Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review
Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review
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DOI：
10.1016/j.mayocp.2016.09.018
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发表时间：
2017-01-01
影响因子：
8.9
通讯作者：
Worsley, Roisin
中科院分区：
文献类型：
--
作者：
Goldstein, Irwin;Kim, Noel N.;Worsley, Roisin
国际妇女性健康研究学会专家共识小组的目标是对性欲减退症（HSDD）的流行病学、生理学、发病机制、诊断和治疗进行简明、临床相关、循证的综述，这是一种影响约10%成年女性的性功能障碍。病因因素包括降低脑多巴胺、黑皮质素、催产素和去甲肾上腺素水平并增加脑5-羟色胺、内源性大麻素、催乳素和阿片样物质水平的病症或药物。症状包括缺乏或失去参与性活动的动机，由于缺乏或减少自发的欲望，性欲对色情暗示或刺激的反应，或通过性活动保持欲望或兴趣至少6个月的能力，伴随着痛苦。治疗遵循生物心理社会模式，并以病史和症状评估为指导。性疗法一直是标准的治疗方法，尽管除了基于正念的认知行为疗法之外，评估疗效的研究很少。尽管安全性和疗效数据有限，但安非他酮和丁螺环酮可能被视为HSDD的标签外治疗。患有HSDD的月经期女性可能受益于标签外睾酮治疗，多项临床试验报告了一些疗效和短期安全性。目前，氟班色林是美国食品和药物管理局批准的唯一一种治疗绝经前妇女全身获得性HSDD的药物。基于现有的数据，我们假设所有这些疗法都改变了中枢抑制和兴奋通路。总之，HSDD显着影响妇女的生活质量，可以有效地管理由卫生保健提供者进行适当的评估和个性化治疗。(C)2016年马约医学教育和研究基金会。爱思唯尔公司出版
The objective of the International Society for the Study of Women's Sexual Health expert consensus panel was to develop a concise, clinically relevant, evidence-based review of the epidemiology, physiology, pathogenesis, diagnosis, and treatment of hypoactive sexual desire disorder (HSDD), a sexual dysfunction affecting approximately 10% of adult women. Etiologic factors include conditions or drugs that decrease brain dopamine, melanocortin, oxytocin, and norepinephrine levels and augment brain serotonin, endocannabinoid, prolactin, and opioid levels. Symptoms include lack or loss of motivation to participate in sexual activity due to absent or decreased spontaneous desire, sexual desire in response to erotic cues or stimulation, or ability to maintain desire or interest through sexual activity for at least 6 months, with accompanying distress. Treatment follows a biopsychosocial model and is guided by history and assessment of symptoms. Sex therapy has been the standard treatment, although there is a paucity of studies assessing efficacy, except for mindfulness-based cognitive behavior therapy. Bupropion and buspirone may be considered off-label treatments for HSDD, despite limited safety and efficacy data. Menopausal women with HSDD may benefit from off-label testosterone treatment, as evidenced by multiple clinical trials reporting some efficacy and short-term safety. Currently, flibanserin is the only Food and Drug Administrationeapproved medication to treat premenopausal women with generalized acquired HSDD. Based on existing data, we hypothesize that all these therapies alter central inhibitory and excitatory pathways. In conclusion, HSDD significantly affects quality of life in women and can effectively be managed by health care providers with appropriate assessments and individualized treatments. (C) 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc.