***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND The efficacy and safety of testosterone treatment for hypoactive sexual desire disorder in postmenopausal women not receiving estrogen therapy  are unknown . METHODS We conducted a double-blind , placebo-controlled , 52-week trial in which 814 women with hypoactive sexual desire disorder were r and omly assigned to receive a patch delivering 150 or 300 microg of testosterone per day or placebo .  Efficacy was measured to week 24 ; safety was evaluated over a period of 52 weeks , with a subgroup of participants followed for an additional year . The primary end point was the change from baseline to week 24 in the 4-week frequency of satisfying sexual episodes . RESULTS At 24 weeks , the increase in the 4-week frequency of satisfying sexual episodes was significantly greater in the group receiving 300 microg of testosterone per day than in the placebo group ( an increase of 2.1 episodes vs. 0.7 , P<0.001 ) but not in the group receiving 150 microg per day ( 1.2 episodes , P=0.11 ) . As compared with placebo , both doses of testosterone were associated with significant increases in desire ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) and decreases in distress ( 300 microg per day , P<0.001 ; 150 microg per day , P=0.04 ) . The rate of and rogenic adverse events - primarily unwanted hair growth - was higher in the group receiving 300 microg of testosterone per day than in the placebo group ( 30.0 % vs. 23.1 % ) . Breast cancer was diagnosed in four women who received testosterone ( as compared with none who received placebo ) ; one of the four received the diagnosis in the first 4 months of the study period , and one , in retrospect , had symptoms before undergoing r and omization . CONCLUSIONS In postmenopausal women not receiving estrogen therapy  , treatment with a patch delivering 300 microg of testosterone per day result ed in a modest but meaningful improvement in sexual function . The long-term effects of testosterone , including effects on the breast , remain uncertain . ( Clinical Trials.gov number , NCT00131495 . INTRODUCTION A wide range of prevalence estimates of female sexual dysfunctions ( FSD ) have been reported . AIM Compare instruments used to assess FSD to determine if differences between instruments contribute to variation in reported prevalence . MAIN OUTCOME MEASURES Sexual Function Question naire combined with  Female Sexual Distress Scale ( SFQ-FSDS ) was our gold st and ard , vali date d instrument for assessing FSD . Alternatives were SFQ alone and two sets of simple questions adapted from Laumann et al. 1994 . Methods . A postal survey was administered to a r and om sample of 356 Australian women aged 20 to 70 years . RESULTS When assessed by SFQ-FSDS , prevalence estimates ( 95 % confidence intervals ) of hypoactive sexual desire disorder , sexual arousal disorder ( lubrication ) , orgasmic disorder , and dyspareunia were 16 % ( 12 % to 20 % ) , 7 % ( 5 % to 11 % ) , 8 % ( 6 % to 12 % ) , and 1 % ( 0.5 % to 3 % ) , respectively . Prevalence estimates varied across alternative instruments for these disorders : 32 % to 58 % , 16 % to 32 % , 16 % to 33 % , and 3 % to 23 % , respectively . Compared with SFQ-FSDS alternative instruments produced higher estimates of desire , arousal and orgasm disorders and displayed a range of sensitivities ( 0.25 to 1.0 ) , specificities ( 0.48 to 0.99 ) , positive predictive values ( 0.01 to 0.56 ) , and negative predictive values ( 0.95 to 1.0 ) across the disorders investigated . Kappa statistics comparing SFQ-FSDS and alternative instruments ranged from 0 to 0.71 but were predominantly 0.44 or less . Changing recall from previous month to 1 month or more in the previous year produced higher estimates for all disorders investigated . Including sexual distress produced lower estimates for desire , arousal , and orgasm disorders . CONCLUSIONS Prevalence estimates of FSD varied substantially across instruments . Relatively low positive predictive values and kappa statistics combined with a broad range of sensitivities and specificities indicated that different instruments identified different subgroups . Consequently , the instruments research ers choose when assessing FSD may affect prevalence estimates and risk factors they report University of Illinois Thirty subjects seeking treatment for primary inorgasmia accompanied by sexual anxiety or aversion were assigned