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To Lube or Not to Lube: Experiences and Perceptions of Lubricant Use in Women With and Without Dyspareunia
Abstract
There are few studies examining the relationship between lubricant use and sexual functioning, and no studies have examined this relationship in women with dyspareunia. Vaginal dryness is a prevalent complaint among women of all ages. There is an association between vaginal dryness and painful intercourse; therefore, women with dyspareunia represent a particularly relevant sample of women in which to investigate lubricant use.
The aim of this study was to examine differences between women with and without dyspareunia in self-reported natural lubrication and attitudes toward and use of personal lubricants.
Respondents completed an online survey including questions on demographics, gynecological/medical history, sexual functioning, and lubricant use and attitudes.
The main outcome measures used were the Female Sexual Function Index (FSFI) and questions regarding attitudes toward and use of lubricants.
Controls scored higher on the lubrication subscale of the FSFI than women with dyspareunia (P < 0.001). Women with dyspareunia reported greater frequency of lubricant use during sexual activity over the last year (P < 0.01). They were also more likely to use lubricant prior to penetration (P < 0.05). The most common use for controls was to enhance sexual experiences. This was also a common answer for women with dyspareunia; however, in this group, the most common reason was to reduce/alleviate pain. Lubricants were rated as less effective among women with dyspareunia vs. controls across all reported reasons for use. Nevertheless, lubricant use was still rated as being moderately effective in alleviating pain for women with dyspareunia.
Women with dyspareunia have more difficulty with natural lubrication; it is consequently not surprising that they reported using lubricant more frequently than control women. Women with dyspareunia reported using lubricants more often than controls to try to prevent or alleviate pain and reported this as being a moderately effective strategy, suggesting that it may be a useful tool for some women with dyspareunia.
... Our search yielded 7578 unique references, of which 60 were retained for full-text review ( Figure 1). Ultimately, we identified seven that met the inclusion criteria for the effectiveness review, 4,16-21 twenty-one values and preferences studies, 4,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and no cost studies. A table of excluded studies is provided in Supplementary Table A. ...
... Values and preferences review Overall, 21 studies were included in the values and preferences review (Table 4). 4,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The studies were primarily quantitative (n = 16, 9 of which were cross-sectional), although there were several qualitative studies (n = 4) and a multimethod study (n = 1). Twelve were conducted in high-income countries, but others took place in upper-middle (n = 6), lower-middle (n = 5), and low-income (n = 1) countries. ...
... In three studies that compared water-based lubricant to either no lubricant or an oil-based lubricant, individuals generally preferred waterbased lubricants. 25,39,40 One study found that participants preferred odourless and tasteless lubricants, while another found that lubricant taste or smell did not matter, or participants preferred lubricants without flavour, colour, or smell. 22,28 Reasons why individuals liked lubricants or would choose to use them ranged widely, and included comfort, reduced dryness/pain/discomfort, increased pleasure (for themselves or their partners), their partner's preference, ease of orgasm (e.g. ...
Promoting sexual health is a World Health Organization (WHO) priority. Lubricants are widely available and used to improve sexual pleasure and reduce pain during intercourse. To inform WHO's self-care interventions guideline, we conducted a systematic review of the peer-reviewed literature to answer the question: does use of lubricants during or prior to sex result in improved sexual health and well-being. We searched PubMed, CINAHL, LILACS and EMBASE on 8 July 2020 for effectiveness, values and preferences, and cost data related to commercially available vaginal and anal lubricants. Data were systematically extracted and qualitatively synthesised. Effectiveness evidence was summarised in GRADE evidence profiles. Seven studies met the effectiveness review criteria. Two randomised trials found lubricant use led to improved female sexual well-being and had no impact on incidence of human papillomavirus (moderate certainty evidence). One observational study with gay and bisexual men showed lubricants were associated with increased reports of pain during receptive intercourse and no difference in pain during insertive intercourse, but a reduced degree of pain in both types of intercourse (low/very low certainty evidence). One observational study with female breast cancer survivors found better outcomes of vaginal dryness and dyspareunia with lubricant use (very low certainty evidence). Twenty-one values and preferences studies from diverse populations globally found that most individuals supported lubricant use for reasons of comfort/reduced pain and sexual pleasure. No cost studies were identified. Although evidence is limited, lubricants appear to offer an acceptable approach to improving sexual health and well-being.
... Lubricants can be used for various reasons-to facilitate comfortable childbirth, gynecological and rectal examinations, sexual intercourse, amelioration of vaginal dryness and for increasing sexual pleasure (Braunstein & Van de Wijgert, 2005;Herbenick et al., 2011Herbenick et al., , 2013Hoffman et al., 2010;Jozkowski et al., 2013;Sutton, Boyer, Goldfinger, Ezer, & Pukall, 2012), or as a medium for medicinal products, such as microbicides. Personal or additional lubricants are "supplied separately and applied to the condom, vagina, penis or rectum at the time of intercourse, [and] are sometimes used to improve lubrication, moistening and comfort during intercourse" (World Health Organization, 2012b). ...
... In some countries, personal additional lubricants are widely available, marketed, and used, whereas in other contexts, personal lubrication (either natural or via personal lubricants) can hold negative connotations, including perceptions of promiscuity and uncleanliness (Sutton et al., 2012). It is therefore important to be familiar with sexual practices, reasons for them, and implications of these before marketing products such as lubricants or gels (Braunstein & Van de Wijgert, 2005). ...
... It is therefore important to be familiar with sexual practices, reasons for them, and implications of these before marketing products such as lubricants or gels (Braunstein & Van de Wijgert, 2005). Few studies have addressed women's use of or interest in using lubricants for sexual activities (Herbenick et al., 2011;Sutton et al., 2012). ...
Personal or additional lubricants are used by individuals to enhance sexual experience. Lubrication norms during sex are linked to factors including sociocultural norms, gender dynamics, age, and education. This article provides an overview of literature, exploring thematic areas of interest and relevance to the topic. In some regions/countries, lubricated sex is preferable, and in others, a dry/tight vagina is preferred. Women may use a variety of products to achieve these states. There is little research on lubrication preferences during sex; however, microbicide gel acceptability and adherence studies have provided some insight into these preferences. There is a need for more information on lubrication preferences, including volumes, frequency of use, and site of application. In addition, condom use with lubricants needs further exploration. Context, gender, and individual preferences have implications for acceptability and use of personal additional lubricants and should be taken into account during marketing and dissemination of these products.
... Postmenopausal women usually benefit from systemic or local hormonal therapy, although natural molecules like isofalvones and natural S-equol have recently been studied to ease menopause-related urogenital disorders [2,3]. Causes of superficial/entry dyspareunia include generalized or localized provoked vulvodynia (PVD), sexually transmitted infections (STIs), vaginal infections, chronic diseases such as endometriosis and dermatological conditions [4,5]. In women affected by gynecological cancer, dyspareunia can be a consequence of surgical treatment and/or chemotherapy [6,7]. ...
... In these patients, creams, moisturizers and lubricants may improve and relieve symptoms during coital activity, but the effect is not long lasting because the time of permanence of these products in the vulvovaginal area is limited. Personal lubricants are not generally used to treat pain caused by this condition, but rather to help relieve dryness and increase sexual pleasure [4]. ...
... In particular moisturizers that are mostly applied at initial penetration were described to have low permanency on the vaginal mucosa and need to be reapplied during following penetration, interrupting sex. In addition, adverse effects including irritation of the vaginal mucosa and damage to rectal epithelium were reported in some patients [4]. Topical anesthetics showed efficacy in reducing nociceptor proliferation and sensitization, leading to longlasting pain reduction [27], however it seems that the numbing effect is localized to the mucosa of the introitus and does not numb subsurface proprioceptive or pain nerves. ...
Introduction
Dyspareunia, especially in reproductive age, often has a negative impact on women’s sexual life, with great psychological impact. Our aim is to assess the effect of a device containing verbascoside, glycerophosphoinositol (GPI), hyaluronic acid sodium salt (HANa) and carrageenan (CG) in the treatment of idiopathic dyspareunia and the impact on sexual function in reproductive age women.
Methods
We recruited 43 sexually active women of reproductive age who had been suffering from superficial idiopathic dyspareunia in the last 6 months. A therapy with a device containing verbascoside, GPI, HANa and CG was applied in the vulvar and vaginal area twice a day for 12 weeks. Quality of Life (QoL) and the sexual function were assessed with Female Sexual Function Index (FSFI) and Female Sexual Distress Scale (FSDS) questionnaires before and after 12 weeks of treatment.
Results
After treatment, the mean FSFI total score was 27.87 ± 1.86, significantly higher than before treatment (p < 0.0001). Improvement in distress about sex life was showed after treatment. The mean FSDS total score decreased significantly after 12 weeks (p < 0.0001). A reduction in dyspareunia measured with VAS scale was observed.
Conclusions
Local application of a combination of verbascoside, GPI, HANa and CG resulted effective in reducing dyspareunia and pain without important adverse effect.
... These products play a pivotal role in not only moisturizing the vaginal region but also fostering mucosal flexibility and elasticity [9,11]. There exists promising evidence supporting the efficacy of vaginal lubricants and gels in alleviating the discomfort associated with VD [11][12][13][14]. The current corpus of high-quality evidence pertaining to their efficacy in alleviating dyspareunia in women remains limited. ...
... Only 3 previous studies have examined sexual well-being and pleasure as outcomes, of which, one of them focused only on postmenopausal women [12,36,37]. The present work is the only one to analyze these factors in a lubricant formulated with HA. ...
Background
Vaginal dryness (VD) represents a significant concern affecting women across diverse life stages, encompassing both pre- and postmenopausal women at any age. Dyspareunia, defined by genital pain that can be experienced before, during, or after intercourse, is often associated with vaginal dryness.
Aim
This study aimed to evaluate the effectiveness and safety of a water-based vaginal lubricant with hyaluronic acid to reduce sexual discomfort associated with vaginal dryness.
Methods
A prospective, multicenter, uncontrolled clinical investigation was conducted over a three-month period in women aged 18 years or older experiencing pain or difficulty during sexual intercourse for whom the use of a vaginal lubricant was recommended.
Results
Significant improvements were observed in the FSFI scores, indicating enhanced sexual function (p < .001). Vaginal dryness symptoms, including irritation, dryness, itching, and dyspareunia, significantly decreased after product use (p < .001).
Clinical implications
This study contributes to the limited scientific knowledge on the application of lubricants in the context of symptoms associated with VD.
Strengths & limitations
In addition to the short study period, inherent limitations of the study design, and lack of placebo control, it is pertinent to acknowledge that some of the pros used in this study were not based on validated questionnaires. However, as far as we know, this study is the only one that analyzes well-being and sexual pleasure as results using a lubricant formulated with hyaluronic acid.
