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Empowering the woman: a comprehensive model of sexual anti-ageing
Abstract
Female ageing is associated with sexual decline and well-documented symptoms of decreased metabolism, increased visceral fat deposits, decreased mobility, increased incidence of body aches and impaired self-confidence, which can lead to depression, marital dissatisfaction, conflicts or apathy. Sexual decline becomes more prominent with diabetic females suffering from neuropathy that is usually a challenge, since traditional methods usually offer temporary pain relief. Hormone replacement interventions treat only part of the systemic hormonal imbalance problem, ignoring the fact that disruption in the hormonal network signifies a disruption in the entire microcosmos of cellular communications leading to bio-disorganisation and health deterioration. New vaginal rejuvenation methods aspire to resolve a complex psychophysiological issue by merely improving vaginal laxity and dyspareunia, via invasive or minimally invasive methods that often reduce sexual sensation for women, while increasing male satisfaction during intercourse. Here, we offer a more comprehensive model of female sexuality, and discuss two new research studies performed entirely on female subjects. Both studies are discussed with respect to the multi-faced, psychophysiological, composite of female sexuality, which cannot show meaningful improvement without treating both its physiological and psychological components.
... 41,42 A number of clinical studies on a novel effortless fitness technology from London University have delineated a reduction in both visceral and overall fat, demonstrating improved hormonal regulation, and a reversal of the diabetic status into either the realm of prediabetes or normalcy. [43][44][45][46][47][48] A more recent clinical study on diabetics with hyperphagia reports hunger suppression as a result of an optimal inverse relationship between leptin increase and ghrelin decrease. 49 The current research examined levels of pre-and-post T3 and C-reactive Protein (CRP), as well as pre and post-fasting and postprandial (PP) insulin and glucose levels in the blood samples of forty-one diabetic and prediabetic subjects. ...
... This new method of effortless, simulated exercise has repeatedly demonstrated a CRP reduction. [45][46][47][48][49][50] These and other studies mentioned earlier that have used either regular or effortless exercise have demonstrated a significant decrease in visceral fat, and both fasting and PP glucose and insulin. The advantage of this effortless method is that it can jumpstart an active lifestyle while bypassing the resistance to exercising that is clinically observed in overweight individuals with a diabetic or a prediabetic condition. ...
Treating physicians have consistently recommended exercise to either prevent diabetes or de-escalate symptomatology. Diabetic complications render physical activity undesirable or unattainable. Diabetes has been often associated with hypothyroidism, weight gain, fatigue, accumulation of white adipose tissue, and inadequate supply of brown fat to generate energy. Accumulated toxicity results in hormonal imbalance, increased hunger, chronic pain, and wounds on extremities associated with diabetic neuropathy. Recent research with an effortless exercise method has demonstrated enhanced fitness and T3 increase, juxtaposed by decreased inflammation, an optimal relationship between leptin and ghrelin that control appetite, and a significant decrease of visceral fat along with VLDL, the very low-density lipoprotein that carries triglycerides to the tissues. This clinical trial measured triglycerides, metabolic efficiency as reflected by T3, inflammation level and fasting / postprandial glucose and insulin of 21 diabetics and 20 prediabetics respectively, pre and post twenty treatments. There was a statistically significant decrease in both fasting and postprandial glucose and insulin for all subjects who exhibited increased skeletal muscle mass, normalized T3 levels, decreased visceral and overall fat, and reduced CRP, advocating diminished inflammation. Dyslipidaemia appeared to subside as indicated by suppressed triglyceride levels contrasted by elevated HDL.
... Estudos evidenciam que condições adversas ao corpo, como o câncer de mama (Santos et al., 2020) e a mastectomia (Hirschle et al., 2018), e fatores evolutivos, como o envelhecimento e a menopausa (Sofra & Lampe, 2020), relacionam-se ao declínio da satisfação sexual, afetando a saúde física e mental da mulher. No entanto, questionamos de que forma as vivências individuais podem contribuir para o prazer feminino. ...
Evaluation of the Association Between Self-Esteem, Satisfaction and Sexual behavior in Women This research aims to investigate the relationship between women's self-esteem and sexual satisfaction , and other variables related to sexual behavior. The participants were 105 women aged 18 to 61 years (M = 24.5; SD = 6.06), from different sexual orientations participated. The instruments used were the Rosenberg's Self-esteem Scale, The Female Sexual Satisfaction Scale and the Female Sexuality Questionnaire. The results showed positive and moderate correlations between self-esteem and sexual satisfaction, as well as the person's concern for sex as the main factor predicted by self-esteem. In conclusion, that the higher self-esteem, the greater the sexual satisfaction of women. We also observed that having sex with the same person, even without the status of a formal relationship, and frequent sexual relations were associated with women's sexual satisfaction. We hope to stimulate discussion about female sexuality, by pointing to the importance of female self-esteem for pleasurable sexual experiences.
... Nicotinamide mononucleotide (NMN), among various anti-aging health remedies, has been gaining global recognition as a highly promising product for combating aging (Omori & Dempsey, 2018;Lampe, 2020). Nicotinamide adenine dinucleotide (NAD + ) acts as a classic coenzyme, essential for cellular redox reaction in the spacious heterogeneity of organisms (Yoshino & Imai, 2013). ...
Nicotinamide mononucleotide (NMN) subsists in all living organisms and has drawn tremendous attention as a nutraceutical and pharmaceutical product for several diseases such as Alzheimer’s, cancer, aging, and vascular dysfunction. Here, NMN was produced intracellularly in a high cell density bioreactor using an engineered Escherichia coli strain via exponential feeding of co-substrates. Fed-batch culture via exponential feeding of co-substrate (glucose) and continuous feeding of substrate (nicotinamide) were performed using different cumulative nicotinamide concentrations. The highest concentration of 19.3 g/L NMN with a dry cell weight of 117 g/L was acquired from a cumulative nicotinamide concentration of 7.2 g/L with a conversion of 98 % from nicotinamide in 28 h. Further, liquid chromatography-mass spectrometry analysis validated the NMN production. This approach will be beneficial in achieving simultaneously low cost and ensuring high quality and quantity of NMN production.
... The results of our research achieved external validity of all variables by confirming previous findings. [56][57][58][59][60][61] We demonstrated a statistically significant improvement in T3 levels for all subjects (100%). T3 was elevated to the normal range in 14 out of 20 subjects, indicating that 70% of subjects reached normalcy after 20 treatments. ...
Treating physicians have consistently recommended exercise to either prevent diabetes or de-escalate symptomatology. Diabetic complications, however, render physical activity undesirable or unattainable. These involve: hypothyroidism leading to substantial weight gain; perpetual fatigue due to accumulation of white adipose tissue serving as fat storage, and inadequate supply of brown fat to generate energy; accumulated toxicity causing hormonal imbalance that increases hunger; chronic pain and wounds on extremities associated with diabetic neuropathy, etc. Recent research with an effortless exercise method demonstrated enhanced fitness and T3 increase, juxtaposed by decreased inflammation, an optimal relationship between leptin and ghrelin that control appetite, and a significant decrease of visceral fat along with VLDL, the very low-density lipoprotein that carries triglycerides to the tissues. We measured the fasting and postprandial glucose and insulin of 21 diabetics and 20 prediabetics respectively, pre and post twenty treatments. Both previously abnormally high fasting and postprandial (PP) glucose decreased considerably in all 21 diabetic subjects (100%). Nine of the diabetic subjects (42.85%) manifested normal fasting glucose levels after 20 treatments, while the fasting glucose of the remaining twelve diabetic subjects (57.2%) dropped down to the prediabetic level. Ten of the diabetic subjects (47.6%) manifested normal PP insulin levels, while the PP insulin of the remaining eleven diabetic subjects (52.38%) dropped to the prediabetic level after the 20 treatments. Prediabetics had more robust results as expected by their baseline healthier status. Eighteen of prediabetics (90%) manifested both normal fasting and PP insulin levels after the 20 treatments, while the fasting and PP insulin of the remaining two subjects (10%) remained within the prediabetic level. All subjects also exhibited a statistically significant increase in muscle mass, normalized T3 levels, decreased visceral and overall fat along with reduced CRP, advocating diminished inflammation. Dyslipidaemia appeared to subside as denoted by suppressed levels of triglycerides contrasted by elevated HDL.
