De WVSD en NVVS richtlijn voor de diagnose en behandeling van vroegtijdige zaadlozing.

Richtlijn voor klinische diagnostiek en behandeling van vroegtijdige zaadlozingDeze Richtlijn is tot stand gekomen door een interdisciplinair internationaal en Nederlands panel van erkende specialisten op het gebied van vroegtijdige zaadlozing met als doel begrijpelijke, praktische en evidence-based aanbevelingen te geven voor de diagnostiek en behandeling van vroegtijdige zaadlozing door huisartsen, seksuologen en specialisten (met name urologen). Erkennende dat niet al het wetenschappelijk bewijs van gelijk niveau is, heeft het ISSM Commitee de wetenschappelijke literatuur doorgenomen en bediscussieerd waardoor bij de aanbevelingen een graad van wetenschappelijkheid gegeven kon worden volgens de Oxford Centre of Evidence-Based Medicine gradaties. Tabel 4 bevat alle relevante aanbevelingen van het Vroegtijdige Zaadlozing ISSM Guidelines Committee. Deze richtlijn bevestigt de ISSM definitie van primaire vroegtijdige zaadlozing en laat zien dat de prevalentie van vroegtijdige zaadlozing aanzienlijk lager is dan eerder is aangenomen. Evidence-based gegevens ten aanzien van biologische en psychologische etiologie van vroegtijdige zaadlozing worden beschreven, evenals op populatie-onderzoek gebaseerde statistiek ten aanzien van normale ejaculatielatentietijden. Korte diagnostische procedures worden aangegeven evenals gevalideerde diagnostische en behandelingsvragenlijsten. Ten slotte, de beste aanbevelingen voor behandeling worden beschreven om een houvast te geven aan de clinicus, die wel of niet bekend is met vroegtijdige zaadlozing, en om de behandeling van zijn patiënt te vergemakkelijken.Wetenschappelijke Vereniging voor Seksuele Disfuncties (WVSD); Nederlandse Vereniging voor Seksuologie (NVVS

Comorbidities Among Women With Vulvovaginal Complaints in Family Practice

Background: The lifetime prevalence of women suffering from provoked vestibulodynia (PVD) is estimated to be approximately 15%. The etiology of PVD is not yet clear. Recent studies approach PVD as a chronic multifactorial sexual pain disorder. PVD is associated with pain syndromes, genital infections, and mental disorders, which are common diseases in family practice. PVD, however, is not included in the International Classification of Primary Care. Hence, the vulvovaginal symptoms, which could be suggestive of PVD, are likely to be missed. Aim: To explore the relationship between specific vulvovaginal symptoms that could be suggestive of PVD (genital pain, painful intercourse, other symptoms/complaints related to the vagina/vulva), and related diseases such as pain syndromes, psychological symptom diagnoses, and genital infections in family practice. Methods: A retrospective analysis of all episodes from 1995 to 2008 in 784 women between 15 and 49 years were used to determine the posterior probability of a selected diagnosis in the presence of specific vulvovaginal symptoms suggestive of PVD expressed in an odds ratio. Selected comorbidities were pain syndromes (muscle pain, general weakness, irritable bowel syndrome [IBS]), psychological symptom diagnoses (anxiety, depression, insomnia), vulvovaginal candidiasis, and sexual and physical abuse. Results: Women with symptoms suggestive of PVD were 4 to 7 times more likely to be diagnosed with vulvovaginal candidiasis and 2 to 4 times more likely to be diagnosed with IBS. Some symptoms suggestive of PVD were 1 to 3 times more likely to be diagnosed with complaints of muscle pain, general weakness, insomnia, depressive disorder, and feeling anxious. Conclusion: Data from daily family practice showed a clear relationship between symptoms suggestive of PVD and the diagnoses of vulvovaginal candidiasis and IBS in premenopausal women. Possibly, family doctors make a diagnosis of vulvovaginal candidiasis or IBS based only on clinical manifestations in many women in whom a diagnosis of PVD would be more appropriate. Copyright (C) 2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserve

Facilitators and barriers in the diagnostic process of vulvovaginal complaints (vulvodynia) in general practice: a qualitative study

Background: The gap between the relatively high prevalence of provoked vulvodynia (PVD) in the general population and the low incidence in primary care can partly be explained by physicians' lack of knowledge about the assessment and management of PVD. Objectives: To recognize barriers and facilitators of GPs in the diagnostic process of women presenting with recurrent vulvovaginal complaints. Methods: A qualitative focus group study in 17 Dutch GPs, five men and 12 women. An interview guide, based on the scientific literature and the expertise of the researchers, including a vignette of a patient, was used to direct the discussion between the GPs. The interviews were audiotaped and transcribed verbatim. A systematic text analysis of the transcripts was performed after data saturation was reached. Results: Analysis of the interviews generated three major themes: Identifying and discussing sexual complaints, importance of gender in professional experience, and coping with professional uncertainty. Within these themes, the reluctance regarding sexual complaints, male gender, negative emotional responses when faced with professional uncertainty, as well as lack of education were barriers to the diagnostic process and management of PVD. Female gender and understanding that patients can profit from enquiring about sexual health issues were found to be facilitating factors. Conclusions: To improve the care for women with PVD, attitude and skills of GPs regarding taking a sexual history and performing a vulvovaginal examination should be addressed, as well as GPs' coping strategies regarding their professional uncertaint

Efficacy and Safety of Flibanserin for the Treatment of Hypoactive Sexual Desire Disorder in Women: A Systematic Review and Meta-analysis