Conclusion
This tested vaginal lubricant with hyaluronic acid has demonstrated efficacy in improving vaginal dryness and female sexual function, particularly in reducing pain and improving lubrication during sexual intercourse, and showed a favorable safety profile, with minimal and transient adverse events.
... Lubricants are liquids or gels applied to minimize dryness and pain during sexual activity. 38 According to the 2012 National Survey of Sexual Health and Behavior, Reece et al 39 reported that 70% of men in the United States older than 24 years of age admit to using lubricants for intercourse, masturbation, and partnered sexual play. Around 90% of men who have sex with men (MSM) reported lifetime lubricant use. ...
... Water-or silicone-based lubricants are recommended because they break down with warm, soapy water. 38 Silicone-based lubricants have an advantage over water-based ones because they persist longer on the skin and mucous membranes. However, there are fewer options on the market and are usually more expensive. ...
Background:
Although sex aids have been used in clinical practice for ages, the scientific literature assessing their application in men with sexual dysfunction is limited.
Aim:
To summarize medical literature regarding scientific uses of the most common sex aids in men with sexual dysfunction and assess their clinical applicability.
Methods:
An extensive literature review was performed with regard to the use of sex aids in sexual medicine. Our search included journal articles, books, and guidelines in different databases: Embase, PubMed, and Cochrane. The key words were "sex aids," "sex toys," "pornography," "lubricants," "constriction bands," "dildos," "vibrators," "vacuum devices," "external penile devices," and "sex swings" were searched. Date of last search was December 4, 2018.
Main outcome measures:
We assessed the utility of sex aids in men with sexual dysfunction and formulated recommendations for clinicians.
Results:
Various sex aids are available for men with sexual dysfunction. We present a comprehensive review of the most common sex aids currently available: pornography, lubricants, constriction bands, dildos, vibrators, vacuum devices, external erectile support devices, and aids to positioning. We discuss their indications, outcomes, precautions, and complications.
Clinical implications:
This review is intended to provide sexual medicine practitioners and academics an overview of sex aids for men with sexual dysfunction for use in both clinical practice and research.
Strengths & limitations:
This is a compilation of scientific data for a topic that has broad application in sexual medicine and yet has been poorly addressed in the scientific literature. Because of the lack of sufficient data and the heterogeneous nature of different sex aids, a systematic review could not be performed.
Conclusion:
Having a comprehensive understanding of the sexual dynamics of individuals and couples combined with the appropriate integration of sex aids may have a positive effect in the treatment of male sexual dysfunctions. Miranda EP, Taniguchi H, Cao DL, et al. Application of Sex Aids in Men With Sexual Dysfunction: A Review. J Sex Med 2019;16:767-780.
... Vaginal dryness can be treated with over-the-counter vaginal moisturizers, gels, oils, and topicals for comfort and topical vitamin D or E. 119,120 Lubricants can be used for sexual activity. 121,122 Local hormonal treatments can also be used, 101,123-127 although some controversy exists regarding their safety in survivors of hormone-dependent cancers. ...
... 79,205 In addition, CBT has been shown to be effective at improving sexual functioning in breast cancer survivors. 206 Vaginal moisturizers and gels, oils, and topical vitamin D or E can help alleviate symptoms such as vaginal dryness and sexual pain, 120,207 although data on these over-the-counter products are limited in the general population. In one study of breast cancer survivors, the control group used a nonhormonal moisturizer and saw a transient improvement in vaginal symptoms. ...
Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. © 2017 JNCCN-Journal of the National Comprehensive Cancer Network.
... There is an association between vaginal dryness and painful intercourse 12 , which is estimated to affect around half of all women at some point in their lives 13 , and inadequate lubrication is a common cause of dyspareunia (i.e. recurrent or persistent pain with sexual activity that causes marked distress) 14 . ...
... Younger women and those without sexual dysfunctions, such as vaginal dryness or dyspareunia, are more likely to use lubricants to enhance the sexual experience and make sex more comfortable, fun, and pleasurable, while older women and those with dyspareunia or symptoms of VVA/GSM report using lubricants to reduce or alleviate discomfort and pain 12,32 . ...
Vaginal dryness is a common condition that is particularly prevalent during and after the menopause, and is one of the symptoms of vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underestimated. Furthermore, barriers exist to treatment-seeking, and this condition is often underreported and undertreated. Greater education about vaginal dryness and the range of available treatments is essential to encourage more women to seek help for this condition.
Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. However, there is a distinction between lubricants and moisturizers, and notable differences between commercially available products. Women should be advised to choose a product that is optimally balanced in terms of both osmolality and pH, and is physiologically most similar to natural vaginal secretions. A series of recommendations for the use of vaginal lubricants and moisturizers, either on their own or in combination with systemic or topical hormone replacement therapy, is presented.
... Nevertheless, the existence of clear fragmentary information on therapies provided to patients as well as a lack of exploration of women's knowledge of available treatments for VVA are evident. Some misconceptions, such as the negative perceptions of estrogen therapy, continue to jeopardize the optimization of VVA management and its effective treatment 4,21 . ...
... For example, participants' main concerns about VVA symptoms were centered on interference with sexual behavior and loss of intimacy. These results follow a similar pattern to those observed previously (i.e. in the VIVA Survey, 64% had sexual intimacy interference and 32% had interference with the loving relationship with a partner) 8,12,17,18,21 . This study clearly shows the important impact of VVA symptoms in European women after menopause, especially in aspects related to sexual satisfaction and spontaneity, with the ability to be intimate, and the ability to establish a trusted relationship with partners. ...
Objectives The aim of the European REVIVE survey was to achieve a better understanding of vulvovaginal atrophy (VVA), a chronic and progressive condition after menopause. We investigated perceptions, experiences and needs in terms of sexual and vaginal health in a sample of European postmenopausal women.
Methods An online internet based survey was conducted in Italy, Germany, Spain and the UK with a total surveyed sample of 3768 postmenopausal women (age: 45–75 years).
Results The most common VVA symptom was vaginal dryness (70%). VVA has a significant impact on the ability to be intimate (62%), to enjoy sexual intercourse (72%) and to feel sexual spontaneity (66%). Postmenopausal women with VVA are sexually active (51%), but their sexual drive is reduced. Health-care professionals (HCPs) have discussed VVA with postmenopausal women (62%), but they initiated the conversation only in 10% of the cases. The most common treatments for VVA are over-the-counter, non-hormonal, local vaginal products. Thirty-two per cent of postmenopausal women were naïve to any kind of treatment, whereas discussion with the HCP was relevant to be on current treatment (60% of postmenopausal women that discussed VVA with a HCP vs. 23% who did not). The top reasons for poor compliance with vaginal treatments were: not bothersome enough symptoms (18%); vaginal changes not therapeutically reversed (18%); relief from VVA symptoms (17%). Approximately 45% were satisfied with treatment. The most frequent disliked aspects of treatment were the route of administration or the messiness. The fear of hormones was common in postmenopausal women using vaginal prescription products.
Conclusions The European REVIVE survey confirmed that VVA symptoms are frequent in postmenopausal women and demonstrates a significant impact on quality of life and sexual life. However, the condition is still under-diagnosed and under-treated, with a high rate of dissatisfaction for actual available treatments in the four European countries surveyed. The discussion of symptoms with HCPs seems the most critical factor for diagnosis and treatment of VVA.
... In fact, although vaginal dryness has been reported in adult women of all ages [32] it is more likely to occur as a consequence of vaginal atrophy caused by the decreased production of sexual hormones after menopause, causing dyspareunia that usually requires the use of lubricants [31]. Nevertheless, lubricants are also used to facilitate or enhance the sexual experience independently of dyspareunia or other atrophy related symptoms [33,34]. Despite this, sexual stimulation was scarcely selected as a possible vaginal product application. ...
... Data are expressed as the mean value for each age group based on the five-point Likert scale ranging from 1-{I would definitely NOT use the product} to 5-{I would definitely use the product}. The number of respondents for this specific question, in each age group, was: 422(18)(19)(20)(21)(22)(23)(24); 853(25)(26)(27)(28)(29)(30)(31)(32)(33)(34); 675(35)(36)(37)(38)(39)(40)(41)(42)(43)(44); 290 (45-54); 118 (55-65). ...
Therapeutic outcomes of vaginal products depend not only on their ability to deliver drugs to or through the vagina but also on acceptability and correct use. Women’s preferences, in turn, may vary according to age and cultural backgrounds. In this work, an anonymous online survey was completed by 2529 Portuguese women to assess their preferences for physical characteristics and mode of application of vaginal products, according to age. Additionally, intention to use and misconceptions about these issues were assessed. The majority of women of all age groups would use vaginal products to treat or prevent diseases, upon medical prescription. Women preferred vaginal products to be odorless and colorless gels, creams and ointments composed by natural origin drugs/excipients and applied by means of an applicator. Although the majority of women would prefer not to insert any product in the vagina, intention to use for self and recommendation to use for others was associated with previous experiences with vaginal products. General concerns and misconceptions related to use of vaginal products were rare. These data may contribute to the development of products that women are more prone to use.
... It is noteworthy that, while vaginal lubrication correlates with all dimensions of the ORS, erection only correlates with the Affective and Sensory dimensions. This could be because the vagina has natural lubrication, and when it is absent, it can be replaced by artificial lubrication [84]. However, erection problems are more difficult to repair and produce immense frustration as well as an extremely negative psychosocial impact [85,86]. ...
Currently, no validated instrument exists for assessing the subjective experience of orgasm in the gay population. The Orgasm Rating Scale (ORS), previously validated in the heterosexual population, comprises four dimensions: Affective, Sensory, Intimacy, and Rewards. This study validated it for sexual relationships in the gay population by obtaining its factorial invariance by sexual orientation and sex, its internal consistency reliability, and evidence of validity in its relationship with other variables. We assessed 1600 cisgender Spanish adults–heterosexuals, gays, and lesbians–divided into 4, sex-based groups of 400 each, according to the Kinsey scale scores. Participants reported recent experiences of orgasm in the context of sexual relationships and responded to the ORS and other scales assessing attitude toward sexual fantasies and sexual functioning. The ORS structure showed a strict multigroup-level invariance by sexual orientation and sex, confirming its four-dimensional structure. The subjective orgasm intensity was associated with a positive attitude toward sexual fantasies and sexual functioning. Scores obtained on the Affective, Intimacy, and Rewards dimensions confirmed the ability to discriminate between gay people with and without orgasmic difficulties. The ORS’s Spanish version presents good psychometric properties as a validated scale to evaluate the subjective experience of orgasm in the gay population.