... A recent clinical trial has documented an effortless exercise method that reports a statistically significant reduction in both fasting and PP insulin and glucose that may be useful as both a preventive and a protective measure in safeguarding health [51] . Similar research has reported significant reductions in visceral adiposity, triglycerides, VLDL, cortisol, and ghrelin, juxtaposed against upraises in leptin, Free T3, testosterone and insulin growth factor-1 (IGF-1) that never spiked above or below normalcy [52,55] . An earlier animal study explored gene expression in fast and slow muscle fiber phenotypes. ...
... In short, cortisol appears to descend towards the bottom of the normal range in subjects with high cortisol, yet remain stable in individuals whose cortisol was already closer to the lower end of this dimension. In contrast, testosterone appeared to climb towards the peak of the normal range in subjects with low testosterone or remain unchanged in those who already manifested high testosterone levels [78][79][80][81][82][83][84][85][86][87][88]. Other observed benefits following a course of treatments that varied from 12 to 20 treatments depending on the research project were as follows: 1. ...
The COVID-19 classification and evolution through its multiple mutations have increased its transmissibility rate up to 70% or more globally, threatening to undermine the promise of a number of emerging medications and vaccines that primarily focus on the immune detection of the Spike trimer. Mutations have been long considered as random events, or mistakes during the viral RNA replication. Usually, what can go wrong will go wrong; therefore, repeated transformations lead to the extinction of a virus. On the contrary, the aggregate result of over 300,000 COVID-19 variants have expanded its transmissibility and infectiousness. COVID-19 mutations do not degrade the virus; they empower and facilitate its disguise to evade detection. Unlike other coronaviruses, COVID-19 amino acid switches do not reflect the random unfolding of errors that eventually eradicate the disease. COVID-19 appears to use mutations adaptively in the service of its survival and expansion. One of the COVID-19 primary strategies is to inhibit the production of interferon type (INF) that is involved in recognizing the virus. The deleterious consequences of the cytokine storm where the CD8+ killer cells injure the vital organs of the host may well be collateral damage, as the blind immune system struggles to annihilate the unidentified COVID-19. It is probable that evolution has programmed COVID-19 with an adeptness designed to debilitate key systemic defences to secure its subsistence. To date the infectiousness of the COVID-19 pandemic is exponentially increasing, denoting the possibility of an even more dangerously elusive, inconspicuous, and sophisticated version of the disease.
... In short, cortisol appears to descend towards the bottom of the normal range in subjects with high cortisol, yet remain stable in individuals whose cortisol was already closer to the lower end of this dimension. In contrast, testosterone appeared to climb towards the peak of the normal range in subjects with low testosterone or remain unchanged in those who already manifested high testosterone levels [78][79][80][81][82][83][84][85][86][87][88]. Other observed benefits following a course of treatments that varied from 12 to 20 treatments depending on the research project were as follows: 1. ...
The COVID-19 classification and evolution through its multiple mutations have increased its transmissibility rate up to 70% or more globally, threatening to undermine the promise of a number of emerging medications and vaccines that primarily focus on the immune detection of the Spike trimer. Mutations have been long considered as random events, or mistakes during the viral RNA replication. Usually, what can go wrong will go wrong; therefore, repeated transformations lead to the extinction of a virus. On the contrary, the aggregate result of over 300,000 COVID-19 variants have expanded its transmissibility and infectiousness. COVID-19 mutations do not degrade the virus; they empower and facilitate its disguise to evade detection. Unlike other coronaviruses, COVID-19 amino acid switches do not reflect the random unfolding of errors that eventually eradicate the disease. COVID-19 appears to use mutations adaptively in the service of its survival and expansion. One of the COVID-19 primary strategies is to inhibit the production of interferon type (INF) that is involved in recognizing the virus. The deleterious consequences of the cytokine storm where the CD8+ killer cells injure the vital organs of the host may well be collateral damage, as the blind immune system struggles to annihilate the unidentified COVID-19. It is probable that evolution has programmed COVID-19 with an adeptness designed to debilitate key systemic defences to secure its subsistence. To date the infectiousness of the COVID-19 pandemic is exponentially increasing, denoting the possibility of an even more dangerously elusive, inconspicuous, and sophisticated version of the disease.
... Additionally, they demonstrate increased fitness and normalized levels of Insulin Growth Factor-1 (IGF-1), the metabolic hormone Triiodothyronine (Free T3), Insulin, Testosterone, Cortisol, the anorexic hormone Leptin and the orexigenic one, Ghrelin, after 10-12 treatments with an alternative to exercise, originally invented in London University. Some of these studies rely on small samples demonstrating reduced inflammation and oxidative damage as measured by wound healing, neuropathic pain analgesia, as well as statistically significant decreases in CRP, creatinine, and bilirubin [121][122][123][124][125][126][127][128][129] . We used T-tests for dependent means to analyse the raw data derived from 95 subjects, 73 females and 22 males, that participated in these clinical trials. ...
The imminent danger of the Covid-19 pandemic has accelerated research in pharmaceuticals that either target the viral Spike proteins fusion with ACE2 receptors, or the infectious RNA replication that often overwhelms immune defences. The scope of this review was to elucidate the main human vulnerabilities to Covid-19, including the accumulation of ACE2 receptors in testes, adipose tissue, thyroid, heart and kidneys that escalate viral affinity in males, the aged, and certain medical conditions, including diabetes, CVD, and pulmonary diseases. Pre-existing inflammation inherent in obesity may exacerbate the “cytokine storm,” a rampaging immune reaction during the course of Covid-19 that is deleterious to the host. We examined the molecular dynamics illustrating the action of new therapeutics necessary for Covid-19 patients; the estradiol advantage hypothesis;alternative therapies including hormone replacement procedures and mesenchymal stem cells; plus preventive and protective interventions.The current perspective also explored the primary components of dysregulated health predisposing individuals to Covid-19, including hormonal imbalance, increased lipids and lipoproteins, thyroid dysfunction, degraded fitness, and age-related testosterone decline accompanied by cortisol increase that provokes stress eating behaviours and weight accumulation.Obesity increases the probability of Covid-19 infection due to its abundance of ACE2 receptors; while physical activity may decrease Covid-19 vulnerability, by reducing fat and increasing muscle mass that manifests a relatively inhibited ACE2 expression. Several weight management solutions feature lasers and radiofrequency which diminish subcutaneous adiposity but do not enhance fitness. A data metanalysis of seven recently published clinical studies on 95 obese individuals, 73 males and 22 females with an average BMI of 30.9, demonstrated visceral fat reduction combined with increased skeletal muscle mass. It also revealed a statistically significant decrease in BMI, lipids, lipoproteins, inflammation and toxicity as measured by CRP, Creatinine and Bilirubin respectively, juxtaposed by optimally healthier levels of Cortisol, Testosterone, Free T3,IGF-1, Insulin, and the appetite controlling hormones Leptin and Ghrelin.
