Rheumatoid arthritis (RA) is a systemic rheumatic disease that often impacts women of childbearing age. Women and men with RA experience higher rates of subfertility compared to the general population. Disease activity, treatment, psychosocial concerns, and sexual dysfunction contribute to subfertility, delayed childbearing, and reduced family size in the RA population. Assisted reproductive technology (ART) procedures are safe and effective options for patients who experience subfertility or are interested in preserving future fertility while continuing pregnancy-incompatible medications. Women with RA also experience increased risk of various adverse pregnancy outcomes compared to the general population, including preterm delivery and having small-for-gestational-age infants. Achieving well-controlled disease on pregnancy-compatible medications prior to conception optimizes maternal and neonatal outcomes. For patients with childbearing potential taking teratogenic medication, contraception is important; there are no RA-specific contraindications to the use of hormonal birth control. Sexual and reproductive health care for women and men with RA requires a multidisciplinary, patient-centered approach. Future studies are needed to elucidate mechanisms of impaired fertility and adverse pregnancy outcomes in RA, to investigate the safety of non-tumor necrosis factor inhibitor biologic disease‑modifying antirheumatic drugs (non-TNFi bDMARDs) during pregnancy and lactation, and to illuminate patient perspectives and priorities regarding their reproductive health across the lifespan.

Despite the recognized emotional importance of post-coital intimate behaviors such as hugging, cuddling, talking, kissing, massaging, listening to sensual music, showering, and reading erotic literature (collectively termed afterplay), their impact on female sexual satisfaction has not been systematically studied. This prospective randomized study evaluated the effect of afterplay on sexual satisfaction among sexually active women in heterosexual relationships. Couples with medical comorbidities, psychiatric disorders, or diagnosed sexual dysfunction were excluded. Participants were randomized into two groups using computer-generated random numbers. Both groups received weekly educational sessions on desire, arousal, lubrication, orgasm, satisfaction, pain, and foreplay, with Group B receiving an additional 15-minute session focused on afterplay. Sexual satisfaction was assessed at baseline and after 8 weeks using the Sexual Satisfaction Scale for Women (SSS-W), supplemented by diary-based records of sexual experiences. A total of 431 women completed the study (Group A: 211; Group B: 220), with comparable baseline characteristics. After 8 weeks, Group B showed significantly greater improvement across all SSS-W domains compared with Group A (p ≤ 0.05). These findings identify afterplay as an important factor influencing female sexual satisfaction. Partner education regarding afterplay may represent a simple and effective intervention for improving sexual well-being and addressing female sexual dissatisfaction.

Alzheimer's disease (AD) affects aged women more than men. The precipitous drop in sex hormone levels in postmenopausal women likely contributes to such sexual dimorphism, with emerging evidence implicating the G protein-coupled estrogen receptor (GPER) as a modulator of AD pathology and cognitive impairments. However, the underlying mechanism remains unknown. GPER is distinctively expressed in key components of the neurovascular unit (NVU), namely astrocytes and mural cells (specifically, pericytes). Using GPER-knockout (GPER-KO) and APP/PS1 transgenic AD mouse models, here we show that GPER deficiency exacerbates Aβ deposition, impairs spatial and working memory, and disrupts neurovascular coupling. GPER activation in pericytes reinforces Lrp1 -dependent endocytic uptake of Aβ. In astrocytes, GPER appears to be essential in regulation of AQP4 polarity, gap junction protein expression and reactivity. Furthermore, GPER interacts directly with Aβ to form a protein complex and loss of GPER leads to astrocytic dysfunction, reduced pericyte coverage, and impaired glymphatic clearance. Our findings reveal GPER as a critical regulator of NVU function and Aβ proteostasis, providing a mechanistic basis for AD sexual dimorphism, further supporting GPER as a potential target for sex-specific therapeutic strategies.

Sexual dimorphism, which is defined as systematic differences between male and female individuals not limited to characteristics related to reproduction, has been recognized in many organ systems and is emerging as an important component of hepatic function in health and disease. Oestrogen is considered the predominant driver of sexual dimorphism in the liver. Other molecular mechanisms independent of oestrogen including epigenetic regulation and immune function contribute to differences between sexes as do other as yet unknown mechanisms. Clinically, hepatic sexual dimorphisms manifest in many ways. For example, women have a lower incidence of many liver disorders including metabolic-dysfunction-associated steatotic liver disease and liver cancer but are more susceptible to benign neoplasms and autoimmune liver diseases such as primary biliary cholangitis. Better understanding the diverse contributors to hepatic sexual dimorphism, including sociodemographic factors, could deepen our understanding of liver biology and aid in sex-specific clinical management and disease prevention. In this Review, we describe the molecular mechanisms of sexual dimorphisms in liver physiology, including oestrogen signalling, genes encoded on sex chromosomes, epigenetic effects on metabolism and immune function. We also describe hepatic sexual dimorphisms in liver pathophysiology, including in metabolic-dysfunction-associated steatotic liver disease, autoimmune diseases, viral hepatitis and liver cancer.

Although lumbopelvic disorders are common during pregnancy, evidence regarding their impact on health-related quality of life (HRQoL) remains limited. This study therefore aimed to assess the associations between urinary incontinence, fecal incontinence, constipation, sexual dysfunction, low back pain, and HRQoL during pregnancy. Analysis of covariance (ANCOVA) models and multivariate linear regression analyses were used to examine the associations between these conditions and HRQoL among 375 pregnant women in Nicaragua. Pregnant women with these disorders had significantly poorer HRQoL than those without them. The physical component score was associated with urinary incontinence (β = -0.22, 95 percent CI: -0.42 to -0.01), constipation (β = -0.43, 95 percent CI: -0.64 to -0.21), sexual dysfunction (β = -0.13, 95 percent CI: -0.24 to -0.02) and low back pain (β = -0.75, 95 percent CI: -1.07 to -0.44). The mental component score was associated with constipation (β = -0.41, 95 percent CI: -0.61 to -0.21 and sexual dysfunction (β = -0.13, 95 percent CI: -0.23 to -0.02). In conclusion, this study suggests that urinary incontinence, constipation, sexual dysfunction, and low back pain may be associated with poor physical well-being during pregnancy. Constipation and sexual dysfunction may also be associated with poor mental HRQoL.

Reduced sexual activity has been reported in women with Turner syndrome (TS), a chromosomal disorder frequently associated with premature ovarian insufficiency (POI), but data on sexual function and its qualitative aspects remain limited. Furthermore, few studies have compared sexual function of women with TS to that of women with POI from other etiologies (non-TS POI). Our aim was to assess sexual function in women with TS and compare it to that of women with non-TS POI, and to evaluate whether sexual dysfunction in TS is related to different comorbidities.

The use of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) resulted in weight loss and long-term cardiovascular (CV) and renal safety preservation. Their role in male sexual hormones and behavior is still not sufficiently investigated. This paper aims at summarizing the effects of GLP1-RA and SGLT2i on obesity-associated hypogonadism and sexual dysfunctions. Both GLP1-RA and SGLT2i resulted in an improvement of body composition and metabolic profile, supporting erectile function amelioration. Only GLP1-RA showed a weight loss dependent increase in total and calculated free testosterone with lower effects on gonadotropin levels, while for SGLT2i, the data are contradictory. Finally, the use of testosterone replacement therapy showed better results as compared to GLP1-RA when orgasm and sexual satisfaction domains were investigated. In conclusion considering the beneficial effects of GLP1-RA on long-term CV mortality and morbidity, compared to the substantially neutral effects derived from the use of testosterone replacement therapy, we support the use of this class of medications for improving sexual dysfunction and its underlying CV problems in overweight and obese patients with erectile dysfunction.

This study aimed to assess anxiety levels and marital relationships among women undergoing infertility treatment. A descriptive observational design was conducted involving 300 infertile women over nine months at Zagazig University Hospital. Data were collected using a Structured Interview Questionnaire, the Female Sexual Function Index (FSFI), and the Taylor Anxiety Scale. Reliability analysis showed high internal consistency (Cronbach's alpha: 0.923 for FSFI; 0.845 for Taylor Scale). Results indicated that 32.6% of participants sought services after one year of marriage, 30.5% visited more than five centers, and 47.5% used IVF. Nearly half of the subjects experienced varying degrees of anxiety (moderate to very severe), which significantly impacted sexual arousal, orgasm, and satisfaction. In conclusion, anxiety and psychosexual dysfunction are highly prevalent among women during fertility treatments, underscoring the critical need to integrate psychological counseling and standardized screening protocols within routine reproductive healthcare.