to one of three groups : systematic desensitization ( SD ) , directed masturbation ( DM ) , or waiting list control ( WL ) . Following treatment , subjects were retested , and the WL group then received directed masturbation treatment . A third testing constituted a follow-up for the SD and DM groups and a posttreatment testing for the WL . Both treatments were equally effective in improving subjects ' sexual self-acceptance and increasing sexual pleasure . Changes in anxiety were negligible ; however , sexual arousal and orgasm for DM and WL subjects increased . The gains of the WL group not only replicated the findings of the DM group but also were of greater magnitude Ginkgo biloba extract ( GBE ) facilitates blood flow , influences nitric oxide systems , and has a relaxant effect on smooth muscle tissue . These processes are important to the sexual response in women and , hence , it is feasible that GBE may have a therapeutic effect . The present study was the first to provide an empirical examination of the effects of both short- and long-term GBE administration on subjective and physiological ( vaginal photoplethysmography ) measures of sexual function in women with Sexual Arousal Disorder . A single dose of 300 mg GBE had a small but significant facilitatory effect on physiological , but not subjective , sexual arousal compared to placebo in 99 sexually dysfunctional women . The long-term effects of GBE on sexual function were assessed in 68 sexually dysfunctional women who were r and omly assigned to 8 weeks treatment of either ( 1 ) GBE ( 300 mg/daily ) , ( 2 ) placebo , ( 3 ) sex therapy which focused on training women to attend to genital sensations , or ( 4 ) sex therapy plus GBE . When combined with sex therapy , but not alone , long-term GBE treatment significantly increased sexual desire and contentment beyond placebo . Sex therapy alone significantly enhanced orgasm function compared with placebo . Long-term GBE administration did not significantly enhance arousal responses beyond placebo . It was concluded that ( 1 ) neither short- or long-term administration of GBE alone substantially impacts sexual function in women , ( 2 ) a substantial placebo effect on sexual function exists in women with sexual concerns , and ( 3 ) teaching women to focus on genital sensations during sex enhances certain aspects of women ’s sexual functioning This paper presents the results of a prospect i ve controlled study evaluating a programme of directed masturbation against a combined sensate focus and supportive psychotherapeutic approach in the management of female primary orgasmic failure .  Of the 20 patients who followed the masturbation programme  90 per cent gained orgasmic capacity compared with 53 per cent of 15 patients who were treated conventionally . Eighty-five per cent of the patients treated by the masturbation programme and 47 per cent of the control group of patients became coitally orgasmic on at least 75 per cent of coital occasions . The difference is statistically significant at the 5 per cent level . The results suggest that directed masturbation is an effective adjunct in the management of primary female orgasmic failure BACKGROUND Oophorectomy reduces serum testosterone levels . We studied the efficacy and safety of transdermal testosterone in treating hypoactive sexual desire disorder in surgically menopausal women . METHODS A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , multicenter trial was conducted in women ( aged 24 - 70 years ) who developed distressful low sexual desire after bilateral salpingo-oophorectomy and hysterectomy and who were receiving oral estrogen therapy .  Women were r and omized to receive placebo ( n = 119 ) or testosterone patches in dosages of 150 microg/d ( n = 107 ) , 300 microg/d ( n = 110 ) , or 450 microg/d ( n = 111 ) twice weekly for 24 weeks . Sexual desire and frequency of satisfying sexual activity were primary efficacy outcome measures . RESULTS Of the 447 women r and omized , 318 ( 71 % ) completed the trial . Compared with placebo , women receiving the 300-microg/d testosterone patch had significantly greater increases from baseline in sexual desire ( 67 % vs 48 % ; P = .05 ) and in frequency of satisfying sexual activity ( 79 % vs 43 % ; P = .049 ) . The 150-microg/d group showed no evidence of a treatment effect . The 450-microg/d group also was not statistically different from the 300-microg/d or placebo groups . Marginally significant linear dose-response trends were observed for total satisfying sexual activity and sexual desire at 24 weeks ( P = .06 and .06 , respectively ) . Adverse events occurred with similar frequency in both groups ; no serious safety concerns were observed . CONCLUSIONS The 300-microg/d testosterone patch increased sexual desire and frequency of satisfying sexual activity and was well tolerated in women who developed hypoactive sexual desire disorder after surgical menopause Three components commonly utilized in sex therapy for secondary orgasmic dysfunction ( Sensate Focus I , Sensate Focus II , and ban on intercourse ) were studied , with the aim of not only exploring their effects on therapy outcome but also , in part , of sensitizing investigators to the benefits of incorporating component analyses within larger investigations of therapy outcome . The subjects were 23 married couples with the problem of secondary orgasmic dysfunction in the wife . Subjects were administered a multicomponent therapy program over a 14-week period . Daily self-monitoring data were analyzed to assess the impact of Sensate Focus exercises and banning intercourse on both broad ( e.g. , enjoyment ) and narrow ( e.g. , orgasmic response ) criteria of therapeutic effectiveness . Results indicated that for females , sensate focus exercises , in combination with a ban on intercourse , led to a significant increase in level of enjoyment for subsequent noncoital sexual caressing as well as intercourse . Orgasmic responsiveness , however , was not affected . The method ological issues of broad versus narrow therapeutic effects , compliance with treatment , and cost-effective techniques for the study of sex therapy components are discussed In an open study , sildenafil ( Viagra ) was prescribed for nine women out patients who reported sexual dysfunction induced by antidepressant medication , primarily selective serotonin reuptake inhibitors . A 50 mg dose of sildenafil was prescribed , and patients were instructed to take it approximately one hour before sexual activity . They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil . The nine patients , all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances , reported significant reversal of sexual dysfunction , usually with the first dose of 50 mg of sildenafil We conducted a double-blind , placebo-controlled study to determine the role of dietary supplementation on sexual function in women of differing menopausal status . One hundred eight ( 108 ) women , age 22–73 years , who reported a lack of sexual desire , enrolled as participants . Of these , 55 received ArginMax for women and 53 received placebo . ArginMax for women contains L-arginine , ginseng , ginkgo , damiana , multivitamins , and minerals . The 108 women , given definitions , self-reported as 59 premenopausal ( PRE ) ; 20 perimenopausal ( PERI ) , and 29 postmenopausal ( POST ) . After 4 weeks , PRE women on ArginMax primarily reported significant improvement in level of sexual desire ( 72 % ; p = 0.03 ) and satisfaction with overall sex life ( 68 % ; p = 0.007 ) , compared with placebo group , according to the Female Sexual Function Index ( FSFI ; Kaplan et al. , 1999 ) scales . Frequency of sexual desire ( 60 % ; p = 0.05 ) and frequency of intercourse ( 56 % p = 0.01 ) also increased among the PRE women . In contrast , among PERI women , primary improvements were reported for frequency of intercourse ( 86 % ; p = 0.002 ) , satisfaction with sexual relationship ( 79 % ; p = 0.03 ) , and vaginal dryness ( 64 % ; p = 0.03 ) compared with placebo group . POST women primarily showed an increased in level of sexual desire , with 51 % showing improvement , compared with only 8 % in the placebo group ( p = 0.008 ) . Nutritional intervention plays an important role in women 's sexual health , but issues and areas of greatest improvement differ among women of different menopausal states . The largest number of attribute improvements were seen in PRE and PERI women , although attribute types vary among these groups . Level of desire was shown to increase significantly in POST women . Since ArginMax for women has been shown to exhibit no estrogen activity , it may be desirable alternative to hormone therapy for sexual concerns Abstract Forty-eight couples complaining of secondary orgasmic 
    Output:
    
Evidence -based , practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition