Bremelanotide for Treatment of Female Hypoactive Sexual Desire

Hypoactive sexual desire disorder (HSDD) is a persistent deficiency or absence of sexual fantasies and desire resulting in significant distress or interpersonal difficulty. Women with this disorder may display a lack of motivation for sexual activity, reduced responsiveness to erotic cues, a loss of interest during sexual activity, and avoidance of situations that could lead to sexual activity. The pathophysiology of HSDD is thought to be centered around inhibitory and excitatory hormones, neurotransmitters, and specific brain anatomy. Due to the multifactorial nature of HSDD, treatment can be complex and must attempt to target the biological and psychosocial aspects of the disorder. Bremelanotide is a melanocortin receptor agonist and has been recently approved by the FDA to treat HSDD. Bremelanotide is administered intranasally or as a subcutaneous injection. The recommended dosage of bremelanotide is 1.75 mg injected subcutaneously in the abdomen or thigh at least 45 min before sexual activity. Studies showed improvements in desire, arousal, and orgasm scores when 1.75 mg of bremelanotide was administered before sexual activity compared to a placebo. Bremelanotide is a promising way to treat HSDD.

Female Sexual Dysfunction in Patients Treated with Antidepressants: A Comparison between Agomelatine and Escitalopram

Aim: This study aims to determine and compare the prevalence of Female Sexual Dysfunction (FSD) between patients on escitalopram and agomelatine, as well as to investigate possible factors associated with their usage. Study Design: Cross-sectional. Place and Duration of Study: Psychiatric Day Care Clinic, Department of Psychological Medicine, University Malaya Medical Centre (UMMC), Malaysia, between November 1, 2020 until February 1, 2021. Methodology: This study is a cross-sectional study involving 66 women with depression from the outpatient psychiatric clinic of a university hospital; 35 of whom were prescribed with escitalopram and 31 with agomelatine. The subjects were in remission and had no significant signs or symptoms of depression for at least 2 months. The prevalence of FSD between the two groups were compared after adjusting for underlying depression severity. Results: This study showed that the overall prevalence rate of FSD was 33.3%, with the prevalence being higher for those on escitalopram (42.9%) than those on agomelatine (22.6%), but did not achieve statistical significance (P=0.081). Out of the six domains of FSD, multivariate analyses revealed that there was a significant reduction of 69% in sexual desire disorder (95% CI:0.110, 0.855), P=0.022 for those on agomelatine compared to escitalopram. Controlling for drug dosage and depression severity (as measured using Montgomery-Asberg Depression Rating Scale), the odds for patients on agomelatine developing sexual desire disorder was 0.267 (95% CI:0.091, 0.783), P=0.016. Conclusion: There was no significant difference in FSD risk between patients on agomelatine and those on escitalopram. Patients on agomelatine were however less likely to develop sexual desire disorder, which demonstrates a slightly better sexual acceptability profile of agomelatine in women in this respect compared to escitalopram.

Women and Men’s Perspectives on the Factors Related to Women’s Dyadic Sexual Desire, and on the Treatment of Hypoactive Sexual Desire Disorder

Sexuality is a basic human need, which is expressed in the context of intimate personal relations. However, in studies of women’s sexuality, men’s attitudes are often overlooked. Health care providers can benefit from the examination of how both women and men perceive women’s sexual desire and what are the most acceptable avenues for treatment for women’s hypoactive sexual desire disorder (HSDD). This research aimed to explore differences between women and men on the factors affecting women’s sexual desire and the appropriate avenues for treatment. Data were collected using an online questionnaire from 233 heterosexual adults who had a dyadic, steady intimate relationship over most of the previous year. A theory-based questionnaire of 28 items was developed to explore the factors associated with women’s sexual desire. One quarter (7/28) of the items affecting women’s sexual desire were ranked significantly differently between women and men. Among women, interpersonal issues and physical attraction, and among men, physical attraction and daily hassles were the significant predictors of women’s sexual desire. Women more than men endorsed psychological help such as a sex therapist or psychologist as a more appropriate treatment for HSDD, while both men and women viewed the internet as a reasonable way to gain treatment information. Both women and men viewed gynecologists as a more acceptable source of treatment than a family doctor. Religious authorities were the least likely source of treatment advice for both women and men. The results support a multi-dimensional model of women’s sexual desire and suggest that psychological interventions to treat HSDD may be preferred by women more than men.

Unconsummated Marriage (“Honeymoon Impotence”): 25 years’ Experience with 871 Couples, in Kermanshah, Iran.

Background: Unconsummated marriage (UCM) is a condition in which the first coitus in a marriage has not occurred in “due time” and thus the bride remains a virgin. UCM, which occurs early in married life, can sometimes last for years and have significant negative effects on a couple’s sexual satisfaction. Here we report our experience with 871 couples in Kermanshah, Iran.Methods: Electronic medical records of couples with UCM, seen by Zargooshi from 1996 to 2021, were reviewed. Some patients whose data were reported in our previous articles at 2000 and 2008, were not included here. For transparency, we voluntarily sent the full identifying data of our patients to the Journal during the first submission of the manuscript.Results: Associated conditions include erectile dysfunction (49.8%), premature ejaculation (14.6%), male hypoactive sexual desire disorder (7.2%), and vaginismus (12.5%). Intracavernosal injection (ICI) was used as the treatment of choice. The consummation rate was 95.1%. We used ICI in presence of vaginismus, too. It may appear “ungentle” to approach the vaginismus this way. However, the couples preferred this expeditious treatment over a time-consuming, and ineffective alternative.Conclusions: In most cases, UCM is due to psychogenic ED, for which ICI (not psychological interventions) is the best treatment because the typical couples who present with UCM are noncompliant with time-consuming treatments. Therefore, the most effective treatment was intracavernosal injection and then the administration of type 5 phosphodiesterase drugs and the most ineffective treatment was psychological counseling.

There is insufficient evidence to recommend bremelanotide for hypoactive sexual desire disorder

An informed consent discussion for a patient with Hypoactive Sexual Desire Disorder.

Inhibited / diminished sexual desire and loss of orgasm in women

In the specialized literature, sexual desire disorder is approached as a decrease in sexual interest, a lack of fantasies about sexual activity, decreased libido or frigidity. Gutceit believes that “out of 10 women 4 do not feel anything during intercourse and endure it without having the slightest pleasant sensation during friction and without having any idea about the pleasure of ejaculation”, and Debruner even adds that 50% of women are insensitive and one cannot speak of a proper libido.