagglutination (PH; available in 650 sera) and the corresponding average anti-TPO Ab by RIA; discrepant results were almost exclusively limited to sera with negative or low (1:100-1:400) anti-M Ab titers. Analysis of these discrepant data indicated higher autoimmune disease specificity and sensitivity of anti-TPO Ab RIA tests compared to anti-M Ab by PH. Absorption studies showed that interference of anti-Tg Ab was responsible for anti-M Ab-positive tests in occasional anti-TPO Ab-negative/anti-M Ab-positive sera from autoimmune thyroid disease patients. Anti-TPO Ab determination by RIA was unaffected by circulating thyroglobulin concentrations up to more than 10,000 ng/mL. In conclusion, anti-TPO Ab assay by monoclonal antibody-assisted RIA appears to be more sensitive and specific for thyroid autoimmune diseases than anti-M Ab determination by PH. Since the assay is easy to perform and employs only tracer amounts of purified antigen, these characteristics should allow its rapid diffusion to the clinical routine.
Article
The original Whickham Survey documented the prevalence of thyroid disorders in a randomly selected sample of 2779 adults which matched the population of Great Britain in age, sex and social class. The aim of the twenty-year follow-up survey was to determine the incidence and natural history of thyroid disease in this cohort. Subjects were traced at follow-up via the Electoral Register, General Practice registers, Gateshead Family Health Services Authority register and Office of Population Censuses and Surveys. Eight hundred and twenty-five subjects (30% of the sample) had died and, in addition to death certificates, two-thirds had information from either hospital/General Practitioner notes or post-mortem reports to document morbidity prior to death. Of the 1877 known survivors, 96% participated in the follow-up study and 91% were tested for clinical, biochemical and immunological evidence of thyroid dysfunction. Outcomes in terms of morbidity and mortality were determined for over 97% of the original sample. The mean incidence (with 95% confidence intervals) of spontaneous hypothyroidism in women was 3.5/1000 survivors/year (2.8-4.5) rising to 4.1/1000 survivors/year (3.3-5.0) for all causes of hypothyroidism and in men was 0.6/1000 survivors/year (0.3-1.2). The mean incidence of hyperthyroidism in women was 0.8/1000 survivors/year (0.5-1.4) and was negligible in men. Similar incidence rates were calculated for the deceased subjects. An estimate of the probability of the development of hypothyroidism and hyperthyroidism at a particular time, i.e. the hazard rate, showed an increase with age in hypothyroidism but no age relation in hyperthyroidism. The frequency of goitre decreased with age with 10% of women and 2% of men having a goitre at follow-up, as compared to 23% and 5% in the same subjects respectively at the first survey. The presence of a goitre at either survey was not associated with any clinical or biochemical evidence of thyroid dysfunction. In women, an association was found between the development of a goitre and thyroid-antibody status at follow-up, but not initially. The risk of having developed hypothyroidism at follow-up was examined with respect to risk factors identified at first survey. The odds ratios (with 95% confidence intervals) of developing hypothyroidism with (a) raised serum TSH alone were 8 (3-20) for women and 44 (19-104) for men; (b) positive anti-thyroid antibodies alone were 8 (5-15) for women and 25 (10-63) for men; (c) both raised serum TSH and positive anti-thyroid antibodies were 38 (22-65) for women and 173 (81-370) for men. A logit model indicated that increasing values of serum TSH above 2mU/l at first survey increased the probability of developing hypothyroidism which was further increased in the presence of anti-thyroid antibodies. Neither a positive family history of any form of thyroid disease nor parity of women at first survey was associated with increased risk of developing hypothyroidism. Fasting cholesterol and triglyceride levels at first survey when corrected for age showed no association with the development of hypothyroidism in women. This historical cohort study has provided incidence data for thyroid disease over a twenty-year period for a representative cross-sectional sample of the population, and has allowed the determination of the importance of prognostic risk factors for thyroid disease identified twenty years earlier.
Article
Clinical thyroid disorders are frequently associated with psychiatric symptomatology, thus supporting a role for thyroid hormones in the biological basis of psychiatric disorders, particularly mood disorders. Despite extensive literature documenting various abnormalities of thyroid function tests in primary major depression, the role of thyroid hormones in the pathophysiology of affective disorders remains to be clarified. In this review, we describe the various abnormalities of thyroid hormone levels reported in primary affective illness. We also review the competing hypothesis to explain the abnormalities of thyroid function observed. Although neither model can fully explain the role of thyroid hormones in depressive illness, they provide working hypotheses for further study. Additional research is required to clarify the regulation of thyroid hormones by mature brain and the role of these hormones in the biological basis of affective illness.