... On the other hand, there is evidence that exercise may induce asthma that usually exacerbates Covid-19 symptomatology, or provoke an inverse cortisol/testosterone relationship, while supressing the anorexic hormone leptin, thus increasing food consumption [109][110][111][112][113][114] . Recent studies report an advantage with an exercise alternative method invented in London University that results in hormonal balance, and enhanced wellbeing as measured by statistically significant decreases of visceral fat, inflammation, CRP, BMI and Triglycerides, juxtaposed by optimal increases of skeletal muscle mass, Free T3, IGF-1 and HDL [115][116][117][118][119][120][121][122][123][124][125] . We combined some of the data presented in these studies and analysed the results with ANOVA for repeated measures. ...
We examined SARS-CoV-2 (Covid-19) available treatments and prophylactic methods that included interventions associated with inhibiting the “type II transmembrane serine protease” (TMPRSS2) to limit the fusion between the Covid-19 Spike proteins and ACE2 receptors, or newly developed therapeutics like Remdesivir that interferes with the viral RNA replication. We explored the dilemma of ACE2 receptors that have a protective function against high blood pressure associated disorders, yet,they serve as the viral points of entry, elevating the probability of infection. Human tissues’ analysis reveals a higher ACE2 expression in adipose tissue, placing obesity-related conditions in the eye of the pandemic storm. It primarily exposes males due to the surge of ACE2 receptors in the testes along with other tissues. Males manifest a relatively higher positive ACE2 orrelations with certain immune cells in the lungs,thyroid, adrenals, liver and colon, while females evidence higher ACE2 correlations with immune cells in the heart. The remaining tissues’ ACE2/immunity expressions are equivalent in both sexes, indicating that despite its preference for males, the threat of Covid-19 can easily target females.Recent reports indicate that Covid-19 is empowered by hindering the critical process of viral recognition during the adaptive immune response leading to the “cytokine storm”, the aggravated immune response that indiscriminately perseveres, rampaging the host’s vital organs. Sedentary lifestyle, age-related hormonal imbalance, and adiposity induced inflammation predispose the body to the immune collapse following Covid-19 invasion, spotlighting the detrimental aftermath of metabolic dysfunction,and excess food consumption provoked by elevated cortisol and dysregulated appetite hormones. ACE 2 expression is suppressed in the skeletal muscle, rendering fitness and weight management an effective Covid-19 preventive intervention, along with social distancing, hygiene, and facial coverings. Physical activity, or exercise alternative methods have recently demonstrated statistically significant reductions of the inflammatory marker C-Reactive Protein (CRP), triglycerides, visceral fat, cortisol and the orexigenic hormone ghrelin, juxtaposed by optimal increases of IGF-1, skeletal muscle mass, Free T3, HDL, and the anorexic hormone leptin.
... A recent clinical trial has documented an effortless exercise method that reports a statistically significant reduction in both fasting and PP insulin and glucose that may be useful as both a preventive and a protective measure in safeguarding health [51]. Similar research has reported significant reductions in visceral adiposity, triglycerides, VLDL, cortisol, and ghrelin, juxtaposed against upraises in leptin, Free T3, testosterone and insulin growth factor-1 (IGF-1) that never spiked above or below normalcy [52][53][54][55]. An earlier animal study explored gene expression in fast and slow muscle fiber phenotypes. ...
The objective was to identify some of the common denominators that undermine health and increase COVID-19 vulnerability. The virus has a binding affinity for ACE2 receptors which are abundant in adipose tissue, placing obesity at the spotlight of the COVID-19 susceptibility factors. Obese individuals manifest respiratory problems that elevate viral mortality rates. Visceral adiposity progressively increases with age, often accompanied by inflammation, high VLDL, triglycerides, Free T3 abnormalities, low testosterone, and exacerbated cortisol. Disturbances in the anorexic and orexigenic hormones leptin and ghrelin respectively, lead to weight gain, rendering physical activity challenging and cumbersome. The lack of exercise compromises health and immunity. Toxicity is enhanced by inactivity, while moderate exercise promotes cardiorespiratory fitness (CRF), safeguarding against most chronic diseases. However, excessive exercise results in an inverse cortisol/testosterone relationship leading to hormonal imbalance. In search of solutions to proactively protect public health, we conducted a randomized double-blind clinical trial on ten overweight menopausal women with medical issues including diabetes and hyperphagia, to investigate the possibility of weight reduction and increased appetite regulation. Results delineated a statistically significant decrease in BMI, visceral adipose tissue, VLDL, and triglycerides, an inverse relationship between both testosterone/cortisol and leptin/ghrelin, and reduced hyperphagia. Testosterone and leptin, along with Free T3 and IGF-1 climbed towards the peak of the normal range, juxtaposed by cortisol and ghrelin that decreased but without regressing outside normalcy.
... 6) During overtraining muscle-derived IL-6 is released into the circulation in high amounts leading to increased inflammation [55]. 7) Recent research using this alternative to exercise procedure has shown a decrease in visceral fat, VLDL, and triglycerides, juxtaposed by an increase of Free T3, and skeletal muscle mass [56] [57]. 8) Goldspink et al. [58] used an earlier modified version of this method exploring gene expression in fast and slow muscle fibre phenotypes. ...
... This investigator reports a significant reduction in visceral adipose tissue, VLDL, and triglycerides, and an elevation in the Free T3 metabolic hormone, accompanied by an increase in skeletal muscle mass. Subjects reported experiencing a large variety of 8-secs long, vigorous contractions, some of them resembling resistance and X. Sofra, S. Badami Health strength exercises, others subjectively perceived as body twists, or fast-paced aerobics [46] [47]. ...
... A lot of research starting with Cheng et al. in 1982 [16] has postulated that ultra-low currents increase adenosine triphosphate (ATP) one of the main biological energy currencies as well as overall protein synthesis which is crucial for neuro-communications and systemic balance. More recently ultra-low energy technologies have been shown to decrease inflammation, alleviate neuropathic pain, increase mobility, and speed up the healing of wounds [17] [18] [19] [20]. These investigators postulate that diabetic wound healing and neuropathic pain relief is the result of electron flow into the ion channels of the cells, acting as a mega antioxidant by donating electrons to free radicals, the group of atoms with unpaired electrons, rendered unstable and highly reactive. ...
The reality of interacting genes and proteins is vastly complex and intricate with many unknowns which currently prevent us from solving the anti-ageing equation in terms of gene expression. Molecular studies involving genome modification should take into consideration the importance of apparently opposing genes and proteins which when seen as a whole, can orchestrate an optimal systemic balance. Gene expression is often a double-edged sword with positive effects turning negative when a particular gene is overexpressed. For this reason, the US National Academy of Sciences and the National Academy of Medicine have placed stringent restrictions on the promising genome editing methods to be used only for the specific DNA sequence associated with a transmissible genetic disease. Rejuvenation as a result of gene expression is still an open area of research with studies that have either been limited to in vitro research or clinical studies claiming success based on a limited perspective that selectively emphasises the benefits of certain genes while leaving the negative outcomes in the shadows of their silence. For example, some investigators relate the presence of ZMPSTE24, IGF1R, NGF4, EEF2, EIF4FBP1 CCL18, and other genes with “rejuvenation,” selectively focusing on potential benefits while ignoring the involvement of some of these genes in malignancies and inflammation. Well-controlled gene expression molecular experimental studies with mechanotherapy and effortless exercise have limited themselves to the observation of increased slow skeletal genes associated with muscle growth that do not present any adverse side effects. Overall, exercise and nutrition are still the safest and most ethical methods of gene expression at least until genome editing can be extended to delaying ageing, in the near or distant future. As observed in the research analysing gene expression as the result of different types of exercise, inflammatory events are counterbalanced by antagonizing anti-inflammatory ones. This signifies optimal biological homeostasis because health depends on the harmonious interaction of opposite processes levelling and stabilizing each other. Exercise modalities and lifestyle are still representing the cornerstone of delaying ageing and the most riskless method of increasing longevity by triggering processes that balance each other.
Inflammation and oxidative damage are immanent in visceral adiposity that is characterised by excess lipids and lipoproteins, viewed as the core components of arterial plaques, ultimately obstructing blood flow and lymphatic drainage. Accumulated toxicity dysregulates the orexigenic hormone ghrelin and anorexic hormone leptin, which are part of a reciprocal network controlling appetite. Weight gain promotes hormonal imbalance, expressed in disturbances in free T3 and an inverse low testosterone/high cortisol incongruity that provokes stress-eating behaviours. The author explored a number of interventions designed to reduce visceral adipose tissue (VAT), including radiofrequency, lasers and exercise, as well as exercise alone. Short-term gymnastics evidenced a modest advantage in VAT decrease, but there were no changes in body mass index (BMI) or physical appearance. Overtraining appeared to negate the benefits of exercise by increasing inflammation and cortisol, while suppressing testosterone and leptin that inevitably instigated hunger and weight gain. The blood samples of 10 overweight, healthy adults who underwent 12 treatments during the course of 1 month were examined. Results demonstrated a statistically significant decline in very-low-density lipoprotein, triglycerides and VAT, accompanied by a substantial increase in basal metabolic rate and skeletal muscle mass. Importantly, free T3, insulin-like growth factor 1, leptin, and testosterone were elevated towards the top of the normal range, while cortisol and ghrelin gravitated towards the low end of the normal range, without ever spiking outside the limits of hormonal balance.
Background:
Over the past two decades, parallel recognition has grown of the importance of both sex steroids and immune activity in metabolic regulation. More recently, these discrete areas have been integrated in studies examining the metabolic effects of sex steroid immunomodulation. Implicit in these studies has been a traditional, endocrine model of sex steroid delivery from the gonads to target cells, including immune cells. Thus, research to date has focused on the metabolic effects of sex steroid receptor signaling in immune cells. This endocrine model, however, overlooks the extensive capacity of immune cells to generate and metabolize sex steroids, enabling the production of sex steroids for intracrine signaling - that is, sex steroid production for signaling within the cell of origin. Intracrine function allows highly cell-autonomous regulation of sex steroid exposure, and sex steroid secretion by immune cells could confer paracrine signaling effects in neighboring cells within metabolic tissues. In this review, immune cell intracrinology will denote sex steroid production within immune cells for either intracrine or paracrine signaling. This intracrine capacity of immune cells has been well established, and prior work has supported its importance in autoimmune disorders, trauma, and cancer. The potential relevance of immune cell intracrine function to the regulation of energy balance, body weight, body composition, and insulin sensitivity has yet to be explored.
Scope of review:
The following review will detail findings to date regarding the steroidogenic and steroid metabolizing capacity of immune cells, the regulation of immune cell intracrine function, and the biological effects of immune-derived sex steroids, including the clinical relevance of immune cell intracrinology in fields other than metabolism. These findings will serve as the basis for a proposed model of immune cell intracrinology constituting a new frontier in metabolism research.
Major conclusions:
The development of highly sensitive mass spectrometric methods for sex steroid measurement and quantitation of metabolic flux now allows unprecedented ability to interrogate sex steroid production, metabolism and secretion by immune cells. Immune cell intracrinology could reveal key mechanisms underlying immune cell-mediated metabolic regulation.
Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed.
Physiologic changes in a woman’s life, such as childbirth, weight fluctuations, and hormonal changes due to aging and menopause, may alter the laxity of the vaginal canal, damage the pelvic floor, and devitalize the mucosal tone of the vaginal wall. These events often lead to the development of genitourinary conditions such as stress urinary incontinence; vaginal atrophy; dryness; and physiologic distress affecting a woman’s quality of life, self-confidence, and sexuality. Various treatment modalities are currently available to manage these indications, varying from invasive vaginal surgery to more benign treatments like topical vaginal hormonal gels or hormone-replacement therapy. A new trend gaining momentum is the advent of energy-based devices for vaginal rejuvenation that apply thermal or nonthermal energy to the various layers of the vaginal tissue, stimulating collagen regeneration contracture of elastin fibers, neovascularization, and improved vaginal lubrication. This review aims to present the available technologies offering vaginal rejuvenation and the scientific evidence that underlines their safety and efficacy for this indication.
The aim of this paper is to present a novel laser technology utilizing the erbium YAG laser for various minimally invasive, non-surgical procedures in gynecology. Non-ablative, thermal-only SMOOTH-mode erbium pulses are used to produce vaginal collagen hyperthermia, followed by collagen remodeling and the synthesis of new collagen fibers, resulting in improved vaginal tissue tightness and elasticity. This erbium laser technology is used for treatments of vaginal laxity, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. In the period from 2010 to 2014, several clinical studies covering all four indications were conducted with the aim to prove the efficacy and safety of this novel technology. An overview is presented of the results of these studies where several objective as well as subjective assessment tools were used. The results have shown that SMOOTH-mode erbium laser seems to be an effective and safe method for treating vaginal laxity, stress urinary incontinence, pelvic organ prolapses and vaginal atrophy.
In recent years increased numbers of healthy women and girls have been seeking female genital cosmetic surgery (FGCS) for esthetic reasons and/or to enhance sexual functioning. This phenomenon is associated with the development of a new vulvovaginal standard due to Internet pornography and the increased exposure of female genitalia. This strict standard may negatively affect women's psychological health and cause increased insecurity, which may drive even teenagers to seek FGCS. Psychological counseling is recommended to inform women that surgery is not a definitive solution to treat psychologically based pain or dysfunction. Moreover, there is no robust evidence supporting the effectiveness of FGCS, especially regarding sexual enhancement, as underlined by major scientific societies. The importance of a definite regulation of FGCS should be emphasized and be based on an ethically-oriented, multidisciplinary model aimed at providing exhaustive information on all gynecological, sexological, and psychological concerns raised by this type of surgery. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Objective:
To investigate the effects of fractional microablative CO2 laser on sexual function and overall satisfaction with sexual life in postmenopausal women with vulvovaginal atrophy (VVA).
Method:
This prospective study included 77 postmenopausal women (mean age 60.6 ± 6.2 years) treated for VVA symptoms with the fractional microablative CO2 laser system (SmartXide(2) V(2)LR, Monalisa Touch, DEKA, Florence, Italy). Sexual function and quality of life were evaluated with the Female Sexual Function Index (FSFI) and the Short Form 12 (SF-12), respectively, both at baseline and at 12-week follow-up. A 10-mm visual analog scale was used to measure the overall satisfaction with sexual life and the intensity of VVA symptoms (vaginal burning, vaginal itching, vaginal dryness, dyspareunia and dysuria) before and after the study period.
Results:
We observed a significant improvement in the total score and the scores in each specific domain of the FSFI at 12-week follow-up compared to baseline (p < 0.001). After concluding the laser treatment, the overall satisfaction with sexual life significantly improved (p < 0.001). Seventeen (85%) out of 20 (26%) women, not sexually active because of VVA severity at baseline, regained a normal sexual life at the 12-week follow-up. Finally, we also found a significant improvement in each VVA symptom (p < 0.001) and in quality-of-life evaluation, both for the scores in the physical (p = 0.013) and mental (p = 0.002) domains.
Conclusions:
Fractional microablative CO2 laser treatment is associated with a significant improvement of sexual function and satisfaction with sexual life in postmenopausal women with VVA symptoms.
