Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, 50139, Italy.
Department of Experimental, Clinical and Biomedical Sciences "Mario Serio," University of Florence, Florence, 50139, Italy.
J Sex Med. 2024 Sep 28;21(10):861-871. doi: 10.1093/jsxmed/qdae102.
Hypoactive Sexual Desire Disorder (HSDD) is a frequent sex-related problem in women; however, a specific tool to characterize HSDD subtypes based on sexual inhibitory and excitatory factors is still lacking.
(1) To find a cutoff value in Sexual Inhibition Scale (SIS)/Sexual Excitation Scale (SES) scores predicting a diagnosis of HSDD in women consulting for sexual symptoms, (2) to explore the sexual inhibitory and excitatory profiles in women referred to a clinic for female sexual dysfunction by stratifying the sample according to the newfound cutoffs, and (3) to identify biopsychosocial factors significantly associated with the 2 profiles.
An overall 133 women consulting for sexual symptoms were retrospectively evaluated for clinical, biochemical, and psychosexologic data collected at the first visit. A subgroup of 55 women treated with transdermal testosterone was retrospectively analyzed at baseline and the 6-month visit.
Patients underwent physical and laboratory examinations and completed the SIS/SES, Female Sexual Function Index, Female Sexual Distress Scale-Revised, Emotional Eating Scale, and Middlesex Hospital Questionnaire.
Specific cutoffs for SIS1 (≥32.5; indicating threat of performance failure) and SES (≤46.5) predicted HSDD diagnosis with an accuracy of 66.4% (P = .002) and 68.7% (P < .0001), respectively. Patients with impaired SIS1 scores showed higher distress and psychopathologic symptoms, while those with impaired SES scores demonstrated lower desire and arousal and a negative association with some metabolic and hormonal parameters. SES score also showed a significant predictive value on testosterone treatment efficacy for HSDD.
A better characterization of HSDD would enable individualized treatment based on the main underlying etiologies.
Limitations of the study include the small sample size and cross-sectional retrospective design, with the choice of treatment for HSDD limited to transdermal testosterone. Strengths comprise the thorough and multifactorial evaluation of every aspect potentially affecting inhibitory and excitatory components of sexual desire.
Validated cutoffs of SIS/SES scores could allow deep characterization of women diagnosed with HSDD, thus ensuring better tailoring of therapy and prediction of the probability of response to specific treatments.
性欲低下障碍（HSDD）是女性常见的与性相关的问题；然而，仍然缺乏一种基于性抑制和性兴奋因素来描述 HSDD 亚型的特定工具。
（1）在因性症状就诊的女性中，找到性抑制量表（SIS）/性兴奋量表（SES）评分预测 HSDD 诊断的截断值，（2）通过根据新发现的截断值对样本进行分层，探讨女性性功能障碍诊所就诊女性的性抑制和性兴奋特征，（3）确定与这两个特征显著相关的生物心理社会因素。
对因性症状就诊的 133 名女性进行回顾性评估，评估她们在首次就诊时收集的临床、生化和性心理数据。对接受透皮睾酮治疗的 55 名女性进行亚组回顾性分析，分析基线和 6 个月随访时的数据。
患者接受了身体和实验室检查，并完成了 SIS/SES、女性性功能指数、女性性困扰量表修订版、情绪性进食量表和米德尔塞克斯医院问卷。
SIS1（≥32.5；表示对表现失败的威胁）和 SES（≤46.5）的特定截断值预测 HSDD 诊断的准确率分别为 66.4%（P=0.002）和 68.7%（P<0.0001）。SIS1 评分受损的患者表现出更高的困扰和精神病理症状，而 SES 评分受损的患者表现出较低的欲望和唤起，并且与一些代谢和激素参数呈负相关。SES 评分对 HSDD 的睾酮治疗疗效也具有显著的预测价值。
更好地描述 HSDD 将能够根据主要潜在病因进行个体化治疗。
该研究的局限性包括样本量小和横断面回顾性设计，HSDD 的治疗选择仅限于透皮睾酮。该研究的优势包括对可能影响性欲抑制和兴奋成分的各个方面进行全面和多因素评估。
SIS/SES 评分的验证截断值可以对诊断为 HSDD 的女性进行深入特征描述，从而确保更好地定制治疗，并预测对特定治疗的反应概率。
