Biomedical subjects
S R Leiblum
Publications and source records attributed to S R Leiblum.
Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.
BACKGROUND: The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause. METHODS: Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 microg of testosterone, and 300 microg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone. RESULTS: The mean (+/-SD) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter (4.2+/-2.8 pmol per liter) during placebo treatment to 3.9+/-2.4 pg per milliliter (13.5+/-8.3 pmol per liter) and 5.9+/-4.8 pg per milliliter (20.5+/-16.6 pmol per liter) during treatment with 150 and 300 microg of testosterone per day, respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women (P=0.03 for both comparisons with placebo). At the higher dose the percentages of women who had sexual fantasies, masturbated, or engaged in sexual intercourse at least once a week increased two to three times from base line. The positive-well-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P=0.04, P=0.03, and P=0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly. CONCLUSIONS: In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.
What every urologist should know about female sexual dysfunction.
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Life after infertility treatment: a long-term investigation of marital and sexual function.
After leaving in-vitro fertilization (IVF) treatment, both successful and unsuccessful women are generally lost to follow-up. In order to assess overall life satisfaction as well as marital and sexual adjustment after the completion of infertility treatment, three groups of women were studied: group 1 (n = 41), successful IVF women; group 2 (n = 16), unsuccessful IVF women who adopted; and group 3 (n = 18), unsuccessful IVF women who remained childless. All women who had completed a minimum of three IVF cycles between the years 1982 and 1993 were invited to participate in a 'life after infertility' follow-up study. Those who agreed were mailed a lengthy questionnaire which included questions about their reproductive history and infertility treatment, the impact of infertility on their marital and sexual relationship and their final thoughts about treatment. Four standardized questionnaires were also administered. Results revealed that women who became biological mothers through IVF were significantly more satisfied with their lives than women who were unsuccessful in IVF and remained childless (F = 8.62, P < 0.001). Childless women reported that infertility had exerted a significantly greater negative impact on their marriages than that reported by the other two groups. There were no significant differences, however, between the three groups on the standardized measures of marital and sexual satisfaction.
Definition and classification of female sexual disorders.
The diagnosis and classification of female sexual disorders has undergone significant changes over the last fifty years as a function of changing societal expectations for female sexual conduct, available knowledge about sexual psychophysiology and actual clinical practice. Currently, female sexual disorders are conceptualized as disturbances in desire, arousal, or orgasm as well as sexual pain disorders which include dyspareunia and vaginismus. The lack of objective, empirically-grounded criteria for diagnosis as well as the comorbidity of female sexual disorders contributes to the lack of reliability in the diagnosis of female sexual complaints. At the present time, hypoactive sexual desire disorder is the most commonly diagnosed female sexual disorder followed by female orgasmic disorder. Nevertheless, the major clinical complaints among women center on their dissatisfaction with such non-genital behaviors as affection, communication, and non-genital touching as well as issues of attraction and passion. These factors should be assessed as well as genital response for greater validity in evaluating female sexual disorders in both research and clinical practice.
Disclosure issues and decisions of couples who conceived via donor insemination.
Disclosing the use of donor insemination (DI) to family, friends, and offspring poses a quandary for many DI patients. A cross-sectional survey was conducted to determine whether couples opted to share information about conception via donor sperm with their children, as well as the issues and concerns that arose for parents once infertility treatment was completed. Twenty-seven married heterosexual infertile husbands and wives who had used DI to conceive completed a follow-up questionnaire asking them about disclosure decisions as well as thoughts about DI as a reproductive option. Results revealed that nearly three-quarters of the sample had not disclosed to their child and did not plan to, although 85% had told at least one other person about conception via DI. With few exceptions, husbands and wives agreed about how to handle disclosure. Notably, 32% of the mothers reported not knowing when or how to disclose. However, the majority of couples were not offered psychological counseling prior or subsequent to DI. It is suggested that mental health professionals should be aware of the divergence of opinion between what they believe about the benefits of disclosure/counseling, the beliefs of infertile couples about disclosure and what is actually known about the benefits of full disclosure among all involved parties.
Treatment of sexual disorders in the 1990s: an integrated approach.
Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders.
Non-traditional mothers: single heterosexual/lesbian women and lesbian couples electing motherhood via donor insemination.