Sexual dysfunction related to depression and antidepressant treatment is clinically important yet underrecognized, affecting adherence, intimate functioning and quality of life. Depression can impair desire, arousal, orgasm and satisfaction before pharmacotherapy, while serotonergic antidepressants may further disturb these domains during treatment, complicating causal attribution and underscoring the need to distinguish depression-related sexual dysfunction from antidepressant-associated sexual dysfunction (AISD). Plant-derived bioactives have attracted interest because several engage systems relevant to both mood and sexual response, including monoaminergic, inflammatory/oxidative, HPA-axis, autonomic and nitric oxide-mediated vascular pathways. We conducted a narrative review based on targeted searches of PubMed/MEDLINE, Web of Science and Scopus through June 2026, synthesizing mechanistic and clinical evidence for selected candidates by phenotype specificity to separate direct AISD studies from adjacent clinical or preclinical evidence and mechanistic plausibility. Saffron provides the most coherent AISD-specific signal, supported by small randomized trials in women and men with fluoxetine-associated sexual dysfunction. Maca shows a narrower signal in female SSRI/SNRI-associated sexual dysfunction, particularly in postmenopausal women. Rosa damascena remains preliminary, whereas Ginkgo biloba shows inconsistent controlled evidence and interaction concerns. Panax ginseng, pomegranate and dietary nitrates are mechanistically plausible through endothelial and nitric oxide pathways but lack direct AISD evidence. Overall, current evidence supports mechanistic plausibility and preliminary phenotype-specific signals rather than established efficacy. Plant-derived bioactives are best positioned as investigational adjunctive nutritional modulators within evidence-based psychiatric and sexual-medicine care, pending larger trials with standardized preparations, validated sexual-function outcomes, sex-specific analyses and mechanism-oriented biomarkers.

Objective The aim of the German-language S3 guideline on lichen sclerosus (LS) is to provide an evidence- and consensus-based foundation for the diagnosis and management of this disease. The present publication offers a concise summary of the relevant content, focusing on genital LS in girls and women. This first part addresses, among other aspects, the definition, symptomatology, and diagnosis of LS, as well as its management during pregnancy. The separately published second part focuses on the treatment of LS. Methods The German-language, evidence- and consensus-based S3 guideline on LS was developed under the leadership of the German Society of Gynecology and Obstetrics (DGGG) and the German Dermatological Society (DDG), based on the European "EuroGuiDerm Guideline on Lichen Sclerosus." The interdisciplinary guideline panel included 24 experts from 16 professional societies and actively involved patient representatives in the development process. Recommendations LS is a chronic inflammatory skin disease with predominant manifestation in the anogenital region. It may be associated with pruritus, pain, sexual dysfunction, urinary symptoms, and constipation, although it can occasionally remain asymptomatic. Awareness of the broad spectrum of symptoms, as well as reversible and irreversible clinical signs, is essential to enable early diagnosis and appropriate treatment. Early and adequate therapy can not only alleviate symptoms but also reduce the risk of permanent damage and the development of associated carcinomas. During pregnancy, treatment with topical glucocorticoids should be continued as needed to control disease activity and prevent complications.

Euthyroid autoimmune thyroiditis (Hashimoto's disease) has been shown to negatively affect female sexual health; however, this adverse impact appears to be mitigated by vitamin D therapy. Emerging research suggests that vitamin E may reduce susceptibility to autoimmune thyroiditis and that supplementation could contribute to improved sexual health outcomes. The present study aimed to investigate whether vitamin E status influences the effects of exogenous vitamin D on female sexual function and depressive symptoms in individuals with this condition. This pilot study included three cohorts of young women with Hashimoto's disease, matched for age, thyroid antibody titers, and 25-hydroxyvitamin D levels, all exhibiting normal TSH and free thyroid hormone concentrations. The cohorts differed in vitamin E intake: below the recommended daily allowance (group 1), adequate intake (group 2), and high intake (exceeding 400 IU daily; group 3). All participants received vitamin D at a daily dose of 100 µg for six months. Serum hormone levels, thyroid antibody titers, and calculated indices of thyroid homeostasis were evaluated at enrollment and at the conclusion of the study. Female sexual function and depressive symptoms were also evaluated at both time points using validated instruments: the Female Sexual Function Index (FSFI) and the Beck Depression Inventory-II (BDI-II). At enrollment, group 2 scored higher than the other cohorts in the sexual desire and arousal domains. Vitamin D supplementation increased serum 25-hydroxyvitamin D in all groups. The decrease in antibody titers was most pronounced in group 2, and only in this group did vitamin D enhance thyroid secretory capacity and increase testosterone levels. In group 2, treatment led to improvements across all FSFI domains and the total score. In group 1, positive effects were limited to the lubrication and lack of pain/discomfort domains, whereas group 3 showed no changes in sexual function. Improvements in female sexual function correlated with vitamin E intake, reductions in antibody titers, and increases in testosterone levels. Significant improvements in depressive symptoms, as measured by the BDI-II, were observed exclusively in group 2. Adequate vitamin E intake is essential to achieve the full effects of vitamin D on female sexual function and mood in young euthyroid patients with Hashimoto's disease.