Thursday, November 17, 2016
Concerns about weight gain may be driving contraception choices, according to Penn State College of Medicine researchers. Women who are overweight or obese are less likely than women who are not overweight or obese to use the birth control pill and other hormonal contraceptive methods.
Weight gain is one of the most commonly cited reasons why women stop using hormonal contraception, and therefore may play a role in the risk of unintended pregnancies, said Cynthia H. Chuang, professor of medicine and public health sciences. Although oral contraception likely does not cause weight gain, says Chuang, many women attribute increasing weight with the birth control pill. The birth control shot has been associated with weight gain in younger women.
Chuang and her co-researchers wanted to learn if women's weight or their perception of weight influenced the type of birth control they used, if any. To do so, they examined demographic and survey data from almost 1,000 privately insured women in Pennsylvania.
The researchers categorized weight category based on body mass index (BMI), a measure of body size based on height and weight.
They determined that overweight and obese women were more likely than women who are not overweight or obese to choose forms of birth control known as long-acting reversible contraceptives (LARCs), and less likely to use methods like the pill, the shot, the patch and the ring. There was also a trend toward overweight and obese women to be more likely to use non-prescription methods such as condoms, withdrawal and natural family planning, or no method. The researchers will report their results in the journal Contraception.
Long-acting reversible contraceptives include intrauterine devices, commonly known as IUDs, and the contraceptive implant. LARCs do not contain estrogen, which some some women believe causes weight gain.
"What we think may be happening is that women who are overweight and obese may be more likely to choose methods other than the pill or the shot because of fear of weight gain," Chuang said. "As a result, they are choosing both more effective methods (LARCS) and less effective, non-prescription methods."
Researchers found that 23 percent of overweight and 21 percent of obese women used LARCs, which are the most effective forms of birth control. In contrast, only 6 percent of under-weight and normal-weight women used LARCs in the study.
"We were actually glad to see that overweight and obese women were at least more likely to choose LARCs because I was expecting to see these women more likely to use non-prescription methods," Chuang said.
Heavier women also were more likely than normal-weight women to use less-effective non-prescription birth control methods -- such as condoms -- or no method at all. However, these results did not reach statistical significance, Chuang said.
The researchers also evaluated whether perception of weight influenced contraceptive choice. In the study, half of the women perceived themselves to be overweight, although only around 42 percent of them were overweight or obese based on BMI. This perception, however, did not appear to influence birth control choice.
"Women may be worried about weight gain when they're making decisions about birth control, so clinicians need to be aware of that," Chung said. "It could be an opportunity to counsel women about LARCs, which are more effective forms of contraception."
During menopause, levels of estrogen decline in vaginal tissues, which may cause a condition known as VVA, leading to symptoms such as pain during sexual intercourse.
"Pain during sexual intercourse is one of the most frequent symptoms of VVA reported by postmenopausal women," said Audrey Gassman, M.D., deputy director of the Division of Bone, Reproductive, and Urologic Products (DBRUP) in the Office of Drug Evaluation III in the FDA’s Center for Drug Evaluation and Research (CDER). "Intrarosa provides an additional treatment option for women seeking relief of dyspareunia caused by VVA."
Efficacy of Intrarosa, a once-daily vaginal insert, was established in two 12-week placebo-controlled clinical trials of 406 healthy postmenopausal women, 40 to 80 years of age, who identified moderate to severe pain during sexual intercourse as their most bothersome symptom of VVA. Women were randomly assigned to receive Intrarosa or a placebo vaginal insert. Intrarosa, when compared to placebo, was shown to reduce the severity of pain experienced during sexual intercourse.
The safety of Intrarosa was established in four 12-week placebo-controlled trials and one 52-week open-label trial. The most common adverse reactions were vaginal discharge and abnormal Pap smear.
Although DHEA is included in some dietary supplements, the efficacy and safety of those products have not been established for diagnosing, curing, mitigating, treating or preventing any disease.
Intrarosa is marketed by Quebec-based Endoceutics Inc.
Thursday, November 10, 2016
Although many of us don't want to think about grandma still "getting it on," multiple studies show that older women are still sexually active beyond their seventh decade of life. A new study published online today in Menopause, the journal of The North American Menopause Society (NAMS), suggests, however, that at least one in seven women aged 65 to 79 years has hypoactive sexual desire dysfunction (HSDD).
In the questionnaire-based, cross-sectional study, more than 1,500 Australian women were assessed for sexual function and sexual distress as defined by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised. The group consisted of 52.6% partnered women, with a mean age of 71 years. Within this group, 88% were found to have low sexual desire, 15.5% had sexually related personal distress, and 13.6% had HSDD, which is defined as the presence of both low sexual desire and sexually related personal distress. This percentage was higher than what had previously been reported for women in this age group and similar to the prevalence reported for younger women.
Although HSDD was found to be more common in women with partners, the study confirmed that unpartnered older women are still sexually active and may be distressed by low sexual desire. Independent factors included vaginal dryness during intercourse in the past month, having moderate to severe depressive symptoms, and having symptomatic pelvic floor dysfunction.