Article
Cognitive and affective functioning is sensitive to changes in thyroid hormones. We have sought to determine: (1) the prevalence of thyroid function abnormalities in a psychiatric population on admission (as compared to the prevalence in a normal population), and (2) whether such thyroid function abnormalities are associated with the occurrence or development of cognitive and affective disorders. Serum was collected 2-3 weeks after hospitalization in 3 major clinics from 3756 psychiatric patients in 1987-1990, stored, and assayed in 1993 for the presence of antibodies against the TSH-receptor and thyroperoxidase (TPO-Ab) and for TSH levels. The psychiatric cohort was matched with a control population of healthy individuals living in the same area (n = 1877). The prevalence study was followed by a case-control study involving patients from one clinic that had routinely assigned a DSM-IIIR classification to its patients. Cases were those admissions with thyroid abnormalities and three subgroups of cases were randomly formed demonstrating either TSH less than 0.4 mU/l (n = 44) or over 4.0 mU/l (n = 44), or TPO-Ab positivity (n = 50). Cases were compared to random controls from the same psychiatric population, viz patients without thyroid abnormalities (n = 83). Comparison was with respect to their psychiatric follow-up diagnosis (the investigator was blinded to the thyroid test results). Prevalence study. The percentage of patients positive for TSH-receptor-Ab was 0.26 (9/3504), for TPO-Ab was 10.0 (331/3316) and outside the TSH range of 0.4-4.0 mU/l was 10.0 ((332/3316): 5.9% (198/3316) > 4.0 mU/l and 4.1% (134/3316) < 0.4 mU/l). Abnormal total thyroxine levels were found in only 9.8% of subjects with abnormal TSH, indicating the predominantly subclinical character of the thyroid alteration. In comparison, the healthy area controls over 55 years of age showed the same prevalence of positive TPO-antibodies and TSH under 0.4 mU/l, but a higher prevalence of TSH over 4.0 mU/l. CASE-CONTROL STUDY: In the case control analysis differences could not be noticed with regard to prevalences of dementia, schizophrenia or other psychiatric illnesses apart from the prevalence of affective disorders which were more prevalent in TPO-Ab positive patients and patients with a low serum TSH. Since prior use of lithium, carbamezapine, carbimazole and/or thyroxine could be a factor of importance in this association, analyses were also carried out excluding patients with such prior drug use. In these analyses affective disorders were still more prevalent in patients with a low serum TSH (particularly in males, 40% in cases vs 9% in controls, P < 0.05). The most significant association was however between TPO-antibody positivity (and in particular with high titre and/or with TSH > 4.0 mU/l) and a subgroup of the affective disorders, viz with a rapid cycling of bipolar disorder (18% in cases vs 0% in controls, P < 0.001). Though causal relations cannot be determined from this cross-sectional study, this admission survey found early forms of autoimmune thyroid disease, sometimes characterized only by TPO-Abs, highly significantly associated with rapid cycles of a bipolar disorder. It also found a weak association between subclinical hyperthyroidism (low serum TSH without TPO-Ab positivity) and affective disorder.
Article
The objective of this study was to examine the relationship between autoimmune thyroid disease and depression in perimenopausal women. Thyroid function [TSH, free T4, and thyroid peroxidase antibodies (TPO-Ab)] and depression (using the Edinburgh Depression Scale) were assessed cross-sectionally together with other determinants of depression. The subjects were 583 randomly selected perimenopausal women (aged 47-54 yr) from a community cohort of 6846 women. The main outcome measures were the occurrence of thyroid dysfunction (abnormal free T4 and/or TSH or elevated levels of TPO-Ab) and the concomitant presence of depression according to the Edinburgh Depression Scale. Neither biochemical thyroid dysfunction nor menopausal status was related to depression. Apart from several psycho-social determinants (the occurrence of a major life event, a previous episode of depression, or financial problems), an elevated level of TPO-Ab (> or = 100 U/mL) was significantly associated with depression (odds ratio, 3.0, 95% confidence interval, 1.3-6.8). We conclude that women with elevated TPO-Ab levels are especially vulnerable to depression, whereas postmenopausal status does not increase the risk of depression.
Article
Despite the importance of sexuality for both men and women of all ages, only in the last few years extensive research has been carried out into female sexual problems. It has been discovered that sexual problems affect a considerable number of women each year, and this indicates the validity and necessity of further medical studies. We know that female genital sexual response is a combination of vasocongestive and neuromuscular events in the genital tract and pelvic floor which are controlled in part by specific neurotransmitters. Other pelvi-perineal genital structures undergo vasculogenic changes, namely the labia, periurethral glands, urethra and the Halban's fascia but much less attention has been paid to the role of these tissues in sexual response compared to the clitoris and the vagina. The most common etiologies of female sexual dysfunction are vasculogenic, neurogenic, hormonal/endocrine, muscologenic. The increasing various problems of female sexual dysfunction and the interest in the matter and the subsequent research are factors which keep the scientific community involved constantly active.
Article
Women's sexuality is multifactorial, rooted in biological, psychosexual and context-related factors, correlated not only to the couple concerned, but also to family and socio-cultural issues. Female sexual identity, sexual function and sexual relationship interact to give female sexual health its full meaning or, on the contrary, its problematic profile. Women's sexuality is discontinuous throughout the life cycle and is dependent on personal, current contextual and relationship variables as well as historical factors. Female sexual dysfunctions (FSD) occur along a continuum from dissatisfaction (with or without significant distress) to complete dysfunction (with or without significant distress). Sexual problems reported by women are not discrete and often co-occur, co-morbidity being one of the leading characteristics of female sexual dysfunctions. Socio-cultural factors may modulate the expression and complaining modality, i.e. wording of a sexual disorder. The meaning of sexual intimacy is to be understood, as it is indeed a strong modulator of the sexual response and of the quality of satisfaction the woman experiences, besides being the simple adequacy of the sexual function. Quality of feelings for the partner and the partner's health and sexual problems may further contribute to FSD. To improve women's sexual health, physicians should receive a formal training in sexual medicine both in the general medical training and in the speciality course; should become competent in the first level medical diagnosis of FSD; have an interdisciplinary approach and acknowledge the socio-cultural and context-dependent differences in FSD etiology and wording.
Article
The deeper understanding of female physiology changed the perspective used to evaluate sexual difficulties. Systems like: vascular, neurological, biochemical, and endocrine are investigated as their modifications for aging or medical conditions may alter the sexual responsivity of women. New data imply that pharmacological interventions may become suitable for women. Gonadal steroids influence mood, wellbeing, and genital physiology but evidence of actions is controversial. Hormone imbalance provokes symptoms that may also derive from other conditions. Clinicians must exclude dismetabolism, depression and family crisis before diagnosing gonadal problems. The female androgen insufficiency syndrome was defined in July 2001 as altered mood, memory and wellbeing, and loss of desire. Estrogen maintains wellbeing and healthy genitals, influencing mood and sexuality. Progesterone provokes tension and nervousness, causing premenstrual syndrome. Hormone replacement is indicated in the treatment of endocrine deficiency. In research projects women receiving one preparation containing androgen reported improvement of mood, and arousal. Sildenafil cures approximately 25% of sexually dysfunctional, menopausal patients; being more effective with hormone replacement therapy (HRT) and consistently active against the block of antidepressants on orgasm. Added to psychiatric regimens, sildenafil ameliorates excitement. Sex therapy helps patients change behavior, overcome anger, communicate needs and redefine sex. We strongly believe that such crucial aspects must be addressed in therapy, even when the etiology is organic.
Article
The integrated model is the interplay of behavioural, cognitive, medical, and surgical approach to sexual problems. Research demonstrates that prognosis and outcome of patients with sexual diseases dramatically improve when medical solutions are proposed along with the evaluation of the therapies' sexual impact on the couple's dynamics. Current classification of treatments for erectile dysfunction (here used as a paradigm of sexual disorder therapies) distinguishes between central and peripheral "initiators" and "conditioners" of erection. However, such a taxonomy does not take into account the impact on the couple, the final recipient of the treatment. For this reason, we propose here a new, couple-based sexological taxonomy which divides therapies into "harmonious" and "inharmonious". Pilot data are also presented on the use of a carnitine analogue as a model of an etiological, harmonious therapy for impotence. The integrated model suggests a strict collaboration between sexologists of different areas. Considering the growing complexity of therapies for sexual symptoms and diseases, there seems to be a need for the new professional figure of the medical sexologist.
Article
Endocrine factors represent an important and potentially treatable cause of sexual dysfunction. The availability of a correct endocrinological diagnosis allows correct identification of most cases of sexual dysfunction in which the endocrine apparatus is involved. Not only the most frequent causes of endocrine sexual dysfunction, such as hypogonadism and hyperprolactinemia, but almost all extra-gonadal endocrinopathies (hyper- and hypothyroidism, hyper- and hypocortisolism, steroidal secreting tumors, etc.) may play a role to a greater or lesser extent in sexual function. It is therefore necessary that the diagnostic process for sexual dysfunctions of an endocrine nature be as integrated and wide as possible, especially as such pathologies are usually extremely responsive to medical or surgical therapy.
Article
Despite the importance of sexuality for both men and women of all ages, only in the last few years extensive research has been carried out into female sexual problems. It has been discovered that sexual problems affect a considerable number of women each year, and this indicates the validity and necessity of further medical studies. We know that female genital sexual response is a combination of vasocongestive and neuromuscular events in the genital tract and pelvic floor which are controlled in part by specific neurotransmitters. Other pelvi-perineal genital structures undergo vasculogenic changes, namely the labia, periurethral glands, urethra and the Halban's fascia but much less attention has been paid to the role of these tissues in sexual response compared to the clitoris and the vagina. The most common etiologies of female sexual dysfunction are vasculogenic, neurogenic, hormonal/endocrine, muscologenic. The increasing various problems of female sexual dysfunction and the interest in the matter and the subsequent research are factors which keep the scientific community involved constantly active.
Article
Current reconceptualization of women's sexual response acknowledges that women have many reasons or incentives for engaging in sex over and beyond sexual desire. Normative changes in their sexuality across the life span, with reproductive events, and with duration of relationship are recognized. Psychophysiological and preliminary functional magnetic resonance imaging data clarify that women's subjective experience of arousal may correlate poorly with signals reflective of genital congestion and also correlate poorly with activation of areas of the brain involved in organizing the reflexive genital vasocongestion. These aspects have been incorporated into new models of sexual response. Definitions of women's sexual dysfunction have recently been revised and expanded in keeping with these concepts. Mental well-being and other psychological and biological factors modulating desire, arousability, and response are areas of active research. Current understanding of the pathophysiology of chronic pain can be applied to the chronic intermittent pain and allodynia of chronic dyspareunia.
Article
Thyroid hormones have a dramatic effect on human behavior. However, their role on sexual behavior and performance has seldom been investigated in men. The objective of this study was to evaluate the prevalence of sexual dysfunctions in patients with hyper- and hypothyroidism and their resolution after normalization of thyroid hormone levels. We conducted a multicenter prospective study at endocrinology and andrology clinics in university hospitals. The study included 48 adult men, 34 with hyperthyroidism and 14 with hypothyroidism. Subjects were screened for hypoactive sexual desire (HSD), erectile dysfunction (ED), premature ejaculation (PE), and delayed ejaculation (DE) on presentation and 8-16 wk after recovery from the thyroid hormone disorder. In hyperthyroid men, HSD, DE, PE, and ED prevalence was 17.6, 2.9, 50, and 14.7%, whereas in hypothyroid men, the prevalence of HSD, DE, and ED was 64.3% and of PE was 7.1%. After thyroid hormone normalization in hyperthyroid subjects, PE prevalence fell from 50 to 15%, whereas DE was improved in half of the treated hypothyroid men. Significant changes were found in the subdomains of the International Index of Erectile Function; ejaculation latency time doubled after treatment of hyperthyroidism (from 2.4 +/- 2.1 to 4.0 +/- 2.0 min), whereas for hypothyroid men it declined significantly, from 21.8 +/- 10.9 to 7.4 +/- 7.2 (P < 0.01 for both). TSH and thyroid hormone levels normalized rapidly after treatment, and changes in circulating sex steroids partially reflected the changes in SHBG levels. In summary, most patients with thyroid hormone disorders experience some sexual dysfunctions, which can be reversed by normalizing thyroid hormone levels. Despite the associated changes in sex hormone levels, the high prevalence of ejaculatory disorders and their prompt reversibility suggest a direct involvement of thyroid hormones in the physiology of ejaculation.
Article
Various endogenous hormones, including estrogen, testosterone, progesterone and prolactin, may influence female sexual function. To provide recommendations for the diagnosis and treatment of women with endocrinologic sexual difficulties. The Endocrine Aspects of Female Sexual Dysfunction Committee was part of a multidisciplinary International Consultation. It included four experts from two countries and several peer reviewers. Expert opinion was based on committee discussion, a comprehensive literature review and evidence-based grading of available publications. The impact of hormones on female sexual function and their etiological roles in dysfunction is complex. Research data are limited as studies have been hampered by lack of precise hormonal assays and validated measures of sexual function in women. Sex steroid insufficiency is associated with urogenital atrophy and may also adversely affect central sexual thought processes. Systemic estrogen/estrogen progestin therapy alleviates climacteric symptoms but there is no evidence that this therapy specifically improves hypoactive sexual desire disorder (HSDD) in premenopausal or postmenopausal women. Exogenous testosterone has been shown in small randomized controlled trials (RCT) to improve sexual desire, arousal and sexual satisfaction in both premenopausal and postmenopausal women. However, as there is no biochemical measure that clearly identifies who to treat, use of exogenous testosterone should be considered only after other causes of HSDD have been excluded, such as depression, relationship problems and ill health. The clinical assessment of HSDD should include detailed medical, gynecologic, sexual and psychosocial history and physical examination including the external/internal genitalia. Hormonal therapy should be individualized and risks/benefits fully discussed, and all treated women should be carefully followed up and monitored for therapeutic side effects. There is a need for prospective, multi-institutional clinical trials to define safe and effective endocrine treatments for female sexual dysfunction.
Article
Endocrine disorders of sex steroid hormones may adversely affect men's sexual function. Aim. To provide expert opinions/recommendations concerning state-of-the-art knowledge for the pathophysiology, diagnosis and treatment of endocrinologic sexual medicine disorders. An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a scientific and debate process. Concerning the Endocrine committee, there were eight experts from seven countries. Expert opinions/recommendations are based on grading of evidence-based medical literature, extensive internal committee discussion over 2 years, public presentation and deliberation. Hypogonadism is a clinical and biochemical syndrome characterized by a deficiency in serum androgen levels which may decrease sexual interest, quality of erections and quality of life. Biochemical investigations include testosterone and either bioavailable or calculated free testosterone; prolactin should be considered when hypogonadism has been documented. If clinically indicated, androgen therapy should maintain testosterone within the physiological range avoiding supraphysiologic values. Digital rectal examination and determination of serum prostate specific antigen values are mandatory prior to therapy and regularly thereafter. Androgen therapy is usually long-term requiring regular follow-up, frequent monitoring of blood levels and beneficial and adverse therapeutic responses. Safe and effective treatments for endocrinologic sexual medicine disorders examined by prospective, placebo-controlled, multi-institutional clinical trials are needed.
Article
The association of low testosterone level and erectile dysfunction (ED) with metabolic syndrome (MS) is receiving increasing attention. The present study determined the psychobiologic characteristics of sexual dysfunction (SD) associated with MS (as defined by the National Cholesterol Education Program's Adult Treatment Panel III criteria) in a series of 803 consecutive male outpatients. Several hormonal, biochemical, and instrumental (penile Doppler ultrasound [PDU]) parameters were studied, along with general psychopathology scores (Middlesex Hospital Questionnaire modified [MHQ]). The Structured Interview on Erectile Dysfunction (SIEDY) was also applied. Among the 236 patients (29.4%) diagnosed as having a MS, 96.5% reported ED, 39.6% hypoactive sexual desire (HSD), 22.7% premature ejaculation, and 4.8% delayed ejaculation. Patients with MS were characterised by greater subjective (as assessed by SIEDY) and objective (as assessed by PDU) ED and by greater somatised anxiety than the rest of the sample. The prevalence of overt hypogonadism (total testosterone <8 nM) was significantly higher in patients with MS. Among MS components, waist circumference and hyperglycaemia were the best predictors of hypogonadism. Hypogonadal patients with MS showed higher gonadotropin and lower free testosterone levels, suggesting a primary hypogonadism. Among patients with MS, hypogonadism was present in 11.9% and 3.8% in the rest of the sample (p<0.0001) and was associated with typical hypogonadism-related symptoms, such as hypoactive sexual desire, low frequency of sexual intercourse, and depressive symptoms. Our data suggest that MS is associated with a more severe ED and induces somatisation. Furthermore, MS is associated with a higher prevalence of hypogonadism in patients with SD. The presence of hypogonadism can further exacerbate the MS-associated sexual dysfunction, adding the typical hypogonadism-related symptoms (including HSD, 66.7%). Recognising MS associated with hypogonadism is important for both sexual and general health and its serious potential associated risks.
Article
The menstrual pattern is influenced by thyroid hormones directly through impact on the ovaries and indirectly through impact on SHBG, PRL and GnRH secretion and coagulation factors. Treating thyroid dysfunction can reverse menstrual abnormalities and thus improve fertility. In infertile women, the prevalence of autoimmune thyroid disease (AITD) is significantly higher compared to parous age-matched women. This is especially the case in women with endometriosis and polycystic ovarian syndrome (PCOS). AITD does not interfere with normal foetal implantation and comparable pregnancy rates have been observed after assisted reproductive technology (ART) in women with and without AITD. During the first trimester, however, pregnant women with AITD carry a significantly increased risk for miscarriage compared to women without AITD, even when euthyroidism was present before pregnancy. It has also been demonstrated that controlled ovarian hyperstimulation (COH) in preparation for ART has a significant impact on thyroid function, particularly in women with AITD. It is therefore advisable to measure thyroid function and detect AITD in infertile women before ART, and to follow-up these parameters after COH and during pregnancy when AITD was initially present. Women with thyroid dysfunction at early gestation stages should be treated with l-thyroxine to avoid pregnancy complications. Whether thyroid hormones should be given prior to or during pregnancy in euthyroid women with AITD remains controversial. To date, there is a lack of well-designed randomized clinical trials to elucidate this controversy.
Article
Endocrine disease frequently interrupts sexual function, and sexual dysfunction may signal serious endocrine disease. Diabetic autonomic neuropathy and endothelial dysfunction impair erectile function, and phosphodiesterase inhibition produces only moderate benefit. The effect of diabetes on women's sexual function is complex: the most consistent finding is a correlation between sexual dysfunction and depression. Reductions in testosterone level in men are associated with low sexual desire and reduced nocturnal erections and ejaculate volume, all of which improve with testosterone supplementation. The age-dependent decline in testosterone production in men is not associated with precise sexual symptoms, and supplementation has not been shown to produce sexual benefit. In women, sexual dysfunction has not been associated with serum testosterone, but this may be confounded by limitations of assays at low concentrations and by the greater importance of intracellular production of testosterone in women than in men. Testosterone supplementation after menopause does improve some aspects of sexual function in women, but long-term outcome data are needed. More research on the sexual effects of abnormal adrenal and thyroid function, hyperprolactinaemia, and metabolic syndrome should also be prioritised. We have good data on local management of the genital consequences of oestrogen lack, but need to better understand the potential role of systemic oestrogen supplementation from menopause onwards in sexually symptomatic women.
Article
We aimed to describe the changing incidence of thyroid disease in a population-based study in Tayside, Scotland (population 390 000) between 1994 and 2001. A retrospective, data-linkage, population-based study measuring the incidence and prevalence of thyroid disease. All patients with newly diagnosed, treated and stable thyroid disease in Tayside were identified by electronic linkage of six datasets, including all regional biochemistry data, hospital admissions, deaths and a thyroid follow-up register. The overall prevalence of thyroid dysfunction has increased from 2.3% to 3.8% (1994-2001). The prevalence of ever having had hyperthyroidism increased from 0.86% to 1.26% in females and 0.17% to 0.24% in males (P < 0.0001 for both). The standardized incidence of hyperthyroidism increased from 0.68 to 0.87 per 1000 females/year, representing a 6.3% annual increase (P < 0.0001). The prevalence of primary hypothyroidism increased from 3.12% to 5.14% in females and 0.51% to 0.88% in males (P < 0.0001 for both). The standardized incidence of primary hypothyroidism did not change and varied between 3.90 and 4.89 per 1000 females/year over the 8 years. Incidence of hypothyroidism in males increased from 0.65 to 1.01 per 1000 males/year (P = 0.0017). Mean age at diagnosis of primary hypothyroidism declined in females from 1994 to 2001. The prevalence of primary hypothyroidism and previous hyperthyroidism has increased in Tayside, Scotland. This is partly due to an increasing incidence of disease, increased ascertainment and earlier diagnosis of disease. This will result in an increased workload for endocrinologists and general practitioners.