... These factors are plausible, but have not been reported before. This circumstance is surprising, as vaginal dryness, which is known to correlate with dyspareunia, is a frequent symptom reported by approximately 15% of premenopausal and 57% of postmenopausal women [20][21][22]. Furthermore, vaginal dryness is arguably one of the major reasons for the increased prevalence of genital trauma in rape victims. ...
This study aimed to assess the validity and efficacy of blue dye in colposcopic assessment of genital injury in pre- and postmenopausal women with and without history of consensual sexual intercourse. Two hundred women were prospectively enrolled and examined colposcopically with and without toluidine blue dye in order to detect and categorize genital lesions (laceration, bruise and abrasion). Examination of genital trauma was accomplished in a standardized way and findings were photo documented. A wide range of influencing factors with a potential impact on prevalence and nature of genital injury was recorded beforehand using a questionnaire. The frequency of diagnostic injury differed substantially depending on the examination technique, ranging from 9% using colposcopic magnification only to 28% with the additional use of toluidine blue dye. A vertical laceration affecting the posterior fourchette was the most frequent lesion detected (17%, n = 32). Menopausal status seems to have significant impact on genital injury prevalence (p = 0.0165), as 42% (16/ 38) of postmenopausal compared to 24% (36/ 151) of premenopausal women had at least one genital lesion. Furthermore, vaginal medication (p = 0.0369), vaginal dryness (p = 0.0228), dyspareunia (p = 0.0234) and low frequency of sexual intercourse (p = 0.0022) were found to significantly correlate with the presence of genital lesions. According to our findings, standardized colposcopy in combination with toluidine blue dye facilitates accurate assessment of genital lesions. Genital trauma situated at another site than the posterior part of the vaginal introitus seems to be uncommon after consensual intercourse.
... [9][10][11] Vaginal dryness will likely lead to painful intercourse which has affected more than half of sexually active women at some point in their lives. [12][13][14] Vaginal dryness and VVA has affected more than half of women during and after menopause. 15,16 Recent survey in the US showed that vaginal dryness could also occur in younger women due to the utilization of antiestrogen medications. ...
Vaginal dryness is a common condition that is particularly prevalent during and after the menopause and it is one of the most important symptoms associated with vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underreported and undertreated. Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. We evaluated the safety and beneficial effects of a new type of estrogen-free vaginal gel, Feminilove BIO-FRESH moisturizing vaginal gel, using in vitro and in vivo experimental tools. Our results suggest that; 1) Feminilove vaginal gel exhibits minimal cell cytotoxicity on various human vaginal cells; 2) Feminilove vaginal gel exhibits minimal side-effects on the structure of vaginal mucosa stratum of experimental animals; 3) Feminiove vaginal gel inhibits the growth of pathogenic vaginal bacteria (E. coli) while promotes the growth of beneficial vaginal bacteria (Lactobacillus spp); 4) Feminilove vaginal gel elicits an anti-inflammatory response on vaginal epithelial cells; and 5) Feminilove vaginal gel promotes the production of tropoelastin and collagen on cultural vaginal smooth muscle and may restore loose vaginal wall (i.e., tightening effects). In summary, our results indicate that Feminilove BIO-FRESH moisturizing vaginal gel is a safe and effective remedy for the treatment of symptoms associated with vaginal dryness and vulvovaginal atrophy in women.
Keyword: vaginal dryness, vulvovaginal atrophy, genitourinary syndrome of menopause, sexual dysfunction, vaginal lubrication, vaginal moisturizer
... [6,7] Several studies have reported a deleterious effect of various commercially available lubricants such as K-Y Jelly ® , Astroglide ® , and Replens ® on sperm function and motility. [9][10][11][12] Vargas et al. [6] showed the toxic effect of glycerine which penetrates across sperm membranes and can disrupt cell function and motility even at low concentrations. Their results showed that both Replens ® and Felis ® contain glycerine and they were found to be toxic. ...
Context:
Some vaginal lubricants and ultrasound gels are known to be detrimental to sperm function and therefore could negatively affect fertility.
Aims:
The aim of the current study was to develop a sperm motility index (SMI) to test the sperm toxicity of ultrasound gels and vaginal lubricants used in reproductive medicine.
Settings and design:
Two ultrasound gels (Aquasonic® and Kefus®) and five vaginal lubricants (Vaginesil™, Velastisa®, K-Y Jelly®, Control®, and Durex®) were studied. Three different concentrations (1%, 5%, and 10%) of each lubricant were tested.
Subjects and methods:
SMI was calculated dividing the percentage of progressively motile sperm in each tested gel by that in the control at 0.5, 1, 2, and 24 h of incubation at 5% of CO2 and 37°C. SMI values <0.75 indicate sperm toxicity.
Statistical analysis used:
The main outcome measured was SMI for each concentration and time of incubation.
Results:
Only Durex® did not show any deleterious effect on sperm quality. The rest of lubricants presented different degrees of toxicity. Vaginesil™ resulted in toxic for all concentrations and incubation periods (SMI < 0.12). Control® and Velastisa® presented toxicity at 10% after 2 h, while K-Y Jelly® showed toxicity at 10% from 1 h of incubation. Regarding ultrasound gels, Aquasonic® showed toxic effects after only 0.5 h (SMI = 0.70 ± 0.15), while Kefus® showed slightly toxic effects after 2 h (SMI 0.69 ± 0.07).
Conclusions:
SMI is an accurate tool to evaluate sperm toxicity. One of the main strengths of the article is the inclusion of representative semen samples and known products used worldwide. This study has a relevant clinical translation since it highlights the importance of evaluating the possible sperm toxicity of simple products used in reproductive medicine.
... 15,29 Although not their main research focus, several studies provided data on religious affiliation and the importance of religion in women with and without pain with intercourse. Sutton et al 30 found that dyspareunia occurred at comparable rates in religious and non-religious women; however, women with dyspareunia tended to report higher importance of religiosity in their lives than the pain-free group. Several other studies collected data on self-identified religious affiliation but did not note statistical significance. ...
Introduction
Despite a growing body of research on psychosocial factors in Genito-Pelvic Pain/Penetration Disorder (GPPPD) during sexual intercourse, there are few studies examining adolescent and young adult women's experiences with painful sex and the effects of religiosity, sexual education, and sex guilt.
Aim
The purpose of the study was to examine the occurrence of GPPPD among sexually active female college students, including psychosocial factors of religiosity and religious practice, sexual education, sex guilt, and sexual distress.
Methods
Data were collected from 974 college women from a university in the Northeastern U.S. We limited our sample to sexually active women (n = 593, 60.9%; mean age: 18.96) who responded to the questionnaire item, “In general, do you feel pain with sexual intercourse?” Participants completed the Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS), Revised Mosher Sex Guilt Scale, Abbreviated Santa Clara Strength of Religious Faith Questionnaire, 10-item Gender Role Beliefs Scale, and measures on sexual wellness and practice and sexual education experiences. Data were analyzed using standard bivariate and regression analyses as well as path analysis.
Main Outcome Measures
Women were asked, “In general, do you feel pain with sexual intercourse?” and categorized into one of three pain groups: occasional (10%–25% of the time), frequent (50% or more), and no pain (less than 10%).
Results
GPPPD with sex was prevalent among young college women, with 113 (19.1%) reporting frequent pain and 143 (24.1%) occasional pain (control n = 337, 56.8%). Numerous statistically significant factors were identified, including frequency of sex, ability to orgasm, sensations during intercourse, presence of a steady sexual partner, expectations of painful sex, sex guilt, and sexual distress. Sex guilt acted as full mediator between religiosity and painful sex.
Implications
Healthcare providers should proactively initiate conversations with young female patients about painful intercourse to identify issues and normalize language on pain with sex. Educators are urged to teach evidence-based information on pain-free and guilt-free sexual experiences inside and outside religious contexts.
Conclusion
Painful sex affects adolescent and young adult women at a similar rate as non-college adult women and while religiosity does not directly impact young women's GPPPD, religiosity does lead to painful sex if it causes sex guilt. Further research is needed into the mechanisms of religion-based sexual shaming and among religiously conservative women who practice abstinence until marriage.
Azim KA, Happel-Parkins A, Moses A, et al. Exploring Relationships Between Genito-Pelvic Pain/Penetration Disorder, Sex Guilt, and Religiosity Among College Women in the U.S. J Sex Med 2021;xxx:xxx–xxx.
... Water-, oil-, or silicone-based lubricants and moisturizers can help alleviate symptoms such as vaginal dryness and sexual pain. 33 In one study of breast cancer survivors, the control group used a nonhormonal moisturizer and saw a transient improvement in vaginal symptoms. 34 Pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction. ...
... Many couples trying to conceive require a coital lubricant when suffering from vaginal dryness or discomfort during intercourse. 14,15 However, couples and physicians are concerned with their effects on fertility. Use of various available commercial products has been strongly discouraged by the previous investigators, who found a significant reduction in motility and viability of sperm with the use of these products in a number of in vitro and in vivo studies. ...
... Vaginal dryness affects pre-and post-menopausal women due to a variety of underlying pathologies, and the most common symptom is insufficient production of vaginal mucosal secretions [53]. The resulting painful sexual intercourse that may occur is known as dyspareunia [54], and may significantly hinder sexual function. Personal lubricants deliver reduced friction during intercourse [55,56], and are typically water-, silicone-, or oil-based liquids [57]. ...
Normal functioning of articulating tissues is required for many physiological processes occurring across length scales from the molecular to whole organism. Lubricating biopolymers are present natively on tissue surfaces at various sites of biological articulation, including eyelid, mouth, and synovial joints. The range of operating conditions at these disparate interfaces yields a variety of tribological mechanisms through which compressive and shear forces are dissipated to protect tissues from material wear and fatigue. This review focuses on recent advances in active agents and biomaterials for therapeutic augmentation of friction, lubrication, and wear in disease and injured states. Various small-molecule, biological, and gene delivery therapies are described, as are tribosupplementation with naturally-occurring and synthetic biolubricants and polymer reinforcements. While reintroduction of a diseased tissue's native lubricant received significant attention in the past, recent discoveries and pre-clinical research are capitalizing on concurrent advances in the molecular sciences and bioengineering fields, with an understanding of the underlying tissue structure and physiology, to afford a desired, and potentially patient-specific, tissue mechanical response for restoration of normal function. Small and large molecule drugs targeting recently elucidated pathways as well as synthetic and hybrid natural/synthetic biomaterials for restoring a desired tissue mechanical response are being investigated for treatment of, for example, keratoconjunctivitis sicca, xeroderma, and osteoarthritis.
... A vast range of topical products, both lubricants and moisturizers, has been tested in women reporting vaginal dryness mainly due to estrogen depletion with menopause of any kind [9]. Very few data are available in premenopausal women, even though clinical experience indicates that they mostly use lubricants to fix transient symptoms of vaginal discomfort, especially during coital activity [10]. Furthermore, women using COC were significantly more likely to report F. Murina, F. Vicariotto Open Journal of Obstetrics and Gynecology decreased vaginal lubrication [11]. ...