Abstract Recently, there has been growing interest in female genital plastic surgery. To the authors' knowledge, no studies have adopted elastic silicone thread for vaginal rejuvenation. This study introduces clinical experience over 4 years with vaginal rejuvenation using elastic silicone thread to specifically assess the overall patient satisfaction (sexual function and correction of the vaginal width). It is hypothesised that this novel surgical method can improve sexual function. Between 2007-2011, 180 patients underwent vaginal rejuvenation using elastic silicone thread performed by the authors at a single institution. Patients with persistent feeling of a wide vagina and/or a decreased ability to reach orgasm were included. Patients were excluded from the study if they were unavailable for follow-up, or if they had been diagnosed with any gynecologic diseases. To measure the 15 degree of improvement with regard to sexual function, this study adopted the validated system; Female Sexual Function Index (FSFI). 92.8% (167/180) of the patients were satisﬠed with outcome with regard to feelings of correction of vaginal width. Vaginal rejuvenation using elastic silicone thread significantly improved postoperative outcomes, resulting in improved sexual function, with a focus on improving the FSFI score. This is especially prominent in FSFI orgasm subscore. However, a prospective multicentre study would be beneficial to provide patients with the best possible management.
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.
Diabetes mellitus is a major cause of peripheral neuropathy, commonly manifested as distal symmetrical polyneuropathy. This review examines evidence for the importance of vascular factors and their metabolic substrate from human and animal studies. Diabetic neuropathy is associated with risk factors for macrovascular disease and with other microvascular complications such as poor metabolic control, dyslipidaemia, body mass index, smoking, microalbuminuria and retinopathy. Studies in human and animal models have shown reduced nerve perfusion and endoneurial hypoxia. Investigations on biopsy material from patients with mild to severe neuropathy show graded structural changes in nerve microvasculature including basement membrane thickening, pericyte degeneration and endothelial cell hyperplasia. Arterio-venous shunting also contributes to reduced endoneurial perfusion. These vascular changes strongly correlate with clinical defects and nerve pathology. Vasodilator treatment in patients and animals improves nerve function. Early vasa nervorum functional changes are caused by the metabolic insults of diabetes, the balance between vasodilation and vasoconstriction is altered. Vascular endothelium is particularly vulnerable, with deficits in the major endothelial vasodilators, nitric oxide, endothelium-derived hyperpolarising factor and prostacyclin. Hyperglycaemia and dyslipidaemia driven oxidative stress is a major contributor, enhanced by advanced glycation end product formation and polyol pathway activation. These are coupled to protein kinase C activation and omega-6 essential fatty acid dysmetabolism. Together, this complex of interacting metabolic factors accounts for endothelial dysfunction, reduced nerve perfusion and function. Thus, the evidence emphasises the importance of vascular dysfunction, driven by metabolic change, as a cause of diabetic neuropathy, and highlights potential therapeutic approaches.
The Female Sexual Functioning Index (FSFI; Rosen et al., 2000) is a self-report measure of sexual functioning that has been validated on a clinically diagnosed sample of women with female sexual arousal disorder. The present investigation extended the validation of the FSFI to include women with a primary clinical diagnosis of female orgasmic disorder (FOD; n = 71) or hypoactive sexual desire disorder (HSDD; n = 44). Internal consistency and divergent validity of the FSFI were within the acceptable range for these populations of women. Significant differences between women with FOD and controls and between women with HSDD and controls were noted for each of the FSFI domain and total scores.
Nociceptive and neuropathic components both contribute to pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is highly desirable. As low back pain (LBP) patients constitute an important subgroup of chronic pain patients, we addressed the following issues: (i) to establish a simple, validated screening tool to detect neuropathic pain (NeP) components in chronic LBP patients, (ii) to determine the prevalence of neuropathic pain components in LBP in a large-scale survey, and (iii) to determine whether LBP patients with an NeP component suffer from worse, or different, co-morbidities.
In co-operation with the German Research Network on Neuropathic Pain we developed and validated the painDETECT questionnaire (PD-Q) in a prospective, multicentre study and subsequently applied it to approximately 8000 LBP patients.
The PD-Q is a reliable screening tool with high sensitivity, specificity and positive predictive accuracy; these were 84% in a palm-top computerised version and 85%, 80% and 83%, respectively, in a corresponding pencil-and-paper questionnaire. In an unselected cohort of chronic LBP patients, 37% were found to have predominantly neuropathic pain. Patients with NeP showed higher ratings of pain intensity, with more (and more severe) co-morbidities such as depression, panic/anxiety and sleep disorders. This also affected functionality and use of health-care resources. On the basis of given prevalence of LBP in the general population, we calculated that 14.5% of all female and 11.4% of all male Germans suffer from LBP with a predominant neuropathic pain component.
Simple, patient-based, easy-to-use screening questionnaires can determine the prevalence of neuropathic pain components both in individual LBP patients and in heterogeneous cohorts of such patients. Since NeP correlates with more intense pain, more severe co-morbidity and poorer quality of life, accurate diagnosis is a milestone in choosing appropriate therapy.
Ageing is associated with decreased metabolism, increased toxicity, decreased skeletal muscle mass (SMM) and increased visceral fat deposits that compromise the normal functioning of vital organs such as the liver, pancreas and intestines, increasing the risk of a number of health problems, including type 2 diabetes, coronary heart disease, hypertension and non-alcoholic fatty liver. Visceral adipose tissue holds large amounts of toxins that alter thyroid hormone metabolism, lowering resting metabolic rate (RMR). Strenuous physical exercise can reach these deeper visceral adipose tissue layers. However, excessive exercise is necessary to reduce visceral adipose tissue elevates cortisol while decreasing testosterone. The hormonal imbalance resulting from this inverse cortisol/testosterone relationship ultimately leads to weight gain, despite all the efforts invested in physical activity. On the other hand, lack of exercise allows for accumulation of toxicity and increased vulnerability to chronic physical disorders. Energy-based technologies report successful results in reducing subcutaneous fat layers; however, data is not currently available about methods that can reduce deeper visceral adipose tissue and relieve the system from visceral fat cells stuffed with excess triglycerides. In this study, we examined hormone and cholesterol fluctuations in the blood tests of eight subjects undergoing six 45 minutes of effortless exercise sessions with a novel London University invention. We also explored changes in their visceral adipose tissue, overall body fat mass, SMM, basic metabolic rate (BMR), waist and abdomen reduction in centimetres (cm) and overall weight loss in kilograms (kg). Subjects' results revealed a statistically significant increase in triiodothyronine (Free T3), accompanied by a significant decrease in the very low-density lipoprotein (VLDL) and triglycerides. Cortisol did not show statistically significant fluctuations. There was a statistically significant decrease in visceral adipose tissue and overall body fat mass and a statistically significant increase in SMM. Waist and abdomen cm loss, and weight loss in kgs were statistically significant, demonstrating a substantial decrease in cm and kgs in all subjects that persisted a week after the last treatment. Results of this study supported the hypothesis that this method of effortless exercise can reduce both overall body fat mass, visceral adipose tissue and VLDL, while increasing SMM and the metabolic hormone free T3, without the aid of diet or change in lifestyle.
Objective:
The treatment of genitourinary syndrome of menopause (GSM) includes prescription hormone therapy, nonhormonal over-the-counter products, and most recently, laser treatment. Although the Food and Drug Administration has cleared fractional carbon dioxide (CO2) laser for a variety of dermatologic and gynecologic indications, lasers have not to date, been approved for use for vulvar/vaginal atrophy, or sexual dysfunction.
Methods:
Four case studies that were referred to a tertiary sexual medicine center regarding laser treatment complications for GSM are reported. Patient data were Health Insurance Portability and Accountability Act of 1996 protected and informed consent was obtained by all patients.