The purpose of the project was to explore the motivation, reproductive and postdelivery experiences, and future concerns of single heterosexual and lesbian women and lesbian couples who attempted conception via donor insemination (DI). All women who had completed at least one cycle of DI between 1987 and 1992 at a large medical school infertility program were mailed a comprehensive 'Motherhood' questionnaire. Forty-five women completed the survey (response rate = 88%) of whom 14 were lesbians, 28 were heterosexuals, two were bisexual and one was celibate. The only major differences between the heterosexual women and the lesbian women were that the heterosexual women were older and had started DI attempts at an older age than the lesbian women. The majority of women reported that four major considerations prompted their decision to initiate DI when they did: feeling secure in their employment, the sense that time was running out, feeling that they had 'worked through' concerns about parenting, and that they had sufficient social support. Three characteristics were deemed moderately or very important in their selection of sperm donors: ethnicity, education and height. After achieving a pregnancy, most women wished to know more detailed information about their donor. Unlike heterosexual couples, all single and lesbian women planned to disclose the fact of DI to their offspring but were uncertain of when or how to accomplish this. The greatest worry reported by respondents was how their child would deal with the absence of a known designated father. Overall, the women were gratified with their experience of DI, and the majority would 'absolutely' recommend it to a friend.
Teaching human sexuality to medical students: a unique challenge.
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Hypoactive sexual desire.
Hypoactive sexual desire is an ubiquitous and challenging disorder that is often associated with other psychiatric or medical conditions. Multiple etiologic determinants have been associated with the disorder, and the role of systemic and interpersonal factors have been emphasized. Treatment interventions have varied widely, including hormonal, pharmacologic, and psychological interventions. There is a paucity of controlled outcome research, and it is uncertain which patients are most likely to benefit from treatment.
Self-report assessment of female sexual function: psychometric evaluation of the Brief Index of Sexual Functioning for Women.
Previous self-report measures of female sexual function have been either overly restrictive or inappropriate for use in large-scale clinical trials. Accordingly, we have developed the Brief Index of Sexual Functioning for Women (BISF-W), a 22-item, self-report instrument for the assessment of current levels of female sexual functioning and satisfaction. The BISF-W was administered at monthly intervals to a standardization sample of 269 women, ages 20-73 years. A principal components analysis yielded a three-factor solution--interest/desire, sexual activity, and satisfaction--which accounted for 51.2% of the variance. Concurrent validity was demonstrated by means of a comparison with the Derogatis Sexual Function Inventory. In addition, the BISF-W was compared to the Brief Sexual Function Questionnaire, a similar self-report measure of sexual functioning for men. Major advantages of the BISF-W are its ease of administration and scoring, suitability for use in both clinical and nonclinical samples, and assessment of key dimensions of female sexuality. However, based on its moderate test-retest reliability and internal consistency, further development of the instrument is indicated.
Psychologically based treatment for male erectile disorder: a cognitive-interpersonal model.
Treatment approaches for male erectile disorder (MED) have proliferated in recent years. Due to the growing emphasis on medical or surgical approaches to treatment, however, there has been a relative neglect of the psychological or interpersonal dimensions of the problem. The present article describes a five-part model for time-limited, cognitive-interpersonal treatment of male erectile disorder. Key elements of the model are: psychoeducational and cognitive intervention; sexual and performance anxiety reduction; script assessment and modification; conflict resolution and relationship enhancement; and relapse prevention training. Although intended primarily for use with psychogenic erectile dysfunction in intact couples, the model can be applied to single males or those with organically based erectile difficulties. Several case examples are provided and the limitations of the model are discussed.
The sexual functioning of elderly hypertensive women.
To assess the sexual interest and behavior of a large cohort of 60-80-year-old women with mild to moderate hypertension, data from a large multicenter study were analyzed. Of the 142 hypertensive women with partners, 87 (61%) were sexually active and 55 (39%) were sexually abstinent. The sexually active women were somewhat younger, had higher household incomes, and reported higher ratings of subjective sexual interest than did the abstinent women. For sexually abstinent women, two major factor appeared to determine the level of sexual activity: their partner's level of sexual desire and his health. Of particular note is the finding that the majority of women in both groups indicated moderate or high satisfaction with their sexual life. When the sample was divided into "younger" elderly (age 69 or below) and "older" elderly (70 or above), the percentage of women displaying moderate or high sexual interest was quite similar (76% and 65%, respectively). Difficulty achieving orgasm and lack of vaginal lubrication were the two most common sexual complaints. Scores on quality of life measures did not differ significantly between the sexual abstinent and active women at baseline.