... Many couples trying to conceive require a coital lubricant when suffering from vaginal dryness or discomfort during intercourse. 14,15 However, couples and physicians are concerned with their effects on fertility. Use of various available commercial products has been strongly discouraged by the previous investigators, who found a significant reduction in motility and viability of sperm with the use of these products in a number of in vitro and in vivo studies. ...
Objective Infertility affects approximately 15% of couples and in about one-third; the primary cause is a male factor. Patients undergoing infertility investigations frequently experience sexual dysfunction, which often is due to inadequate vaginal lubrication. This can lead to increased use of coital lubricants. Sperm motility is one of the best prognostic indicators of fertilization and DNA Fragmentation Index (DFI) is index that showed cellar and intracellular health. In this study, we evaluated the effects of such lubricants on sperm motility and DNA fragmentation index (DFI). Methods About 20 semen samples from normozoospermic donors were collected. Each sample is divided into five groups. Each tube first incubated in modified human tubal fluid (mHTF) and after treated by 10% KY jelly, Mineral oil (Fertipro®), sesame and olive oils, and normal saline as negative control groups. Total sperm motility and DFI was evaluated 30 min of incubation. Results Control negative samples exhibited no significant decrease in sperm motility. All of the groups showed significant motility decreases (P < 0.001). But the amount of decrease was different in groups that mean differ with 95% confidence interval (CI), Sidak post hoc analysis showed it clear. Fertipro® and Natural oil was not significantly increase the DFI and slight drop down in motility after 30 min. Total sperm motility significantly declined under KY jelly and olive oil, but not significantly drop in sesame oil incubation. All other lubricants had significantly higher DFI than Fertipro and controlled group of sperms. Conclusion Sesame and olive oil and KY jelly coital lubricants impaired sperm motility but only KY jelly® may hamper fertility. Fertipro® showed no deleterious effect and may be considered sperm-friendly coital lubricants with least DFI increment compared with control group. Natural oils, such as olive and sesame oil like Fertipro® have a little effect on DFI although effect on motility is considerable. We should consider that natural oil was used as a cured product and more study such as pharmaceutical formulation adjusted of these products is needed. So Fertipro® can be used to relieve vaginal dryness and preserve fertility. Keywords coital lubricants, sperm motility, DFI, fertipro®
... Such lubricants are also used to produce a sensation of 'wetness' [6,15], when the body does not produce sufficient natural frictionlowering lubrication (e.g. menopausal and post-menopausal individuals, and individuals experiencing dyspareunia) [16], or for other reasons including enhancing foreplay, curiosity and 'spicing up' one's sex life [17,18]. Condom-associated discomfort is a common 'turn-off' [7] and a highly cited reason for persuading one's partner to forgo using condoms [19], so many individuals choose to use lubricants to decrease this discomfort. ...
Personal lubricants can increase user satisfaction with male condoms by reducing friction and yielding a slippery sensation. However, lubricants pose disadvantages of dilution in physiologic fluids and sloughing away over repeated articulations. To address these drawbacks, a latex surface modification, which becomes lubricious in the presence of physiologic fluid, has been developed and evaluated. This study assesses (i) the frictional performance of the lubricious coating compared to non-coated latex and latex lubricated by personal lubricant, (ii) the level of agreement between human-perceived slipperiness and machine-measured friction, and (iii) human preference for a hypothetical male condom containing the lubricious coating. Friction coefficient of the lubricious coating was 53% lower than that of non-coated latex and approximately equal to that afforded by personal lubricant. A touch test and survey of a small population sample (N = 33) revealed a strong correlation (R² = 0.83) between human-perceived slipperiness and machine-measured friction. A majority of participants (73%) expressed a preference for a condom containing the lubricious coating, agreeing that an inherently slippery condom that remained slippery for a long duration would increase their condom usage. Such a coating shows potential to be an effective strategy for decreasing friction-associated pain, increasing user satisfaction and increasing condom usage.
... Lubricants and moisturizers-Application of vaginal lubricant during sexual activity or vaginal moisturizers as maintenance may assist with atrophic symptoms and dyspareunia. [126][127][128] Examples of some lubricants are described below, although no one lubricant or moisturizer has been adequately studied to recommend it over others. Additionally, not all products are available in all countries. ...
Introduction and hypothesis:
The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report.
Methods:
This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction.
Results:
A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible.
Conclusions:
A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
... Lubricants and moisturizers-Application of vaginal lubricant during sexual activity or vaginal moisturizers as maintenance may assist with atrophic symptoms and dyspareunia. [126][127][128] Examples of some lubricants are described below, although no one lubricant or moisturizer has been adequately studied to recommend it over others. Additionally, not all products are available in all countries. ...
Aims:
The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report.
Methods:
This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction.
Results:
A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible.
Conclusion:
A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
... avoidance of the product drifting beyond reach), any sexual device inserted into the anus must have a string or a wide base. Insertional discomfort may be reduced, and pleasure increased, with the use of a lubricant (described further in what follows) (Herbenick et al., 2015;Sutton, Boyer, Goldfinger, Ezer, & Pukall, 2012). ...
Vibrators are an evidence-based treatment for a variety of sexual dysfunctions and sexual enhancement; however, the use of a genital vibrator lacks best practice recommendations. This aim of this article is to provide current, best practice recommendations regarding the use of vibratory stimulation for the treatment of sexual dysfunction and/or sexual or relationship enhancement. A multidisciplinary team of sexual health specialists collaborated to develop best practice recommendations based on a narrative literature review. Recommendations for the use of vibratory stimulation for the treatment of sexual dysfunction are provided, with special attention to counseling patients on choosing and safely using a vibrator. Further study is needed to determine the most effective methods to counsel patients on vibrator use and to provide evidence-based cleaning recommendations.
... Vaginal lubricants are used to prevent dryness and dyspareunia during sexual activity [17,18]. Although water-based vaginal lubricants are commonly recommended, many contain preservatives that may aggravate sensitive vaginal mucosa [19,20]. ...
... 6 The objective of the present analysis, based on the REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs-Europe (REVIVE-EU) survey, was to achieve a deeper understanding of the VVA problem knowledge by Italian women after menopause, together with their experiences and needs in terms of sexual and vaginal health, as well as the current nature of their interactions with HCP. This will help to gain better clinical and therapeutic approaches, avoiding the misconceptions and specific regrets on estrogen therapy that usually jeopardize the optimization of VVA management [6,23]. ...
Objectives:
To achieve a deeper understanding of the attitudes and perceptions of Italian post-menopausal women (PMW) regarding vulvo-vaginal atrophy (VVA).
Study design:
As part of the EU REVIVE study, an online survey was conducted in four European countries; the Italian arm comprised 1000 participants from representative regions of Italy.
Main outcome measures:
The perceptions, experiences and needs of Italian PMW in relation to sexual and vaginal health.
Results:
The most frequent VVA symptom was vaginal dryness (78%). Usually, the severity of symptoms was similar to or worse than when they first appeared. This was particularly true for dyspareunia, the most bothersome symptom (76%). VVA symptoms had a significant impact on Italian participants' ability to achieve pleasurable relations (74%) and spontaneity (70%). Although 75% of participants were still sexually active, their sex drive had been reduced by a third because of VVA. Women expected that doctors would start a discussion of menopausal symptoms and sexual health, but this was rarely the case (11%). Most women had been treated with a vaginal over-the-counter (OTC) product. Women who had discussed their condition with a physician were more likely (68%) to be under treatment for VVA than those who had not (36%). Low compliance was associated with symptom improvement (23%), not having annoying symptoms (22%), and the impossibility if restoring the vagina to normal (14%). Common reasons for treatment dissatisfaction were related to route of administration or discomfort. Lack of efficacy and fear of a hormone effect were perceived as the main limitations for OTC and local estrogen products, respectively.
Conclusions:
Despite the commonness of VVA and its significant impact on quality of life, the condition remains underdiagnosed in Italy. Discussion of symptoms with doctors influences the diagnosis, and patients' satisfaction with available treatments is not high.
... A vast range of topical products, both lubricants and moisturizers, has been tested in women reporting vaginal dryness mainly due to oestrogen depletion with menopause of any kind [15]. Less data are available in premenopausal women, even though clinical experience indicates that they mostly use lubricants to fix transient symptoms of vaginal discomfort, especially during coital activity [22,23]. Research data indicate that the perception of vaginal dryness may be culturally driven and linked to women's preference to feel wetter, in order to enhance sexual pleasure and satisfaction [7,24]. ...
... Water-, oil-, or silicone-based lubricants and moisturizers can help alleviate symptoms such as vaginal dryness and sexual pain. 33 In one study of breast cancer survivors, the control group used a nonhormonal moisturizer and saw a transient improvement in vaginal symptoms. 34 Pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction. ...
Cancer treatment, especially hormonal therapy and therapy directed toward the pelvis, can contribute to sexual problems, as can depression and anxiety, which are common in cancer survivors. Thus, sexual dysfunction is common in survivors and can cause increased distress and have a significant negative impact on quality of life. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and treatment recommendations for female sexual problems, including those related to sexual desire, arousal, orgasm, and pain.
Background
Psychological difficulties, including depression, anxiety, and somatization, are among the most important predictors for women's sexual function (i.e., arousal, desire, lubrication, pain, and satisfaction) and sexual distress. These associations have largely been studied at the construct level, with little research examining which specific symptoms might be most important for maintaining links between psychological difficulties and domains of sexual function. The present research sought to establish and characterize networks of women's psychological symptoms, sexual function, and sexual distress, and identify potential bridge symptoms that connect them.
Methods
In a cross–sectional study, 725 women reported on their sexual function, sexual distress, and depressive, anxiety, and somatization symptoms. A series of network analyses was used to identify central symptoms and connections between psychological symptoms, sexual function domains, and sexual distress.
Results
Across the modeled networks, sexual distress and pain during sex were consistent bridges between other sexual function domains and psychological symptoms.
Discussion
Overall, our models revealed sexual distress as an important potential mediator between sexual function problems and psychological symptoms that might contribute to the development and maintenance of comorbid sexual function and psychological problems.
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy but are related to a complex network of perceptions, preferences, personal and cultural backgrounds and results from previous experiences. Women’s preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches) and much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women’s preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women’s preferences and acceptance for different dosage forms and drug delivery routes involved in women’s health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
Objective
To explore the efficacy of CO2 laser treatment in postmenopausal women with vulvovaginal atrophy.
Method
PubMed, Embase, Cochrane Library and Web of Science were searched to June 9, 2020. Prospective studies on the efficacy of CO2 laser treatment were included. Two researchers independently reviewed articles and extracted data. Heterogeneity test was conducted for each outcome indicator. Sensitivity analysis was performed in all models.
Results
Twelve articles including 459 participants were enrolled. Compared with baseline, vaginal health indeices (VHIs) were significantly higher at the 1‐, 3‐, 6‐, and 12‐month follow ups (P < 0.001). For VVA severity, the visual analog scale scores for vaginal dryness at 1‐, 3‐, 6‐, and 12‐month follow‐ups (P < 0.050), vaginal burning, itching, and dysuria at 1‐month follow up (P < 0.001), and dyspareunia at 1‐, 3‐, 6‐, and 12‐month follow‐ups (P < 0.001) were all significantly lower. For FSFI, total scores at 1‐, 3‐, 6‐, and 12‐month follow ups (P < 0.001), and the scores in desire, arousal, lubrication, orgasm, satisfaction, and pain at 1‐month follow up (P < 0.050) were all significantly higher. For quality of life, the PCS12 and MCS12 scores were all significantly higher (P < 0.050) at the 1‐month follow up.
Conclusion
CO2 laser treatment may be effective for postmenopausal women with VVA symptoms in improving quality of life and sexual function.
Almost half of all women experience a sexual pain disorder in their lifetime, including dyspareunia, vaginismus, vulvodynia, and provoked vestibulodynia. Despite significant negative consequences across quality of life indices, few women seek treatment for sexual pain, and among those who do access support, more than half report that currently available strategies are ineffective or even harmful in some cases. This outcome may partly result from a standard of care that prioritizes pharmacotherapy and/or physiotherapy within pain management protocols rather than psychological interventions despite their demonstrated ability to yield comparatively better treatment outcomes. In considering that some women experience sexual pain in the aftermath of a sexually traumatic event, Eye Movement Desensitization and Reprocessing (EMDR), a type of evidence-based trauma therapy, may be a suitable adjunctive treatment to mitigate symptoms by targeting psychological risk factors. In this report, the authors first review the impact of sexual trauma on sexual pain, particularly the biopsychosocial effects of trauma within the body and its hypothesized mechanisms of action on sexual functioning, and then provide an overview of EMDR therapy, including how it promotes the resolution of trauma symptoms and its effects on sexual pain. By presenting this evidence, the authors will explore how EMDR therapy may have utility as a novel adjunctive treatment to address sexual trauma-induced sexual pain disorders and optimize the provision of care among this clinical population.
Vaginal dryness is common during and after menopause due to declining estrogen. It is one of the symptoms of vulvovaginal atrophy (VVA), which is part of the genitourinary syndrome of menopause. This can be distressing for women and cause pain, discomfort, and dyspareunia. Vaginal dryness affects over 50% of postmenopausal women but is under-reported and thus under-treated due to barriers to seeking help. Estrogen replacement can resolve symptoms, but may be contraindicated or not desired by all women. Over-the-counter vaginal moisturizers and lubricants can ease the symptoms of VVA. However, their chemical composition varies enormously and some are known to cause detrimental effects due to unphysiological pH, osmolality, and additives. The primary purpose of this review is to assess both their efficacy and safety. Women should be directed toward products that are as 'body-similar' as possible to vaginal secretions in terms of pH and osmolality. Products with potentially harmful ingredients should be avoided. Lubricants can be trialed for sexual activity and moisturizers for symptom control, even if topical or systemic menopause hormone therapy is being used.
Sexual dysfunctions are prevalent disorders in psychiatric patients that too often are not addressed by psychiatric-mental health nurses. An integrative review was conducted using PubMed, Joanna Briggs Institute, SCOPUS, PsycINFO and CINAHL databases to evaluate the evidence for independent, nursing interventions for sexual dysfunction across all nursing literature that could be implemented by psychiatric-mental health nurses. Out of 2448 articles, nine papers met inclusion criteria and were synthesized. Best available evidence was found for sexual teaching interventions for female sexual dysfunction. The implications for psychiatric-mental health nursing practice and recommendations for future research are discussed.
Genitourinary syndrome of menopause (GSM), formerly referred to as vulvovaginal atrophy or atrophic vaginitis, is a common chronic condition that requires a collaborative treatment plan between a health care provider and a woman to relieve symptoms and improve quality of life. Many women are not aware that symptoms can be controlled with treatment. Current treatment options approved for GSM include vaginal moisturizers, lubricants, and hormones. For women with GSM symptoms that are unresponsive to nonhormonal therapy, low-dose vaginal estrogen therapy is the preferred pharmacologic treatment. Clinicians should be trained to routinely ask appropriate questions during the history to elicit sufficient information to assess for GSM. Physical examination findings may further confirm suspicion of GSM.
Background and aim:
Fractional CO2 lasers have been shown to provide improvement of vulvovaginal atrophy (VVA). The aim of the current study was to assess the early effect of a fractional CO2 laser system in treating postmenopausal women with clinical symptoms of VVA.
Methods:
28 healthy post-menopausal women (mean age 60.1 ± 5.55 years) with VVA-related symptoms were treated with fractional CO2 laser 3 times, in 4-week intervals. At each study visit, VHIS score and VVA symptom severity were recorded. Sexual function was assessed with the Female Sexual Function Index (FSFI).
Results:
One month following the first laser treatment, the mean VHIS score was significantly improved (13.89 ± 4.25 vs. baseline 11.93 ± 3.82; p < 0.05), and improved further at 3 and 6 months following all three laser treatments (16.43 ± 4.20 and 17.46 ± 4.07, respectively). Almost all VVA symptoms were significantly improved at one month following the first treatment. A further significant improvement in VVA symptoms was noted at 3 and 6 months following the third laser treatment. Following treatments, the FSFI score increased significantly (22.36 ± 10.40 vs. baseline 13.78 ± 7.70; p < 0.05), and remained significantly higher than baseline at the 3- and 6-month follow-up visits.
Conclusion:
CO2 laser therapy for post-menopausal women can be considered an effective therapeutic option providing relief of symptoms already noted after one laser treatment.
In the shadows of the cultural obsession with male erections, women’s vaginal lubrication and experiences of wetness have received surprisingly little academic attention. Framed largely as a biological or normative behavioral “sexual function” issue and not as a subjective experience, no previous qualitative studies have asked women to discuss their feelings about their vaginal lubrication and wetness. This study analyzed semi-structured interviews with 20 women from a diverse 2014 community sample collected in a large Southwestern U.S. city in order to examine American women’s subjective feelings about their own vaginal lubrication and wetness, particularly the sensations they experience and the meanings they make around wetness. Results revealed four themes in how women described vaginal lubrication: (1) wetness as pleasure, joy, and connection; (2) wetness as physical and biological phenomenon; (3) anxiety about insufficient wetness; and (4) having excessive or “too much” wetness. Tensions surrounding women’s sexual anxieties and where they place responsibility for “too little” wetness is discussed in tandem with analyses of how pleasure and arousal may (or may not) overlap with feelings about sexual normality and health. Ultimately, renewed attention to the complexities of women’s sexual arousal and function, particularly in stark contrast with pharmaceutical efforts to medicate women’s sexual arousal and reduce it to “brain chemistry,” are examined.
The human papillomavirus (HPV) infection, which is strongly related to cervical cancer, can be reduced by the topical application of imiquimod. Some strategies have been used to increase the adhesion and penetration of drugs through the vaginal mucosa. Two of them are the development of mucoadhesive semisolid formulations and the development of polymeric nanocarriers. In this paper, we hypothesize that the combined use of these two strategies results in a better performance of the formulation to retain imiquimod into the vaginal tissue. Aiming this, two different systems are proposed: a) chitosan-coated poly(ε-caprolactone)-nanocapsules incorporated into hydroxyethylcellulose gel (HEC-NCimiq-chit), and b) poly(ε-caprolactone)-nanocapsules incorporated into chitosan hydrogel (CHIT-NCimiq). These formulations were submitted to three main tests: mucoadhesivity by interaction, permeation and washability test (or retention test). We developed an integrative index that allows comparing the global performance of the proposed formulations by considering jointly the results of these three tests. Thus, when considered the integrative indexes for the formulations, our results show that CHIT- NCimiq presents the best performance for the treatment of HPV.
De bekkenfysiotherapeutische diagnostiek is in zijn geheel in deel II beschreven; dit is de basis van het diagnostisch proces zoals dit bij elke patiënt zal kunnen verlopen, waarbij steeds bekeken wordt of alle elementen van de basisdiagnostiek relevant zijn bij de hulpvraag of klacht van de patiënt. Bezien vanuit de samenhang van de domeinen blijft de brede blik tijdens het diagnostische proces noodzakelijk. Op deze manier worden geen disfuncties gemist die een relatie kunnen hebben met de klacht, of die op termijn tot nieuwe klachten kunnen leiden.
Objectives:
To gain a deeper comprehension of current vulvovaginal atrophy (VVA) knowledge among Spanish postmenopausal women.
Methods:
An online survey (REVIVE) was conducted in four European countries with an overall sample of 768 participants included in Spain. Perceptions, experiences and needs of Spanish postmenopausal women in terms of sexual and vaginal health were reported.
Results:
Vaginal dryness was the most common VVA symptom in Spain (81%). The severity of symptoms reported by postmenopausal women tended to be similar or worse than at onset, especially in the most troublesome symptom, dyspareunia (80%). VVA symptoms significantly impact on Spanish participants' ability to achieve sexual enjoyment (75%), relationship with partner (67%) and sexual spontaneity (66%). Although 71% of participants with partners (83%) were sexually active, their sex drive was reduced by one-third as a consequence of VVA. Despite the fact that women expected doctors to start asking them about menopausal symptoms, this rarely occurred. Treatments were administered mainly vaginally without prescription (62% were using over-the-counter products at the time). Postmenopausal women who had discussed their symptoms with physicians were twice as likely to be treated (66% vs. 33%) than those who had not. Low compliance with treatment was justified by Spanish participants with not bothersome enough symptoms (22%), relief (21%), inability to reverse vaginal changes (15%) and treatment price (13%). Almost half of the participants with a current local estrogen prescription showed satisfaction. The acknowledged main limitation for all treatments was the inability to restore the natural conditions of the vagina. The price of over-the-counter products was also reported as an important concern in Spanish postmenopausal women.
Conclusion:
VVA remains underdiagnosed and undertreated in Spain, despite its high frequency and significant impact on quality of life. Since patient satisfaction with available treatments remains compromised, an effective discussion of symptoms and therapies with doctors would improve its management.
To achieve a better comprehension of the variability of perceptions, experiences and needs in terms of sexual and vaginal health in postmenopausal women (PMW) from four different European countries.