Results:
Four cases are presented, which demonstrate complications after completion of three consecutive laser treatments for GSM. Case 1 is a 65-year-old woman with GSM and moderate vaginal stenosis who had two vaginal wall lacerations after resumption of intercourse. Case 2 is a 61-year-old woman who had persistent dyspareunia following vaginal laser treatments. Case 3 is a 68-year-old woman who reported worsening dyspareunia and had a fibrous band mid vagina that impinged on the canal. Case 4 is a 55-year-old woman who complained of dyspareunia and insertional pain, after her laser. Assessment and follow-up treatment are presented.
Conclusions:
Laser therapy for the vagina shows excellent promise for the treatment of GSM in some women; however, complications such as fibrosis, scarring, agglutination, and penetration injury have been documented. Food and Drug Administration-approved products for GSM should be considered frontline treatments until long-term, prospective, randomized, sham-controlled trials are conducted that confirm efficacy and safety for device treatments.
Introduction
Sex steroids are important in female sexual function and dysfunction.
Aim
To review the role of estrogens in the physiology and pathophysiology of female sexual functioning and the evidence for efficacy of estrogen therapy for female sexual dysfunction to update the previously published International Society of Sexual Medicine Consensus on this topic.
Methods
Panel members reviewed the published literature using online databases for studies pertaining to estrogen in female sexual function and dysfunction. Attention was specifically given to clinical trials that had reported on sexual function outcomes in women treated with estrogen.
Main Outcome Measures
Quality of data published in the literature and recommendations were based on the GRADES system.
Results
Observational studies that have considered relationship factors and physical or mental health have reported that these factors contribute more to sexual functioning than menopausal status or estrogen levels. Few clinical trials have investigated estrogen therapy with sexual function as a primary outcome. The available data do not support systemic estrogen therapy for the treatment of female sexual dysfunction. Topical vaginal estrogen therapy improves sexual function in postmenopausal women with vulvovaginal atrophy (VVA) and is considered first-line treatment of VVA. Oral ospemifene, a selective estrogen receptor modulator, is effective for the treatment of VVA and might have independent systemic effects on female sexual function.
Conclusion
For sexual problems, the treatment of VVA remains the most pertinent indication for estrogen therapy. When systemic symptoms are absent, estrogen therapy ideally can be administered by a vaginal preparation alone. Systemic estrogen therapy with combined estrogen and progestin in non-hysterectomized women is indicated for women who require treatment for vasomotor and/or other systemic estrogen deficiency symptoms. The improvement in well-being achieved by relief of vasomotor and other symptoms might improve libido in some women and abrogate further intervention.
Unlabelled:
Recently, we introduced functional vaginal rejuvenation with elastic silicone threads. However, some patients with specific indications need other biocompatible materials for rejuvenation of the vagina. Gore-Mycromesh is one of the most commonly used materials in plastic and reconstructive surgical fields and it is composed of expanded poly-tetrafluroethylene. In this study, we introduced our clinical experience with static vaginal rejuvenation using Gore-Mycromesh to specifically assess the overall patient satisfaction (Female Sexual Function Index, FSFI). This study included 50 patients who underwent vaginal rejuvenation with a Gore-Mycromesh between 2010 and 2012. After marking two incisions at the inner side of the vaginal inlet and posterior wall, respectively, we performed submucosal dissection at the posterior vaginal wall and then grafted and secured a Gore-Mycromesh to the dissected area (muscle/fascia). Overall the FSFI improved as time progressed up to a year postoperatively. This is especially prominent in the FSFI satisfaction subscore. All but eight patients (42/50, 84 %) were "very satisfied (5)" or "satisfied (4)" with the outcomes after the vaginal rejuvenation. The overall complication rate was 8 %. Based on our clinical experience with the 50 cases, we think that vaginal rejuvenation with Gore-Mycromesh significantly improved postoperative outcomes, resulting in improved sexual function with a focus on improving the FSFI satisfaction subscore in mid-term follow-up. Elderly patients experience better outcomes using gore mycromesh rather than silicone thread because we can plicate the vaginal posterior wall with senile changes simultaneously using an open technique. However, further studies would be warranted for better positioning and adherence of grafted implants to surrounding tissue and for increasing the tightening effect of the implant and its sufficient longevity.
Level of evidence iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Introduction:
Vaginal childbirth may result in vaginal introital laxity, altered genital sensation during sexual intercourse, and reduced sexual satisfaction. We report the long-term effectiveness of a single nonsurgical procedure with radiofrequency (RF) energy for laxity at the vaginal introitus.
Materials and methods:
Prospective single-arm study of 30 premenopausal women (21-52 year) with one 30-minute office procedure using RF applied to the vaginal introitus; 12-month outcome assessments included the linguistic validated Japanese versions of the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) and the Vaginal Laxity and Sexual Satisfaction Questionnaires.
Results:
Sexual function improved significantly throughout 6 months (30 subjects); mean FSFI total score was 22.4±6.7 before treatment and then improved to mean 26.0±5.8 at month 6 (P=0.002), inclusive of improved scores in five of six FSFI domains except desire (P<0.001 -<0.01). In the 22 of 30 subjects remaining evaluable at 12 months, the mean was 26.0±5.2 (P=0.08). Distress related to sexual activity decreased significantly; baseline FSDS-R mean score of 15.8±11.7 improved to 9.8±8.0 at one month and was sustained throughout 12 months (P<0.001 - 0.002). Subjects reported decreased vaginal laxity within the first month after the procedure (P<0.001); responses peaked, and effectiveness was sustained through 12 months (P<0.001).
Conclusions:
A single nonsurgical office-based RF procedure for vaginal introital laxity achieved significant and sustainable 12-month effectiveness with respect to improved integrity at the vaginal introitus and improved sexual satisfaction. Treatment was well-tolerated with no adverse events.
The healing response is the vital means by which an organism marshals its diverse repair strategies in reaction to injury or disease. This article discusses the question of how much energy may be necessary to stimulate or ‘jump start’ the repair of injuries, or to reverse disease processes. The question obviously is of major clinical importance. Clinical and behavioral research validates the ‘less is more’ principle of energetic interactions. Convincing evidence came in 1975, when a number of scientists confirmed that extremely weak low frequency electric fields can have significant effects on important regulatory processes in the brain. These findings led to the concept of the power/frequency window, the narrow range of signal properties that will produce a maximum biological effect. This was a turning point in a lingering controversy over beneficial vs harmful environmental field effects on physiology and behavior and the applications of subtle energies in healing.
Background:
Comprehensive assessment of safety, tolerance, and patient satisfaction has not been established from noninvasive body contouring techniques, such as low-level laser therapy, ultrasound, radiofrequency, and infrared light, for reduction of subcutaneous fat.
Objective:
This multicenter study investigated the clinical outcomes of noninvasive cryolipolysis in European subjects.
Methods:
A retrospective study was performed at clinical sites in Belgium and France. Safety was assessed according to reports of side effects. Tolerance was evaluated according to pain scores and patient perception of treatment duration. Clinical outcomes were assessed according to patient surveys, caliper measurements, and assessment of photographs.
Results:
The investigators treated 518 patients. No significant side effects or adverse events were reported. The procedure was well-tolerated, with 89% of respondents reporting a positive perception of treatment duration and 96% reporting minimal to tolerable discomfort. Survey results demonstrated 73% patient satisfaction and that 82% of patients would recommend the cryolipolysis procedure to a friend. Caliper measurements demonstrated 23% reduction in fat layer thickness at 3 months. Abdomen, back, and flank treatment sites were most effective, with 86% of subjects showing improvement per investigator assessment.
Conclusions:
With proper patient selection, cryolipolysis is a safe, well-tolerated, and effective treatment method for reduction of subcutaneous fat.