Effects of antihypertensive medications on quality of life in elderly hypertensive women.
The impact of antihypertensive medications on the quality of life of elderly hypertensive women has rarely been systematically evaluated in large clinical trials using drugs from the new generations of pharmaceutic preparations. We carried out a multicenter, randomized double-blind clinical trial with 309 hypertensive women aged 60 to 80 years to assess effects of atenolol, enalapril, and isradipine on measures of quality of life over a 22-week period. The patients had mild to moderate hypertension. Hydrochlorothiazide was added to treatment if monotherapy was inadequate in lowering blood pressure. At the conclusion of the trial the three drug groups did not differ in degree of reduction of diastolic blood pressure or in supplementation with hydrochlorothiazide. Over the 22-week trial, linear trend analysis showed no differences between the treatment groups in change from baseline on quality of life measures of well-being, physical status, emotional status, cognitive functioning, and social role participation. Regarding each of 33 physical side effects over the 22 weeks, we found no general difference between atenolol, enalapril, and isradipine groups on measures of change in distress over symptoms except for enalapril patients who worsened in distress over cough (P = .001) and atenolol patients who worsened in distress over dry mouth (P = .014). Centering on three medications that are relatively new additions to the armamentarium for blood pressure control, the findings underline the increasing opportunities for the physician to select drugs that can control blood pressure while maintaining the quality of life of elderly hypertensive women.
Prevalence of sexual dysfunction in women: results of a survey study of 329 women in an outpatient gynecological clinic.
Few studies have investigated the prevalence of sexual dysfunction in nonclinical samples. In the present study, a standardized sexual function questionnaire was administered to 329 healthy women, aged 18-73 years, all of whom were enrolled in a Women's Wellness Center. About two-thirds of the sample were married or living with a partner, and most women were employed outside of the home. A broad range of sexual behavior frequencies were observed, with 48.5% reporting at least weekly intercourse, compared to 28.4% who were not sexually active at the time of study. Among the most common sexual problems reported were anxiety or inhibition during sexual activity (38.1%), lack of sexual pleasure (16.3%), and difficulty in achieving orgasm (15.4%). Other common problems were lack of lubrication (13.6%) and painful intercourse (11.3%), each of which was significantly more prevalent in the postmenopausal group. Despite these difficulties, 68.6% of the sample rated their overall sexual relationship as satisfactory. Age and relationship status were significant predictors of sexual satisfaction, with older women and singles reporting a higher incidence of sexual problems. Educational level, religious affiliation, and employment status were not predictive of sexual dysfunction in the present study.
Screening in or out of the new reproductive options: who decides and why.
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Screening in or out of the new reproductive options: who decides and why.
A lively controversy exists among infertility specialists about the value and necessity of screening candidates for inclusion into infertility programs. Advocates of screening argue that there is both a child advocacy and community welfare responsibility to evaluate prospective candidates (and donors) for the new assisted reproductive techniques. Opponents of screening argue that screening is costly and superfluous, since the majority of applicants are highly motivated and well-adjusted individuals who have the 'right' to pursue parenthood, if they choose. A pilot survey was undertaken to determine whether infertility programs currently have explicit policies regarding suspension or refusal of treatment on psychological grounds and to determine what would (or should) constitute grounds for denial of infertility treatment. A Treatment Refusal Questionnaire was mailed to all members of the Psychological Special Interest Group of the American Fertility Society. Forty-two responded (response rate of 47%). Results revealed that the majority of respondents did not have a formal policy regarding suspension or refusal of treatment, although they did have informal criteria. Four criteria were significantly endorsed as constituting 'red flags' for treatment rejection: substance abuse, physical abuse, severe marital strife, and coercion of one spouse by another. Furthermore, treatment decisions were modified by the type of intervention sought, so that for example, more stringent criteria were operative if clients sought ovum donation than if they sought ovulation induction. These and other findings are presented and discussed.
To tell or not to tell: attitudes of reproductive endocrinologists concerning disclosure to offspring of conception via assisted insemination by donor.
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