An internet-based survey was conducted in Italy, Germany, Spain and the United Kingdom with a total surveyed population of 3,768 PMW aged between 45 and 75 years.
The UK sample was significantly older, with almost a quarter of participants over 65 years of age, and had the highest proportion of women experiencing recent vulvar and vaginal atrophy (52.8%). The majority of Italian and Spanish participants were receiving VVA treatment, whereas in the UK only 28% of PMW were on medication. The most common menopausal symptom was vaginal/vulvar dryness, with almost 80% of participants reporting it in all the countries except the UK (48%). On the other hand, vaginal/vulvar irritation was more frequently reported in the UK (41%). The percentage of participants with a partner was lower in the UK (71%), as was the monthly rate of sexual activity (49%). In the UK, the proportion of participants who had seen a healthcare professional for gynaecological reasons in the last year was lower than in other countries (27% vs. ≥50%), as was the proportion who has discussed their VVA symptoms with them (45% vs. ∼67%). In this sense, UK PMW waited for a longer before asking for help (especially for pain with intercourse and dryness). The main issues relating to VVA treatment difficulties expressed by participants were administration route in the UK, efficacy in Germany, and side-effects in Italy.
Although all European women shared the same expectation of improving the quality of their sex lives, the opportunity for that varied among different countries in relation to the healthcare system and to the effective communication achieved with healthcare professionals when managing VVA.
It is critical to keep in mind, especially in this chapter that multiple lifestyle options exists that can improve or actually not improve and even exacerbate side effects from cancer treatments. And there are many integrative medicines, especially dietary supplements that can improve, have no impact or actually cause a side effect from cancer treatment to become worse! The purpose of this chapter just like the rest of this book is to cover all of those integrative medicines that work, have no effect or are worthless for multiple cancer treatment side effects. When applicable prescription drug treatments are mentioned and reviewed. Still, this chapter and the book is not intended to provide a summary or exhaustive list of the conventional prescription treatment options for these side effects from A to Z because it would not only create an unreadable voluminous text, but this also would not serve the purpose of this text—to simply provide a non-biased and objective review of the medical research in the area of breast cancer and integrative medicines, especially in regard to lifestyle changes and dietary supplements. This is the area of oncology that appears to have arguably the greatest current needs for more objective and educational attention to this issue.
Purpose:
While previous research suggests that lubricant use may be common among lesbian- and bisexually-identified women, it remains unclear from this research whether lubricant was being used with a male or female partner. The present study explores the behavioral, emotional, situational, and relational aspects of lesbian- and bisexually-identified women's lubricant use during their most recent female-partnered sexual event.
Methods:
Nationally representative data was collected as part of the 2012 National Survey of Sexual Health and Behavior (NSSHB). The 2012 NSSHB had an oversample of lesbian, gay, and bisexual (LGB) individuals. Participants were included in the present study if they identified as a lesbian or bisexual women and indicated that their most recent sexual partner was a female. Participants were asked a variety of questions about the context and experience of lubricant use during this event.
Results:
Nearly a quarter (21.9%, n=32) of the participants reported that they used a lubricant during their most recent female-partnered sexual event. The likelihood of lubricant use significantly differed based upon age, race/ethnicity and sexual identity. The most commonly reported reason for lubricant use was to "make sex more comfortable," with half reporting use for clitoral stimulation (50.6%, n=16). Overall, participants indicated that lubricant use enhanced their sexual experience.
Conclusion:
Lubricant use may improve comfort and increase pleasure during certain sexual acts between women. The use of lubrication should be considered as a means of reducing pain and enhancing sexual pleasure during sexual behavior between women.
Complementary & Alternative Medicine for Prostate and Urologic Health is designed to capture and clinically review the comprehensive database of clinical research articles that support and do not support the utilization of a variety of dietary supplements and other complementary medicines that physicians are exposed to in their daily practice. This is a critical distinction between this book and any other Complementary & Alternative Medicine (CAM) books published to date. Each section of the book provides an easy to reference guide into the topic of interest for the individual that works in urology. The various sub-specialty groups in urology are adequately represented, which allows for a physician to rapidly and thoroughly investigate their topic of interest regardless of whether it is fertility, bladder cancer, or prostate disease. Rather than having to sort through the now thousands of articles published yearly on CAM in medicine, this volume focuses first on the specialty and secondarily how it compares to the overall CAM literature. Each chapter includes a summary page that will allow the physician a rapid review of the subject with a patient, colleague or student. The practical nature of this book in urology also cannot be overstated. Chapters include a general overview of the CAM agent, whether or not it has data in medicine and urology, and a list of potential drug interactions and specific clinical scenarios where it can be utilized or discouraged in the specialty. Complementary & Alternative Medicine for Prostate and Urologic Health represents a gold standard text for use in teaching, not only for the students interested in the urologic field but for all current urologic health providers.
Introduction:
The diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level.
Aims:
The aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States.
Methods:
Data were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U.S. adults ages 18 and older.
Main outcome measures:
We examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used.
Results:
A majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex.
Conclusions:
Lubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly.
This review focuses on two formulation approaches, mucoadhesion and thermogelling, intended for prolonging residence time on vaginal mucosa of medical devices or drug delivery systems, thus improving their efficacy. The review, after a brief description of the vaginal environment and, in particular, of the vaginal secretions that strongly affect in vivo performance of vaginal formulations, deals with the above delivery systems. As for mucoadhesive systems, conventional formulations (gels, tablets, suppositories and emulsions) and novel drug delivery systems (micro-, nano-particles) intended for vaginal administration to achieve either local or systemic effect are reviewed. AS for thermogelling systems, poly(ethylene oxide-propylene oxide-ethylene oxide) copolymer-based and chitosan-based formulations are discussed as thermogelling systems. The methods employed for functional characterization of both mucoadhesive and thermogelling drug delivery systems are also briefly described.
Copyright © 2015. Published by Elsevier B.V.
Objective We aimed to identify Portuguese women's experiences, preferences and perceptions regarding vaginal products.
Methods A descriptive cross-sectional study was conducted (February–May 2013) among Portuguese women (aged 18 to 65 years) using an online questionnaire. Descriptive and chi-squared statistics were applied.
Results Among 2529 women, 85.4% had used vaginal products, mostly to manage vulvovaginal infections (75.3%). Gels, creams and ointments (semi-solids) were the most frequently used (82%), followed by vaginal suppositories (56.5%) and tablets/capsules (41.8%), while vaginal rings were used by 10% of women. Semi-solids were preferred as an intravaginal medication both by women who had previously used them and by women who had never used an intravaginal product, while preference for vaginal rings was higher only among women who had previously used them. Even though 87.1% of all women considered vaginal drug delivery to be advantageous, the majority preferred to use oral products. Leakage (84.8%) and insertion difficulties (58.4%) were the main problems reported for vaginal products.
Conclusions Overall, semi-solids were the most used and preferred vaginal products, while vaginal rings were highly acceptable for women who had previously used them. Although they considered the vaginal route to be more efficient and safe, many women felt it to be less appealing than the oral route, particularly due to comfort issues.
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.
This paper examines young heterosexual men's participation in unsafe sex. A qualitative study of young heterosexual Australian men's understandings and practices of safe and unsafe sex, involving in-depth interviews conducted with 17 men aged between 18 and 26, found that five principal themes recur in young men's accounts for the non-use of condoms. First, men stress the risk of pregnancy rather than the risks of HIV or other sexually transmitted infections, and they respond to the former risk by relying on their partners' use of the contraceptive pill. Second, men perceive that wearing condoms decreases penile sensation and that condoms are difficult to use. Third, men find that the 'heat of the moment' of sexual episodes, and their spontaneous and passionate ambience, makes it hard to incorporate condoms. Fourth, men privilege 'trust' as fundamental to their sexual involvements, and quickly define involvements as 'relationships' and therefore as trusting and monogamous, such that they abandon condoms. Fifth, men believe that they are very unlikely to contract HIV because they see their social circles, the 'heterosexual community' or heterosexual sex per se as safe and free of HIV/AIDS. Future education and prevention efforts directed at the heterosexual sexual transmission of HIV should address such configurations of sociosexual meaning and practice in men's lives.
Introduction. Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management.
Aim. To provide recommendations/guidelines for the assessment and management of women's sexual dysfunctions focusing on low desire, low interest, and lack of arousal.
Methods. An international consultation, in collaboration with major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One subcommittee of five members focused on women's sexual desire and arousal, developing over a 2-year period various recommendations.
Main Outcome Measure. Expert opinion was based on grading of evidence-based scientific literature, widespread internal committee discussion, public presentation, and debate.
Results. Women's sexual response in health can be reconceptualized as a circular model of overlapping phases of variable order influenced by psychological, societal, and biological factors. Subsequent revisions to definitions of arousal and desire disorder are given. Recommendations regarding assessment and management focus on factors reducing arousability and satisfaction. These include women's mental health and feelings for their partner, generally and at the time of sexual activity. Recommendations reflect the poor correlation of subjective arousal and increases in genital vasocongestion.
Conclusion. Further outcome research of management based on new conceptualization of sexual response and revised definitions of dysfunction is needed. The basis of the variable correlation between genital vasocongestion and subjective arousal needs clarification as do the biological underpinnings of sexual response and their changes with age and life cycle.
Western culture portrays sex as most gratifying when it is spontaneous. However, portraying sex in this way can lead to unrealistic
expectations. If perfect and spontaneous sexual performances are expected, this may then impede one’s ability to enjoy satisfying
sexual relationships. The “myth of sexual spontaneity” functioning as a sexual script operates in terms of the rationale that
sexual behavior follows desire and arousal without a conscious awareness of the process, such that satisfying sex is the result
of reflexive bodily impulses and not conscious communication. Through a brief exploration of the influence of modern mass
media, Simon and Gagnon’s theory of sexual scripts, and discussion of several inherent tensions within the myth, the present
paper problematizes the logic behind this belief. We subsequently argue that expectations of spontaneous sex as the pinnacle
of “good sex,” may negatively impact the sexual lives of people who may be sexually marginalized such as those with HIV/AIDS
and STI’s, female sexual dysfunctions, erectile dysfunction and mobility impairments.
One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for 8 standard statistical tests: (1) the difference between independent means, (2) the significance of a product-moment correlation, (3) the difference between independent rs, (4) the sign test, (5) the difference between independent proportions, (6) chi-square tests for goodness of fit and contingency tables, (7) 1-way analysis of variance (ANOVA), and (8) the significance of a multiple or multiple partial correlation.
The importance of the acceptability of rectal microbicides for HIV and sexually transmissible infections (STIs) prevention is widely recognised. Given relatively consistent use of lubricants for anal intercourse (AI) and the potential for lubricant-like rectal microbicides, understanding barriers to lubricant use may help inform hurdles likely to be encountered once a rectal microbicide becomes available.
We conducted an internet-based survey using a 25-item questionnaire to assess AI and lubricant use, including lubricant preferences and barriers to use.
The majority of the 6124 respondents who reported AI were male (93%), 25 years or older (80%) and from North America (70%). Consistent condom use during AI was reported by a minority (35%) and consistent lubricant use was reported by over half of respondents. Reasons for non-use differed by age and region. Among men, those <25 years were more likely to report barriers around cost compared with those 45 and older (odds ratio (OR) = 6.64; 95% confidence interval (CI) 3.14-14.03). European men (OR = 1.92; 95% CI 1.50-2.45), Latin American women (OR = 3.69; 95% CI 1.27-10.75) and Asian women (OR = 4.04; 95% CI 1.39-11.78) were more likely to report sexual preference as a reason for non-use.
Rectal lubricants are widely used, but barriers to use vary by age and region for dry sex. A lubricant-like rectal microbicide would potentially be acceptable and such a product may be useful as a method of HIV prevention. However, targeted marketing and educational approaches may be needed to enhance use and acceptability of such a product.
Using data from a U.S. clinical safety trial of tenofovir gel, a candidate microbicide, we explored the intersection of sexual pleasure and vaginal lubrication to understand whether and under what circumstances women would use a microbicide gel covertly with primary partners. This study question emerged from acceptability research in diverse settings showing that even though future microbicides are extolled as a disease prevention method that women could use without disclosing to their partners, many women assert they would inform their primary partner. Participants (N = 84), stratified by HIV-status and sexual activity (active vs. abstinent), applied the gel intra-vaginally for 14 days. At completion, quantitative acceptability data were obtained via questionnaire (N = 79) and qualitative data via small group discussions (N = 15 groups, 40 women). Quantitatively, 71% preferred a microbicide that could not be noticed by a sex partner and 86% experienced greater vaginal lubrication with daily use. Based on our analysis of the qualitative data, we suggest that women's perception that their primary partners would notice a microbicide gel is a more important reason for their caution regarding covert use than may previously have been recognized. Our findings also showed that women's assessment of the possibility of discreet, if not covert, use was strongly related to their perception of how a microbicide's added vaginal lubrication would influence their own and their partner's pleasure, as well as their partner's experience of his sexual performance. A microbicide that increases pleasure for both partners could potentially be used without engendering opposition from primary partners.
This study assessed the acceptability and preference for sexual barrier and lubricant products among men in Zambia following trial and long-term use. It also examined the role of men's preferences as facilitators or impediments to product use for HIV transmission reduction within the Zambian context. HIV-seropositive and -serodiscordant couples were recruited from HIV voluntary counseling and testing centers in Lusaka between 2003 and 2006; 66% of those approached agreed to participate. HIV seropositive male participants participated in a product exposure group intervention (n = 155). Participants were provided with male and female condoms and vaginal lubricants (Astroglide [BioFilm, Inc., Vista, CA] & KY gels [Johnson & Johnson, Langhorne, PA], Lubrin suppositories [Kendwood Therapuetics, Fairfield, NJ]) over three sessions; assessments were conducted at baseline, monthly over 6 months and at 12 months. At baseline, the majority of men reported no previous exposure to lubricant products or female condoms and high (79%) levels of consistent male condom use in the last 7 days. Female condom use increased during the intervention, and male condom use increased at 6 months and was maintained over 12 months. The basis for decisions regarding lubricant use following product exposure was most influenced by a preference for communicating with partners; participant preference for lubricant products was distributed between all three products. Results illustrate the importance of development of a variety of products for prevention of HIV transmission and of inclusion of male partners in interventions to increase sexual barrier product use to facilitate barrier acceptability and use in Zambia.
Infertility affects approximately 15% of couples, and in about one-third the primary cause is a male factor. Patients undergoing
infertility investigations frequently experience sexual dysfunction, which often is due to inadequate vaginal lubrication.
This can lead to increased use of coital lubricants. The effects of such lubricants on sperm motility have not been widely
studied, although sperm motility is one of the best prognostic indicators of fertilization. Using a prospective longitudinal
control-based study, we analysed the effect of adding four lubricants: KY jelly, baby oil, olive oil and saliva on sperm motion
in 16 samples from patients undergoing infertility investigations. Sperm samples were prepared by density gradient centrifugation
prior to mixing with lubricants. Motility parameters were determined using computer-assisted semen analysis after 5, 15 and
30 min. All lubricants except baby oil significantly decreased percentage progressive motility, progressive velocity, curvilinear
velocity and lateral head displacement at 12.5% concentration. At a lower concentration of 6.25%, both olive oil and saliva
still significantly reduced progressive motility parameters, while KY jelly diminished head movement parameters. Hence, even
at these very low concentrations, coital lubricants impair sperm motility and thus may adversely affect fertility.
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.
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.
Female sexual dysfunction is a significant age–related, progressive and highly prevalent problem that affects a substantial number of women in the United States. The female sexual response cycle is initiated by neurotransmitter–mediated vascular and nonvascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. These mechanisms are mediated by a combination of neuromuscular and vasocongestive events. Physiological impairments that interfere with the normal female sexual response bring about complaints associated with diminished sexual arousal, libido, vaginal lubrication, genital sensation, and ability to achieve orgasm. Therapy aimed at restoring hormone levels as well as genital blood flow will be discussed.
STIs are common, particularly in young women. Sexual history-taking is eased by private and comfortable surroundings, establishing a good professional relationship, having a non-judgemental attitude, and choosing words that are both appropriate to the consultation and readily understood by the woman. Genital examination is facilitated by privacy, careful and sensitive technique and the availability of the right equipment, including a gynaecological examination couch and a range of speculums. The screening investigations selected depend on the setting, local availability of investigations and prevalence of infections, and the presentation and wishes of the client. Sampling requirements are changing with the advent of new diagnostic techniques such as nucleic acid amplification tests for Chlamydia; these can be undertaken on samples taken by the woman herself (e.g. perineal swabs, urine), thereby avoiding the need for speculum examination in some circumstances.
b>Introduction. Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction.
Aim. Investigate female sexual difficulty/dysfunction using data from prevalence studies.
Methods. We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100.
Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more.
Results. Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16–75%) experienced desire difficulty, 35% (range 16– 48%) experienced orgasm difficulty, 31% (range 12–64%) experienced arousal difficulty, and 26% (range 7–58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62–89% persisted for at least several months and 25–28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21–67%).
Conclusions. Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.<br /
Objective To provide information on the extent of problems of urogenital ageing in older British women.
Design A MORI survey of a representative population sample of older British women.
Setting Home interviews.
Participants Two thousand and forty‐five women aged 55–85+.
Results Urogenital symptoms had affected 48.8% of the women at some time, but no more than 11% were currently affected by individual symptoms; however, these were often of long duration. The majority (73%) were not sexually active, with lack of a partner being a factor for many. There was also a decreasing prevalence of sexual activity with increasing age. Those sexually active in the 65–74 year old age group ( n = 148 ) tended to have a similar sexual frequency (at least once per month) compared with the younger women studied. Approximately 12% of those who reported dyspareunia and/or vaginal dryness claimed a severe problem; 33% did not seek professional advice and 36% resorted to an over the counter remedy. Use of hormone replacement therapy was generally of relatively short duration. There was a declining gradient of ever‐use with age.
Conclusions The extent of significant urogenital symptoms is relatively low, but some women are seriously affected and use self‐help as well as professional assistance. The extent of sexual activity in older women and factors affecting this have been defined, and the effect of urogenital symptoms on sexual activity demonstrated.
We review conceptual issues and theoretical frameworks related to users' acceptability of new technologies designed to protect reproductive health and prevent unwanted pregnancy. Special attention is given to distinctions among different kinds of users' perspectives regarding acceptability, as well as differentiating acceptability from assessments of the efficacy of innovative methods. Emphasis is also given to the larger context of couple decision-making and cultural variation. We argue that concern for sexual pleasure plays a central role in determining user perspectives regarding new methods. The female condom, contraceptive ring, contraceptive skin patch, microbicides, vaccines, emergency contraception, and PERSONA are discussed within the context of the identified critical issues.
Introduction. Although lubricant use is commonly recommended to women for solo and partnered sexual activities, little is known about women's use of lubricant or their relationship to sexual pleasure and satisfaction.
Aim. The aim of this study was to assess: (i) how adult women used lubricant during partnered and solo sexual activities; (ii) relations between women's reports of sexual pleasure and satisfaction and their use of a lubricant during a particular sexual event; and (iii) to what extent lubricant use was associated with subsequent genital symptoms.
Methods. A total of 2,453 women completed a 5-week internet-based, double-blind prospective daily diary study in which they were assigned to use one of six water- or silicone-based lubricants.
Main Outcome Measures. Baseline data included demographics, contraceptive use, and sexual behavior during the 4 weeks prior to study enrollment. Daily diary data included reports of penile–vaginal sex, penile–anal sex, solo sex, lubricant use, lubricant application, ratings of sexual pleasure and satisfaction, and genital symptoms.
Results. Water-based lubricants were associated with fewer genital symptoms compared with silicone-based lubricants. In addition, the use of a water-based or silicone-based lubricant was associated with higher ratings of sexual pleasure and satisfaction for solo sex and penile–vaginal sex. Water-based lubricant use was associated with higher ratings of sexual pleasure and satisfaction for penile–anal sex as compared with no lubricant use.
Conclusion. The water- and silicone-based lubricants used in this study were associated with significantly higher reports of sexual pleasure and satisfaction and rarely associated with genital symptoms. Herbenick D, Reece M, Hensel D, Sanders S, Jozkowski K, and Fortenberry JD. Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: A prospective daily diary study. J Sex Med 2011;8:202–212.
In the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives.
This study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50.
Information regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined.
Sexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience.
Although sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participant's evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to men's evaluation of the experience. Relationship status was the most consistent predictor of women's evaluation of the experience. Condom use rates remained low for participants across age groups.
Many older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.
Initial psychometric evaluation of the Female Sexual Well-Being Scale(TM) (FSWB Scale(TM)) demonstrated its validity for assessing sexual well-being in sexually functional US women.
To evaluate the responsiveness of the FSWB Scale to interventional products in sexually functional women and to confirm its psychometric validity.
In a 5-week, randomized, multicenter study, the responsiveness of FSWB Scale scores to interventional products was evaluated in 326 sexually functional, heterosexual women randomized to: (i) no intervention; (ii) couple lubricants (1 lubricant for female and second lubricant for male partner); (iii) female arousal gel; or (iv) female lubricant. At baseline, participants were instructed to have >or=3 occurrences of vaginal intercourse over the next 4 weeks. Participants assigned to an intervention were instructed to use the product immediately before intercourse. Women completed the self-administered FSWB Scale at week 1 (screening), week 2 (baseline), and week 5 (study end).
Changes from baseline in the FSWB Scale overall score and four domain scores were analyzed using analysis of covariance. Additional analyses were conducted to confirm psychometric validity.
The mean change from baseline in the FSWB Scale overall score improved significantly among the four arms (treatment-effect P = 0.03). The within-treatment mean increase from baseline in the overall score was significant for each product arm (all P <or= 0.002), whereas no significant change was observed for the no intervention arm (P = 0.13). Changes from baseline in the four domain scores improved differentially according to the expected effects of each product. Factor structure, reliability, and construct validity results confirmed those reported previously.
The FSWB Scale demonstrated excellent responsiveness to interventional products, with scores remaining relatively stable with no intervention and changing differentially and by domain with different product types. The results strongly support the usefulness of the FSWB Scale for assessing sexual well-being in future studies.
Vaginal microbicides currently under development are substances that may prevent the transmission of HIV. Qualitative, in-depth post-trial interview data from a Phase III clinical trial of 6% Cellulose Sulfate microbicide gel in two sites in Africa (Uganda and Benin) and two in India (Chennai and Bagalkot) were examined in order to better understand factors that influence microbicide acceptability and adherence in a clinical trial setting. Women found the gel relatively easy to use with partners with whom there were no expectations of fidelity, in situations where they had access to private space and at times when they were expecting to engage in sexual intercourse. Adherence to gel seemed significantly more difficult with primary partners due to decreased perceptions of risk, inconvenience or fear of partner disapproval. Findings suggest that women in a variety of settings may find a microbicide gel to be highly acceptable for its lubricant qualities and protective benefits but that adherence and consistent use may depend greatly on contextual and partner-related factors. These findings have important implications for future trial designs, predicting determinants of microbicide use and acceptability and marketing and educational efforts should a safe and efficacious microbicide be found.
Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18-60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed.
This article reviews and critiques the DSM-IV-TR diagnostic criteria for Female Sexual Arousal Disorder (FSAD). An overview of how the diagnostic criteria for FSAD have evolved over previous editions of the DSM is presented and research on prevalence and etiology of FSAD is briefly reviewed. Problems with the essential feature of the DSM-IV-TR diagnosis-"an inability to attain, or to maintain...an adequate lubrication-swelling response of sexual excitement"-are identified. The significant overlap between "arousal" and "desire" disorders is highlighted. Finally, specific recommendations for revision of the criteria for DSM-V are made, including use of a polythetic approach to the diagnosis and the addition of duration and severity criteria.
There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness.
To examine international differences in the prevalence of vaginal dryness, the degree to which it is experienced as problematic or bothersome, the use of lubricants to alleviate it, and women's discussion of this problem with physicians.
Questionnaire measuring the level of vaginal dryness and degree to which it is perceived as bothersome.
The Global Survey of Sexual Attitudes and Practices was administered to 6,725 women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand.
Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with self-reported vaginal dryness who found it very bothersome varied as well (e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as compared with younger women (18-34 years) reported significantly more vaginal dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P values <0.02). The majority of women under 50 attributed vaginal dryness to inadequate sexual arousal while women over 50 believed it was because of aging or menopause. Cross-culturally, women differed substantially in the likelihood of discussing their sexual life/concerns with a physician.
Women from different countries differ substantially in their experiences, concerns, and reports of vaginal dryness/sexual pain, as well as their familiarity with personal lubricants as a treatment. Researchers should assess the prevalence and degree of the bother of vaginal dryness in order to make international comparisons of the burden of this condition.
One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided here. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for eight standard statistical tests: (a) the difference between independent means, (b) the significance of a product-moment correlation, (c) the difference between independent rs, (d) the sign test, (e) the difference between independent proportions, (f) chi-square tests for goodness of fit and contingency tables, (g) one-way analysis of variance, and (h) the significance of a multiple or multiple partial correlation.
Psychosocial and psychophysical functioning in 25 women with and 25 without provoked vestibulodynia (PVD) were examined. Participants underwent quantitative sensory testing and completed psychosocial measures. Women with PVD displayed lower pain thresholds, higher pain ratings, lower sexual functioning and sexual self-efficacy, and higher levels of somatization and catastrophization than controls. Lower psychosocial functioning correlated with decreased vulvar pressure-pain threshold and increased cotton-swab test pain ratings. For PVD women, decreased sexual function and sexual self-efficacy were associated with higher vulvar pressure-pain ratings. Findings suggest that women with PVD would benefit from treatment that addresses pain-focused and psychosocial components.
Currently in clinical trials, microbicides have historically been promoted as a woman-controlled (although more recently woman initiated) method of sexually transmitted infection (STI) prevention. The contradicition that exists in this rationale is that women's bodies, specifically the genitals, have been constructed as a negotiated space within sexual interactions. This study qualitatively explored the factors influencing 40 young women's use of a vaginal moisturizer (VM), utilized as a microbicide surrogate. The results indicated that use of the VM was dependent upon product characteristics (i.e., the lubricating qualities affect on sexual pleasure, timing of insertion), individual factors (i.e., reproductive health goals, experiences with side effects of existing contraceptive methods), and contextual factors (i.e., social norms). An understanding of these bodily and social issues may be beneficial in designing targeted educational campaigns and effective instructional materials as well as in facilitating positive dialogue around women's bodies and their sexuality.
To elucidate a number of hypotheses about the development of sexual responsivity in women, a random sample of 100 undergraduate women was interviewed about their masturbation histories, techniques in masturbation, and the relationship of masturbation to intercourse. Masturbation had been practiced by 74%. It began most commonly as an accidental discovery. Learning the sexual nature of masturbation from peers and written sources seemed to result in methods more imitative of heterosexual activities and to increase the enjoyment and goal-directedness of the behavior. The view that experiencing sexual pleasure depends on social transmission of scripts was thus supported. Several techniques were related to orgasm ability in masturbation and intercourse. Women who were orgasmic in masturbation and who masturbated with that goal were more likely to continue the behavior than those with other goals. Frequency of masturbation and frequency of intercourse were not related, failing to support the notion of a unitary "sex drive". Nor was "clitoral fixation" documented by any relationship between reliance on clitoral stimulation in both masturbation and intercourse. Masturbating to orgasm was not related to orgasm ability in intercourse.
Dyspareunia is one of the most common sexual symptoms that carries wide-ranging potential foor emotional and physical pain. Informed therapeutic intervention can be useful in helping a person with sexual problems. Organic causes underlying dyspareunia are usually temporary and easily correctable. They are rare as a cause of a continuing problem, compared to issues of intrapersonal and interpersonal conflict. One of the keys to achieving a satisfying relationship on an adult-to-adult basis requires that each partner assume responsibility for his/her own sexual pleasure. The woman who withdraws into the assumption that she has an organic problem in the absence of abnormal findings, or that her partner or therapist must find a solution, abdicates responsibility for her own sexual pleasure. Although few of us will be therapists in the sense that the role is generally understood, indentifying and responding to sexual concerns of patients is part of the professional's commitment. Ultimately, our goal is the same for any problem of human development-- to facilitate the realization of the potentialities of the person.
A questionnaire regarding sexual experience and dyspareunia was sent to 428 women, of whom 324 (75.7%) responded. Ten refused to participate and one had never had heterosexual intercourse, leaving 313 evaluable responders. One hundred twenty-two (39.0%) had never had dyspareunia and 86 (27.5%) had had dyspareunia at some point in their lives which resolved, either spontaneously or with specific treatment. One hundred five women (33.5%) still had dyspareunia at the time of the survey, 51 of whom had had dyspareunia for their entire active sexual lives. Twenty-two (21%) rarely had dyspareunia, 58 (55.2%) occasionally had discomfort, and 25 (23.8%) had dyspareunia frequently or virtually all the time. Frequency of intercourse was not different among any of the groups analyzed, although 49 (48.0%) of the women reported a decrease in sexual frequency and 35 (33.7%) reported an important adverse effect on their relationships as a result of dyspareunia. Most of the women had not discussed their dyspareunia with a health care professional and were unaware of the cause of their problem.
As little as sixty seconds' exposure of commercial latex condoms to mineral oil, a common component of hand lotions and other lubricants used during sexual intercourse, caused approximately 90% decrease in the strength of the condoms, as measured by their burst volumes in the standard ISO (International Standards Organization) Air Burst Test. Burst pressures were also reduced, although less dramatically. Lubricants such as Vaseline Intensive Care and Johnson's Baby Oil, each containing mineral oil, also affected condom integrity. Five min. exposure of condoms to glycerol, a frequent component of hand lotions and 'personal lubricants', did not significantly affect burst volume or pressure. Aqueous nonoxynol-9 spermicide did not affect either burst index. The implications of these results for contraception and protection from sexually transmitted diseases, including AIDS, are discussed.
To determine the prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in a clinical population of reproductive-age women.
A ten-page questionnaire was administered to a consecutive sample of women age 18-45 years who were approached in the waiting areas of two obstetrics and gynecology practices and three family medicine practices in central North Carolina. Of 701 women approached to fill out the questionnaire, 581 (83%) returned completed forms suitable for analysis.
The reported prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome was 90, 46, 39, and 12%, respectively. Low income was found to be a risk factor for dysmenorrhea and dyspareunia, and African-American race was found to be a risk factor for pelvic pain. Pelvic pain was also more common among women 26-30 years old. Otherwise, dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome were not associated with age, parity, marital status, race, income, or education.
Dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome are common complaints among women of reproductive age and are not consistently associated with demographic risk factors. Therefore, inquiry about these pelvic pain complaints should be a routine part of health care for women.
To provide information on the extent of problems of urogenital ageing in older British women.
A MORI survey of a representative population sample of older British women.
Home interviews.
Two thousand and forty-five women aged 55-85+.
Urogenital symptoms had affected 48.8% of the women at some time, but no more than 11% were currently affected by individual symptoms; however, these were often of long duration. The majority (73%) were not sexually active, with lack of a partner being a factor for many. There was also a decreasing prevalence of sexual activity with increasing age. Those sexually active in the 65-74 year old age group (n = 148) tended to have a similar sexual frequency (at least once per month) compared with the younger women studied. Approximately 12% of those who reported dyspareunia and/or vaginal dryness claimed a severe problem; 33% did not seek professional advice and 36% resorted to an over the counter remedy. Use of hormone replacement therapy was generally of relatively short duration. There was a declining gradient of ever-use with age.
The extent of significant urogenital symptoms is relatively low, but some women are seriously affected and use self-help as well as professional assistance. The extent of sexual activity in older women and factors affecting this have been defined, and the effect of urogenital symptoms on sexual activity demonstrated.