Previous studies have shown that single or multiple treatments by focused ultrasound are effective and safe. However, most include focused ultrasound only and not radio-frequency treatment. There is paucity of magnetic resonance imaging (MRI) measurements and pictures in the literature. This study aimed to assess the efficacy, safety, and pain and satisfaction levels of the combination therapy of focused ultrasound and radio-frequency for improving body contours. Thirty-two Asian patients received 3 sequential treatments every 2 weeks in the abdominal region. Safety parameters and adverse events were recorded. The subjects' pain and satisfaction levels were evaluated using a five-point Likert scale. Two patients underwent MRI study randomly. There was a mean reduction in circumference of 3.91 ± 1.8 cm (p ≤ 0.001). In MRI measurement, the average in fat thickness reduction was 21.4 and 25 % on the upper and lower abdomen, respectively. There were three mild and self-limited localized adverse events. The satisfaction survey showed that 71.9 % was satisfied with the results, while pain level evaluation showed that 90.5 % felt no pain. Combination therapy of focused ultrasound and radio-frequency for noninvasive body contouring is an effective, safe, and painless procedure in Asians. Although the change is minor compared to traditional surgical procedure, it is real, definite, and effective.
Obesity is now growing at an alarming rate reaching epidemic proportions worldwide thus increasing morbidity and mortality rates for chronic disease. But although we have ample information on the complications associated with obesity, precisely what causes obesity remains poorly understood. Some evidence attributes a major role to a low-grade chronic inflammatory state (neurogenic inflammation) induced in obesity by inflammatory mediators produced and secreted within the expanded activated adipocyte pool. Adipose tissue is an endocrine organ that secretes numerous adipose tissue-specific or enriched hormones, known as adipokines, cytokine-like molecules thought to play a pathogenic role in cardiovascular diseases. The imbalance between increased inflammatory stimuli and decreased anti-inflammatory mechanisms may depend on chronic stress. Hence the positive correlation found between stress, obesity and cardiovascular diseases. The chronic inflammatory state associated with insulin resistance and endothelial dysfunction is highly deleterious for vascular function. This review focuses on the proposed neuroimmunodulatory mechanisms linking chronic (psychological) stress, obesity and cardiovascular diseases.
This article introduces an interdisciplinary subject of bioelectrodynamics in living organisms and its related research challenges and opportunities. Bioelectrodynamics in living organisms is aimed to reveal critical roles of electromagnetism and mechanics in biology, to correlate biophysical functions of living organisms with biochemical processes at the cellular level, and to introduce theoretical basis and methodology, such as modeling and simulations, for stimulating technical innovations and promoting technology development in biomedicine as well as for the study of human healthcare issues related to environments among others in our modern society. The article reviews some important issues in bioelectrodynamic modeling. This includes the modeling of living cells, blood, bones and soft tissues that may have unique properties, such as active control, regulation and remodeling capabilities that are completely different from those of conventionally man-made materials. Possible biological effects and potential biomedical usages of endogenous and exogenous electromagnetic fields and mechanical stresses in living organisms are also reviewed, which indicate promising future of biomedical imaging and therapeutic methods based on bioelectrodynamic techniques. The fact that living organisms may have well-organized structures, actively controlled actions and responses, extremely sensitivity in electromagnetic fields and mechanical actions, and amazing signal amplification functions may not only cause complexity and variety of the biological world, but also create opportunities for technical innovations in biomedicine to improve future quality of human life.
To assess knowledge of vaginal atrophy among women using the Vaginal Health: Insights, Views & Attitudes (VIVA) survey.
A structured online questionnaire was used to obtain information from 3520 postmenopausal women aged 55-65 years living in Great Britain, the United States, Canada, Sweden, Denmark, Finland, and Norway.
In total, 45% of women reported experiencing vaginal symptoms. Only 4% of women attributed these symptoms to vaginal atrophy, and 63% failed to recognize vaginal atrophy as a chronic condition. Overall, 44% of respondents did not have a gynecologist, but this percentage varied between countries. Most women (75%) felt that vaginal atrophy had a negative impact on life, but this perception also showed country-specific differences. Most Finnish respondents (76%) were satisfied with the amount of information available about vaginal atrophy, compared with just 37-42% of women from other countries. Most women used over-the-counter products for vaginal atrophy symptoms, but specific means of treating the underlying cause were less well known. Almost half (46%) of all respondents lacked knowledge about local estrogen therapy, with women in Great Britain, the United States and Canada being most likely to lack knowledge of such treatment. Overall, 30% of women would consider taking local estrogen therapy, with vaginal tablets being the preferred option in all countries.
Postmenopausal women have a low understanding of vaginal atrophy. Medical practitioners should proactively raise this topic, help patients to understand that vaginal atrophy is a chronic condition, and discuss treatment options. Country-specific approaches may be required.
Unlike that of mammals, the brain of teleost fish exhibits an intense aromatase activity due to the strong expression of one of two aromatase genes (aromatase A or cyp19a1a and aromatase B or cyp19a1b) that arose from a gene duplication event. In situ hybridization, immunohistochemistry and expression of GFP (green fluorescent protein) in transgenic tg(cyp19a1b-GFP) fish demonstrate that aromatase B is only expressed in radial glial cells (RGC) of adult fish. These cells persist throughout life and act as progenitors in the brain of both developing and adult fish. Although aromatase B-positive radial glial cells are most abundant in the preoptic area and the hypothalamus, they are observed throughout the entire central nervous system and spinal cord. In agreement with the fact that brain aromatase activity is correlated to sex steroid levels, the high expression of cyp19a1b is due to an auto-regulatory loop through which estrogens and aromatizable androgens up-regulate aromatase expression. This mechanism involves estrogen receptor binding on an estrogen response element located on the cyp19a1b promoter. Cell specificity is achieved by a mandatory cooperation between estrogen receptors and unidentified glial factors. Given the emerging roles of estrogens in neurogenesis, the unique feature of the adult fish brain suggests that, in addition to classical functions on brain sexual differentiation and sexual behaviour, aromatase expression in radial glial cells could be part of the mechanisms authorizing the maintenance of a high proliferative activity in the brain of fish.
Sexual pain disorders refer to conditions of genital pain that interfere with intercourse. They often have a musculoskeletal component related to the pelvic floor and are included in the DSM-IV as sexual dysfunctions. Musculoskeletal pain (MP) that is not essentially genitally based often interferes with sex as well yet is not considered a distinct sexual dysfunction. MP is generally addressed by physiatrists, orthopedists, and rheumatologists who are not traditionally trained in sexual medicine, and therefore, the sexual concerns of women with MP often go unaddressed.
The purposes of this review article were to describe how MP is perceived in the literature as affecting sexual function, illustrate how specific MP conditions prevalent in women may affect sexual function, and offer recommendations for clinical practice.
PubMed and Medline searches were performed using the keywords "musculoskeletal pain and sex,"lower back pain and sex,"arthritis and sex," and "fibromyalgia and sex". Main Outcome Measure. Review of the peer-reviewed literature.
Most studies cite fatigue, medication, and relationship adjustment as affecting sexuality much as chronic illness does. While musculoskeletal contributors to genital sexual response and pain are considered relevant to sexual function, little is understood about how MP syndromes specifically affect sexual activity.
Lack of mobility and MP can restrict intercourse and limit sexual activity, and gender differences are noted in response to pain. Sexual and relationship counseling should be offered as a component of rehabilitative treatment. Physical therapists are uniquely qualified to provide treatment to address functional activities of daily living, including sexual intercourse, and offer advice for modifications in positioning.