"This study demonstrates that healthcare providers need to have honest and open discussions with their patients as they age with regard to desire, mood, vaginal dryness, and pelvic floor issues to determine whether these factors are affecting a woman's desire or ability to be sexual," says Dr. JoAnn Pinkerton, NAMS executive director.
Friday, November 4, 2016
Women experience marked decline in sexual function in months immediately before and after onset of menopause
Women experience a notable decline in sexual function approximately 20 months before and one year after their last menstrual period, and that decrease continues, though at a somewhat slower rate, over the following five years, according to a study led by a researcher at Wake Forest Baptist Medical Center.
The study, published ahead of print in the online issue of Menopause: The Journal of the North American Menopause Society, also found that various factors that frequently co-occur with menopause have less direct influence on declining sexual function than menopause itself.
"Sexual functioning in women declines with age, and there has been much debate about how much this is due to menopause, aging or other physical, psychological or social factors," said the study's lead author, Nancy Avis, Ph.D., professor of public health sciences at Wake Forest School of Medicine, part of Wake Forest Baptist. "Our findings support that menopause has a negative effect on sexual functioning in many women."
Additionally, the study found that women who have a hysterectomy before the onset of menopause do not experience a marked decline in sexual function immediately before undergoing the procedure but do so afterward, for as long as five years.
The researchers based their findings on information collected from 1,390 participants in the federally funded Study of Women's Health Across the Nation (SWAN), which began in 1996. These women, who were between the ages of 42 and 52 at the time of enrollment in the study and who had a known date of final menstrual period during their participation, responded to questionnaires dealing with various aspects of sexual function -- including desire, arousal, satisfaction and pain -- between one and seven times over the course of the study. The researchers analyzed 5,798 of these self-assessments (4,932 from the 1,164 women in the natural menopause group and 866 from the 226 women in the hysterectomy group) and tracked the changes in the respondents' scores on the sexual-function questionnaires relative to either their final menstrual period among women who experienced a natural menopause or the hysterectomy. Of note, in the natural menopause group the researchers found that race/ethnicity played a major role in the decline of sexual function, with African-American women experiencing a significantly smaller decline and women of Japanese descent experiencing a much greater decline when compared with white women.
"Sexual functioning is an important component of women's lives. More than 75 percent of the middle-aged women in the SWAN study reported that sex was moderately to extremely important to them when the study began," Avis said. "It is important for women and their health care providers to understand all the factors that may impact women's experience of sex in relation to both the natural menopausal transition and hysterectomy, and we hope our findings will contribute to better understanding in this area."
Tuesday, November 1, 2016
The nature of a woman's orgasm has been a source of debate for over a century. Since the Victorian era, the pendulum has swung from the vagina to the clitoris, and to some extent back again.
Today, the debate is stuck over whether an orgasm can be produced through vaginal stimulation alone, or if arousal of the external clitoris is always necessary.
A new review by Concordia research published in Socioaffective Neuroscience & Psychology details the vast potential women have to experience orgasms from one or more sources of sensory input.
In the review, senior author Jim Pfaus, a psychology professor from the Faculty of Arts and Science, and his co-authors -- Concordia graduate students Gonzalo Quintana Zunino and Conall Mac Cionnaith, as well as Mayte Parada from McGill University -- look into the evolution of the clitoral versus vaginal orgasm debate.
They arrive at a new understanding of the female orgasm that incorporates the external clitoral glans, the internal region around the G-spot, the cervix and sensory stimulation of non-genital areas such as the nipples.
"With experience, stimulation of one or all of these triggering zones are integrated into a 'whole' set of sensory inputs, movements, body positions, arousals and cues related to context," Pfaus says.
"That combination of sensory input is what reliably induces pleasure and orgasm during masturbation and intercourse. That said, we think it's likely this changes across the lifespan, as women experience different kinds of orgasms from different types of sensations in different contexts and with different partners."
The article explains that the distinction between different orgasms is not between sensations of the external clitoris and internal vagina, but between levels of what a woman understands a "whole" orgasm to consist of.
This depends firstly on her experience with direct stimulation of the external clitoris, internal clitoris and cervix. But it also relates to knowledge of the arousing and erotic cues that predict orgasm, knowledge of her own pattern of movements that lead to it and experience with stimulation of multiple external and internal genital and non-genital sites -- for example, lips, nipples, ears, neck, fingers and, yes, toes.
"Orgasms don't have to come from one site, nor from all sites. And they don't have to be the same for every woman, nor for every sexual experience even in the same woman, to be whole and valid."
Pfaus hopes that this article will drive home the fact that the female orgasm is not simply a different version of the reproductive model of male ejaculation.
"Unlike men, women can have a remarkable variety of orgasmic experiences, which evolve throughout the lifespan. A woman's erotic body map is not etched in stone, but rather is an ongoing process of experience, discovery and construction."