Medicalization of Sexual Desire

Medicalisation is a social phenomenon in which conditions that were once under legal, religious, personal or other jurisdictions are brought into the domain of medical authority. Low sexual desire in females has been medicalised, pathologised as a disease, and intervened upon with a range of pharmaceuticals. There are two polarised positions on the medicalisation of low female sexual desire: I call these the mainstream view and the critical view. I assess the central arguments for both positions. Dividing the two positions are opposing models of the aetiology of low female sexual desire. I conclude by suggesting that the balance of arguments supports a modest defence of the critical view regarding the medicalisation of low female sexual desire.

Dialing Up Desire and Dampening Disinterest: Regulating Sexual Desire in the Bedroom and Sexual and Relationship Well-Being

Romantic partners often regulate their emotions and affection to achieve certain goals, but research has yet to explore how partners regulate their expression of sexual desire during sex and its implications for couples’ well-being. In two multi-part dyadic diary studies of primarily mixed-gender couples in longer-term relationships residing in North America, we examined three questions. First, is amplifying desire and suppressing disinterest during sex associated with both partners’ daily sexual and relationship satisfaction? Second, do these associations differ by level of sexual desire and gender? Third, tested in our second sample, can these associations be explained by feelings of sexual inauthenticity? Across both samples (Ntotal = 225 couples, 450 participants), amplifying desire was associated with lower sexual satisfaction, while suppressing disinterest was not associated with daily satisfaction. Importantly, sexual desire played a role in the links between desire regulation during sex and satisfaction: on days when people were low in sexual desire, amplification was associated with both partners’ lower sexual satisfaction, while suppression was associated with a partner’s higher relationship satisfaction. In addition, amplification (on low desire days) and suppression (regardless of desire level) were associated with lower sexual authenticity which, in turn, was linked to lower relationship satisfaction. The findings suggest that desire regulation during sex plays an important role in couples’ daily sexual satisfaction and relationship satisfaction—in part because it feels sexually inauthentic—with the implications of this regulation being particularly strong when people feel low sexual desire.

Factors influencing low sexual desire and sexual distress in pregnancy: A cross-sectional study

Background: Sexual desire and sexual distress are determined by emotional, psychosocial, hormonal, and anatomical factors during pregnancy. Objective: To identify the factors contributing to female low sexual desire and sexual distress during pregnancy separately and concurrently. Materials and Methods: Overall, 295 pregnant women were enrolled in this cross-sectional study. Sexual desire and distress were assessed by the sexual interest and desire inventory-female (score ≤ 33.0 indicates low sexual desire) and the female sexual distress scale-revised (score ≥ 11 indicates sexual distress). Results: 56.3% and 17.3% of pregnant women met the clinical cut-off for low sexual desire and sexual distress, respectively. After adjusting for the effect of the confounding variables by logistic regression multivariate analysis, satisfaction with body image before and during pregnancy, frequency of sexual intercourse, and satisfaction with foreplay were found to be significantly associated with low sexual desire. Factors related to sexual distress were similar to those noted for common sexual desire, except for satisfaction with foreplay. Other factors related to sexual distress included increased age, fear of abortion, and pregnancy trimester. Factors linked to concurrent low sexual desire and sexual distress were similar to those found for sexual distress, except for pregnancy trimester. Conclusion: Low sexual desire and sexual distress are relatively common sexual experiences during pregnancy. Several factors could predict low sexual desire but were not associated with sexual distress, and conversely. Comprehensive attention to all of these factors is essential while screening for sexual health during pregnancy. Key words: Pregnancy, Sexual desire, Sexual distress, Sexual dysfunctions, Influencing factors.

The Prevalence and Side Effect of Nexplanon in Baghdad

BACKGROUND Nexplanon is a pregnancy-prevention device that is both safe and reliable. It is a novel reversible long-term contraceptive technique. It's a modern long-acting contraceptive device with a subcutaneous implant that releases etonogestrel (ENG). The main objective of this research was to determine the distribution, tolerability, and adverse reactions of Nexplanon among females who used it in Baghdad and find any relationship between these side effects and the acceptability of the device among contraceptive users. METHODS This study was done via the participation of 80 women who were using Nexplanon at the time of study or had recently removed the implant; the data was obtained from a direct interview and medical records. RESULTS The total number of women enrolled for the study was 80. The mean age of contributors was 33.24 (± 2.69) years. None of the participants was nulliparous; 15 % had two children, 85 % had three or more children. Of the participants, 26.25 % and 65 % had secondary and higher education degrees respectively, while only 7 % had primary education and none of the participants had any education. 6.25 % were smokers, only 28.75 % had irregular cycle and the remaining percentage had a regular one. 57 (71.25 %) of them underwent adverse events while using the contraceptive implant, the most common one was bleeding disorders most likely in the form of light intermittent bleeding. 69 (86.25 %) from those only 18 (26.08 %) removed implant because of this irritant bleeding, the next common adverse event was headache 44 (55 %), 8 (18.18 %) of them removed the implant because of headache, 41 (51.25 %) underwent variable mood swing changes, 36 (45 %) suffered from weight gain with use of the implant, 33 (41.25 %) nausea and bowel habits changes, androgenic effects presented in 19 (23.75 %) and 10 (12.5 %) in the form of acne and hirsutism, respectively. 3 (10.34 %) of them removed the device as they could not cope with this complication, only 6 (7.5 %) suffered from low sexual desire. CONCLUSIONS Nexplanon can be a suitable alternative for women who have been adequately informed about long-term contraception but bleeding disturbances and cycle durations (> 8 days) are also key indicators for early removal. The process of consulting the patient and giving them the appropriate educational advice on this subject should be a priority before using the implant, in addition to establishing special induction and educational programs. KEY WORDS Nexplanon, Contraception Method Contraception Method, A Subcutaneous Implant and Etonogestrel.

Bremelanotide and flibanserin for low sexual desire in women: the fallacy of regulatory precedent

The US Food and Drug Administration (FDA) has approved two drugs for ‘hypoactive sexual desire disorder’ in women, flibanserin (Addyi) in 2015 and bremelanotide (Vyleesi) in 2019. In this paper we examine the outcome measures and clinical trial data upon which regulatory approval was based. In clinical trials, flibanserin led to an average of only one additional enjoyable sexual experience every two months, bremelanotide to none. Trials for both drugs feature shifts in primary outcomes and a contested indication. A politicised industry-sponsored advocacy campaign and conflicted patient and expert testimony likely influenced flibanserin’s approval at its third attempt. Bremelanotide, with even weaker efficacy, capitalised on the regulatory precedent set by the approval of flibanserin. Reconsideration of regulatory decisions to approve these drugs is in order, as well as a broader examination of how future regulatory decisions can better address conflicts of interest and clinically meaningful benefit.

437 - The elderly and their sexuality: specific challenges and the roleof the psychiatrist

The model of sexuality currently in force is a young, genitalized model, that does not tolerate failures and often forgets about affective communication, sharing and body contact. This model is also not compatible with the natural aging process, generating manymyths about sexuality in later life.Although a taboo subject, the majority (up to 70%) of healthy 70-year-olds revealedthemselves to be sexually active even with some sexual dysfunction reports. Low sexual desire (up to 43%) was the most prevalent reported sexual difficulty in women, and erectiledifficulties (up to 37%) were most prevalent among men.Aging impacts sexuality in various ways: age-related organic/metabolic changes in men and women; age-related affective and cognitive changes also in both genders; age-and duration-related changes in a couple’s dynamic interaction, which can lead to discrepancy between the partners and their sexual narratives.In the sexual response cycle, aging affects the stages of desire, arousal/excitement,plateau, orgasm, and resolution/refractory period both men and women.Depressed mood as well as the use of antidepressant drugs, deterioration of cognitive function and difficulties to communicate can cause loss of intimacy and emotional closeness which then may result in sexual withdrawal and difficulties. Repetitive experiences of failure increase even more the couple distress.There are also to consider medical conditions, medication side effects, loss of physical capacity, subjective loss of attractiveness, lack of a partner, institutionalization or living withtheir children, which can be obstacles to sexual activity in the elderly.Diagnostic workup has to integrate not only general medical, gynecological, urological andpsychiatric factors, but also take a systemic perspective which deals with the interaction pattern of the partners. Treatment of sexual dysfunctions in later life combines biomedical interventions with psychotherapeutic and psychosocial strategies. An essential therapeutic contribution for allcouples is, however, basic counseling and psychoeducation. Explaining how aging has an impact and how other individuals and couples experience these changes is an important step in empowering the couple, clarifying and correcting the sociocultural myths andencouraging the couple to build their very own sexuality.

#DebunkingDesire: Sexual Science, Social Media, and Strategy in the Pursuit of Knowledge Dissemination (Preprint)

BACKGROUND Approximately 1 in 3 women experience low sexual desire. Despite this being a common concern, many women never seek professional help for their difficulties and will instead turn to online resources for information. OBJECTIVE We sought to address this need for digitally-accessible, evidence-based information on low sexual desire by creating a social media Knowledge Translation (KT) campaign aimed at women called #DebunkingDesire. METHODS Our team led a 10 month social media campaign where our primary outcomes for the campaign were impressions, reach, and engagement. RESULTS We generated over 300,000 social media impressions; appeared on 11 different podcasts that were listened to/downloaded 154,700 times; hosted and participated in eight online events; and attracted website users from 110 different countries. CONCLUSIONS Over the course of the campaign we learned many lessons on what worked for advertising our content and the importance of creating community for this population. Based on our campaign results, we recommend that others pursuing KT campaigns use social media, collaborate with a Patient Partner, and consider social media ads and podcasts to meet reach goals.