Labiaplasty is the surgical term for labia minora reduction. This procedure has become popular with plastic surgery patients because physical discomfort and cosmetic concerns are virtually always combined. Demand for this procedure is becoming common amongst very young patients who appear to have nurtured a complex since their early adolescent years, disturbing their love life. There are several possible corrective surgical techniques, the postoperative courses of which vary significantly. The traditional method (longitudinal resection) remains the most widely used, but requires resection of the larger part of the labia minora, which is why in our opinion the V plasty technique seems more appropriate. The benefits, technical details, complications and postoperative course of the V plasty technique are detailed by the author in this article.
Copyright 2008 Elsevier Masson SAS. All rights reserved.
In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."
Painful sensory neuropathy (PSN) is the most common neurological disorder associated with HIV infection and affects up to 30% of HIV-positive individuals. PSN may develop as a consequence of HIV infection or from the toxic effect of the antiretrovirals. Although several tools have been developed to screen for PSN, their validity and reliability has yet to be established among HIV-positive patients. The Subjective Peripheral Neuropathy Screen (SPNS) is a brief self-report tool that is currently being administered in the AIDS Clinical Trials Group. The objective of this study was to establish the psychometric properties of the SPNS screening tool for the correct identification of PSN in HIV-positive individuals. Specifically the goals were to determine the reliability, the validity, and the diagnostic efficiency of the SPNS in the detection of PSN. Data were abstracted on subjects enrolled in an ongoing natural history cohort. The SPNS was administered to a convenience sample of 39 HIV-positive individuals with PSN and 44 HIV-positive controls. Results showed the SPNS to be internally consistent (Cronbach's alpha = .86). SPNS score differences assessed by t-test were significantly different for individual symptoms of parasthesias, numbness, and pain of the lower extremities, and for severity measures (the Clinical Severity Grade, and the Average Severity Score) between the HIV-positive groups (p < .05). Using Spearman's rank, significant correlations were demonstrated between the neurological exam and the Clinical Severity Grade and the Average Severity Score, the neurological exam and vibratory quantitative sensory testing (QST) only, and the severity measures and vibratory QST only. Sensitivity and specificity analysis demonstrated that numbness of the lower extremities was the symptom with the highest efficiency for correctly classifying PSN. Thus, internal consistency, construct validity, and criterion related validity were confirmed with the SPNS for the correct classification of PSN in HIV-positive individuals.
An intimacy-based sex response cycle was used in the assessment of 47 women referred with low sexual desire. All could relate to the model and multiple breaks in the cycles were identified. Emotional intimacy to motivate the women to find sexual stimuli to elicit arousal was insufficient in 50%. Sexual stimuli and context were minimal in 53%. Psychological factors diminishing arousability were identified in 85%, depression contributing in 43%. Androgen deficiency (the cause suggested by referring doctors) contributed in 25%. Identifying missing components of their "normal" but currently problematic sex response cycles was itself therapeutic.
Menopause is associated with physiological and psychological changes that influence sexuality. During menopause, the primary biological change is a decrease in circulating estrogen levels. Estrogen deficiency initially accounts for altered bleeding and diminished vaginal lubrication. Continual estrogen loss often leads to numerous signs and symptoms, including changes in the vascular and urogenital systems. Alterations in mood, sleep, and cognitive functioning are common as well. These changes may contribute to lower self-esteem, poorer self-image, and diminished sexual responsiveness and sexual desire. Other important nonhormonal factors that affect sexuality are health status and current medications, changes in or dissatisfaction with the partner relationship, social status, and cultural attitudes toward older women. The problems in sexual functioning related to estrogen deficiency can be treated with hormone therapy that includes estrogens alone and estrogens combined with androgens. Vaginal lubricants and moisturizers also may be useful in ameliorating postmenopausal sexual complaints. This article reviews the literature on the impact of menopausal estrogen loss on sexuality and on the effect of hormone therapy on sexual function during menopause.
The arcus tendineous fasciae pelvis (ATFP) provides support to the anterior vagina. The objective of this study was to determine the impact of menopause on the structural components of the ATFP.
Biopsy specimens of the ATFP were obtained from 10 premenopausal, 5 postmenopausal, and 12 postmenopausal women on hormone therapy. Scanning confocal microscopy of fluorescent micrographs was used to define the amount of collagen subtypes, smooth muscle, and elastin. Collagen fiber orientation was determined by scanning electron microscopy.
The ATFP is comprised primarily of parallel bundles of type III collagen fibers (84%), an intermediate amount of elastin (13%), and very little smooth muscle. The ratio of collagen I/(III+V) was decreased in postmenopausal not on hormones relative to premenopausal women (P=.04) due to a 75% decrease in collagen I (P=.046). The decrease in collagen I and change in collagen ratios was not present in women on hormone therapy. Comparison of the amounts of elastin and smooth muscle showed no difference in the ATFP of premenopausal and postmenopausal women.
Menopause in the absence of hormone therapy is associated with a decrease in quantity of collagen I in the ATFP resulting in a decrease in the ratio of collagen I/(III+V). This may compromise the tensile strength and an increase susceptibility to anterior vaginal wall prolapse.
Data on the sexual activity of middle-aged and older women are scant and vary widely. This analysis estimates the prevalence and predictors of sexual activity and function in a diverse group of women aged 40-69 years.
The Reproductive Risk Factors for Incontinence Study at Kaiser (RRISK) was a population-based study of 2,109 women aged 40-69 years who were randomly selected from long-term Kaiser Permanente members. Women completed self-report questionnaires on sexual activity, comorbidities, and general quality of life. Logistic and linear regression and proportional odds models were used when appropriate to identify correlates of sexual activity, frequency, satisfaction, and dysfunction.
Mean age was 55.9 (+/- 8) years and nearly three fourths of the women were sexually active. Of the sexually active women, 60% had sexual activity at least monthly, approximately two thirds were at least somewhat satisfied, and 33% reported a problem in one or more domains. Monthly or more frequent sexual activity was associated with younger age, higher income, being in a significant relationship, a history of moderate alcohol use, and lower body mass index (BMI) (all P < .05). Satisfaction with sexual activity was associated with African-American race, lower BMI, and higher mental health score (all P < .05). More sexual dysfunction was associated with having a college degree or greater, poor health, being in a significant relationship, and a low mental health score (all P < .05).
Middle-aged and older women engage in satisfying sexual activity, and one third reported problems with sexual function. Demographic factors as well as some issues associated with aging can adversely affect sexual frequency, satisfaction, and function.
II-3.
Effects of nonionizing electromagnetic (EM) fields that raise tissue temperature in general differ very little from effects of hyperthermia induced by other means. However, fields raising tissue temperature orders of magnitude less than 0.1°C may result in major physiological changes not attributable to raised temperature per se. These weak fields have been observed to produce chemical, physiological, and behavioral changes only within windows in frequency and incident energy. For brain tissue, a maximum frequency sensitivity occurs between 6 and 20 Hz. Two different intensity windows have been seen, one for ELF tissue gradients around 10-7V/cm, and one for amplitude modulated RF and microwave gradients around 10-1V/cm. The former is at the level associated with navigation and prey detection in marine vertebrates and with control of human biological rhythms; the latter is at the level of the electroencephalogram (EEG) in brain tissue. Coupling to living cells appears to require amplifying mechanisms that may be based on nonequilibrium processes, with long-range resonant molecular interactions. These cooperative processes are now recognized as important in immune and hormonal responses, as well as in nerve cell excitation. Polyanionic proteinaceous material forming a sheet on cell membrane surfaces appears to be the site of detection of these weak molecular and neuroelectric stimuli.
Molecular Dynamics of Skin Disorders
- X Sofra-Weiss
Textbook of diabetic neuropathy
- F A Gries
- Cameron Ne
- P A Low
- D Ziegler