In August 2015, the US Food and Drug Administration (FDA) approved flibanserin as a treatment for hypoactive sexual desire disorder (HSDD) in premenopausal women, despite concern about suboptimal risk-benefit trade-offs. To conduct a systematic review and meta-analysis of randomized clinical trials assessing efficacy and safety of flibanserin for the treatment of HSDD in women. Medical databases (among others, Embase, Medline, Psycinfo) and trial registries were searched from inception to June 17, 2015. Reference lists of retrieved studies were searched for additional publications. Randomized clinical trials assessing treatment effects of flibanserin in premenopausal and postmenopausal women were eligible. No age, language, or date restrictions were applied. Abstract and full-text selection was done by 2 independent reviewers. Data were extracted by one reviewer and checked by a second reviewer. Results were pooled using 2 approaches depending on the blinding risk of bias. Primary efficacy outcomes included number of satisfying sexual events (SSEs), eDiary sexual desire, and Female Sexual Function Index (FSFI) desire. Safety outcomes included, among others, 4 common adverse events (AEs): dizziness, somnolence, nausea, and fatigue. Five published and 3 unpublished studies including 5914 women were included. Pooled mean differences for SSE change from baseline were 0.49 (95% CI, 0.32-0.67) between 100-mg flibanserin and placebo, 1.63 (95% CI, 0.45-2.82) for eDiary desire, and 0.27 (95% CI, 0.17-0.38) for FSFI desire. The risk ratio for study discontinuation due to AEs was 2.19 (95% CI, 1.50-3.20). The risk ratio for dizziness was 4.00 (95% CI, 2.56-6.27) in flibanserin vs placebo, 3.97 (95% CI, 3.01-5.24) for somnolence, 2.35 (95% CI, 1.85-2.98) for nausea, and 1.64 (95% CI, 1.27-2.13) for fatigue. Women's mean global impression of improvement scores indicated minimal improvement to no change. Treatment with flibanserin, on average, resulted in one-half additional SSE per month while statistically and clinically significantly increasing the risk of dizziness, somnolence, nausea, and fatigue. Overall, the quality of the evidence was graded as very low. Before flibanserin can be recommended in guidelines and clinical practice, future studies should include women from diverse populations, particularly women with comorbidities, medication use, and surgical menopaus

Richtlijn 'Vroegtijdige zaadlozing'

In 2010 the International Society of Sexual Medicine published its practice guideline for the diagnosis and treatment of premature ejaculation. This guideline was translated and adapted on a number of points by a committee consisting of members of two Dutch sexological societies, the 'WVSD' and the 'NVVS'. The most important subjects in this guideline are: (a) the case history is the most important diagnostic tool; (b) a physical examination is usually not necessary; (c) determination of the subtype of premature ejaculation can guide treatment; (d) pharmacotherapy alone is only applicable for primary premature ejaculation; (e) combination therapy is preferable for the secondary form of premature ejaculation, and pharmacotherapy is contraindicated for the other 2 subtype

The Relationship Between Vulvovaginal Candidiasis and Provoked Vulvodynia: A Systematic Review

Background: Provoked vulvodynia (PVD) is a chronic vulvar pain condition affecting up to 8.3% of the female population. Despite many years of research, no clear cause for PVD has been identified. Several risk factors have been studied, including vulvovaginal candidiasis (VVC). However, to date, the role of Candida infections in PVD has remained unclear. VVC and PVD have an overlap of symptoms that may contribute to diagnostic inaccuracy and mistreatment. Aim: To systematically review the literature on the relationship between VVC and PVD. Methods: Cohort and case-control studies were included that compared women with PVD with healthy controls with respect to the presence of a history of Candida vulvovaginitis. PVD had to be diagnosed by Friedrich's criteria or the International Society for the Study of Vulvovaginal Disease criteria. The inclusion process as well as the quality appraisal of the studies, using the Newcastle-Ottawa Quality Assessment Scale, were performed independently by 2 authors. Main Outcome Measure: Outcomes of the population-based case-control studies were listed as odds ratio. Outcomes of the pathophysiological studies were based on local pro-inflammatory responses on Candida in vitro. Results: We included a total of 14 studies, both population and clinic-based case-control, and pathophysiological research. 7 studies were of low methodological quality, and 7 studies were of medium methodological quality. The population-based case-control studies showed a significantly increased odds ratio for self-reported VVC in PVD cases compared with controls. The pathophysiological studies revealed a tendency for an increased local proinflammatory response on Candida in vitro in patients with PVD. Owing to the substantial heterogeneity of the studies, meta-analysis was not performed. Clinical Implications: Health care providers may consider a diagnosis of PVD in women with self-reported VVC, and to act on this properly. Reiteration of antifungal prescriptions by physicians without a decent diagnosis, will lead to mistreatment. Women should be informed by their health care provider that intercourse during (or shortly after) the treatment of VVC might worsen the vulnerability of the vulvar skin. Strength and Limitations: This is the first systematic review performed to describe the relation between VVC and PVD. An independently performed in- and exclusion process and quality appraisal, ensured optimal internal validity. However, there were important methodological limitations and the size of heterogeneity prevented establishing a meta-analysis. Conclusion: This systematic review is unable to draw conclusions regarding a relationship between actual VVC and PVD because studies were based on self-reported VVC. Until new evidence becomes available, we advocate that PVD should be considered as an unexplained chronic pain condition. In women with recurrent or persistent VVC-like complaints, physicians should consider a diagnosis of PVD. Leusink P, van de Pasch S, Teunissen D, et al. The Relationship Between Vulvovaginal Candidiasis and Provoked Vulvodynia: A Systematic Review. J Sex Med 2018;15:1310–1321