Articles & Research
Managing Female Sexual Pain
Female sexual pain disorder or genito-pelvic pain/penetration disorder (GPPPD), previously known as dyspareunia, is defined as persistent or recurrent symptoms with one or more of the following for at least 6 months: marked vulvovaginal or pelvic pain during penetrative intercourse or penetration attempts, marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of penetration, and marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. In this review, we discuss etiology, diagnosis, and treatment for common disorders that cause GPPD.
Male delayed orgasm and anorgasmia: A practical guide for sexual medicine providers
Delayed orgasm (DO) is defined as increased latency of orgasm despite adequate sexual stimulation and desire. Anorgasmia (AO) is characterized as the absence of orgasm. Etiologies of DO/AO include medication-induced, psychogenic, endocrine, and genitopelvic dysesthesia. Given the multifactorial complex nature of this disorder, a thorough history and physical examination represent the most critical components of patient evaluation in the clinical setting. Treating DO/AO can be challenging due to the lack of standardized FDA-approved pharmacotherapies. There is no standardized treatment plan for DO/AO, though common treatments plans are often multidisciplinary and may include adjustment of offending medications and sex therapy. In this review, we summarize the etiology, diagnosis, and treatment of DO/AO.
The clinical management of testosterone replacement therapy in postmenopausal women with hypoactive sexual desire disorder: a review
As women age, there is an overall decrease in androgen production due to decline of ovarian and adrenal function during menopause. Androgens have been demonstrated to play an important role in sexual motivation in women. As a result, many postmenopausal women experience Female Sexual Dysfunction (FSD) which are a group of disorders that pertain to sexual arousal, desire, orgasm, and pain. A prevalent manifestation of FSD is Hypoactive Sexual Desire Disorder (HSDD) or the absence of sexual fantasies, thoughts, and/or desire for or receptivity to sexual activity. There is gaining interest in the use of Testosterone Replacement Therapy (TRT) for the treatment of HSDD in postmenopausal women. This article reviews the literature on the relationship of androgen decline and HSDD, describes our methodology for evaluation, diagnosis of HSDD, and the use of TRT in treating postmenopausal women with HSDD. Our results conclude that testosterone is a vital hormone in women in maintaining sexual health and function. TRT is an effective treatment option for postmenopausal people with HSDD. There is still limited data on the effectiveness in premenopausal people with HSDD. Further research in the strengths and weaknesses for the long-term effect of TRT in women of all ages is needed.
Clinical implications of the historical, medical, and social neglect of the clitoris
Sexual pleasure is intrinsic to human existence and serves as an important metric of quality of life. The clitoris plays a central role in the sexual response cycle and attainment of sexual pleasure in individuals with vulvar anatomy. Despite its significance, the clitoris has remained gravely misunderstood, misrepresented, and often neglected in medical literature and social consciousness. There exists a significant deficit in our fundamental knowledge of the basic anatomy and physiology of the clitoris. In contrast, the penis, the anatomic homologue of the clitoris, has fared much better in its assigned importance in human sexuality and scientific discovery. Published research dedicated to the glans penis is 20 times that focused on the clitoris (Table 1 and Figure 1). This has resulted in the accumulation of medical knowledge and innovation in the treatment of penile conditions that far surpasses our understanding of the clitoris and the management of its associated conditions.
How many nerve fibers innervate the human glans clitoris: a histomorphometric evaluation of the dorsal nerve of the clitoris
It is frequently quoted in mainstream media that the clitoris has "8000 nerve endings." However, no study has yet quantified the number of nerve fibers (axons) innervating the human clitoris. The dorsal nerves of the clitoris (DNCs) are the primary source of sensation and somatic clitoral innervation. Therefore, reporting the number of axons in the DNCs is an important step in our understanding of clitoral innervation and sexual response with implications for many fields of medical practice. The purpose of this study is to quantify the mean number of axons in the human DNCs and to report the approximate mean number of nerve fibers that innervate the human glans clitoris.
Lumbar endoscopic spine surgery for persistent genital arousal disorder/genitopelvic dysesthesia resulting from lumbosacral annular tear-induced sacral radiculopathy
Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by distressing, abnormal genitopelvic sensations, especially unwanted arousal. In a subgroup of patients with PGAD/GPD, cauda equina Tarlov cyst-induced sacral radiculopathy has been reported to trigger the disorder. In our evaluation of lumbosacral magnetic resonance images in patients with PGAD/GPD and suspected sacral radiculopathy, some had no Tarlov cysts but showed lumbosacral disc annular tear pathology.
Additional Publications
Irwin Goldstein, MD; Rachel S. Rubin, MD; Natalie Gaines, MD; Allison Polland, MD;
Maria Uloko, MD; Jessica Yih, MD. Female Sexual Dysfunction: Medical and Surgical
Management of Pelvic Pain and Dyspareunia. AUA University Core Curriculum
Irwin Goldstein, MD; Rachel S. Rubin, MD; Natalie Gaines, MD; Allison Polland, MD;
Maria Uloko, MD; Jessica Yih, MD.Female Sexual Dysfunction. Disorders of Desire,
Orgasm and Arousal . AUA University Core Curriculum
Maria Uloko,MD, Rachel Rubin, MD. Female Sexual Pain: AUA Update. Published.
2020