***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Hypoactive sexual desire disorder ( HSDD ) is one of the most common sexual problems reported by women , but few studies have been conducted to evaluate treatments for this condition . OBJECTIVE The objective of this study was to evaluate the efficacy and safety of a testosterone patch in surgically menopausal women with HSDD . DESIGN The design was a r and omized , double-blind , parallel-group , placebo-controlled , 24-wk study ( the Intimate SM 1 study ) . SETTING The study was performed at private or institutional practice s. PATIENTS The subjects studied were women , aged 26 - 70 yr , with HSDD after bilateral salpingo-oophorectomy who were receiving concomitant estrogen therapy . Placebo ( n = 279 ) or testosterone 300 microg/d ( n = 283 ) was administered . There were 19 patients who withdrew due to adverse events in the placebo group and 24 in the 300 mug/d testosterone group . INTERVENTION Testosterone ( 300 microg/d ) or placebo patches were applied twice weekly . MAIN OUTCOME MEASURE(S ) The primary end point was the change in the frequency of total satisfying sexual activity at 24 wk . Secondary end points included other sexual functioning end points and safety assessment s. RESULTS At 24 wk , there was an increase from baseline in the frequency of total satisfying sexual activity of 2.10 episodes/4 wk in the testosterone group , which was significantly greater than the change of 0.98 episodes/4 wk in the placebo group ( P = 0.0003 ) . The testosterone group also experienced statistically significant improvements in sexual desire and a decrease in distress . The overall safety profile was similar in both treatment groups . CONCLUSION In the Intimate SM 1 study , the testosterone patch improved sexual function and decreased distress in surgically menopausal women with HSDD and was well tolerated in this trial Phase I pharmacokinetic ( PK ) study assessed circulating estrogens in breast cancer ( BC ) patients on a non-steroidal aromatase inhibitor ( NSAI ) with vaginal atrophy using vaginal ultra-low-dose 0.03 mg estriol ( E3 ) and Lactobacillus combination vaginal tablets ( Gynoflor ® ) .  16 women on NSAI with severe vaginal atrophy applied a daily vaginal tablet of Gynoflor ® for 28 days followed by a maintenance therapy of 3 tablets weekly for 8 weeks . Primary outcomes were serum concentrations and PK of E3 , estradiol ( E2 ) , and estrone ( E1 ) using highly sensitive gas chromatography – mass spectrometry . Secondary outcomes were clinical measures for efficacy and side effects ; microscopic changes in vaginal epithelium and microflora ; and changes in serum FSH , LH , and sex hormone-binding globulin . Compared with baseline , serum E1 and E2 did not increase in any of the women at any time following vaginal application . Serum E3 transiently increased after the first application in 15 of 16 women , with a maximum of 168 pg/ml 2–3 h post-insertion . After 4 weeks , serum E3 was slightly increased in 8 women with a maximum of 44 pg/ml . The vaginal atrophy resolved or improved in all women . The product was well tolerated , and discontinuation of therapy was not observed . The low-dose 0.03 mg E3 and Lactobacillus acidophilus vaginal tablets application in postmenopausal BC patients during AI treatment suffering from vaginal atrophy lead to small and transient increases in serum E3 , but not E1 or E2 , and therefore can be considered as safe and efficacious for treatment of atrophic vaginitis in BC patients taking NSAIs PURPOSE / OBJECTIVES To determine whether breast cancer survivors ( BCSs ) who received an uncertainty management intervention  , compared to an attention control condition  , would have less uncertainty , better uncertainty management , fewer breast cancer-specific concerns , and more positive psychological outcomes . DESIGN A 2 × 2 r and omized block , repeated- measures design , with data collected at baseline and two other points postintervention , as well as a few days before or after either a mammogram or oncologist visit . SETTING Rural and urban clinical and community setting s. SAMPLE 313 female BCSs aged 50 or younger ; 117 African Americans and 196 Caucasians . METHODS Participants were blocked on ethnicity and r and omly assigned to intervention or control . The intervention , consisting of a scripted CD and a guide booklet , was supplemented by four scripted , 20-minute weekly training calls conducted by nurse interventionists . The control group received the four scripted , 20-minute weekly training calls . MAIN RESEARCH VARIABLES Uncertainty in illness , uncertainty management , breast cancer-specific concerns , and positive psychological outcomes . FINDINGS BCSs who received the intervention reported reductions in uncertainty and significant improvements in behavioral and cognitive coping strategies to manage uncertainty , self-efficacy , and sexual dysfunction . CONCLUSIONS The intervention was effective as delivered in managing uncertainties related to being a younger BCS . IMPLICATION S FOR NURSING The intervention can realistically be applied in practice because of its efficient and cost-effective nature requiring minimal direct caregiver involvement . The intervention allows survivors who are having a particular survival issue at any given point in time to access information , re sources , and management strategies . KNOWLEDGE TRANSLATION Material s tested in CD and guide booklet format could be translated into online format for survivors to access as issues arise during increasingly lengthy survivorship periods . Material s could be downloaded to a variety of electronic devices , fitting with the information needs and management styles of younger BCSs PURPOSE Controversy exists about whether vaginal estrogens interfere with the efficacy of aromatase inhibitors ( AIs ) in breast cancer patients . With the greater incidence of vaginal atrophy in patients on AIs , a safe and effective nonestrogen therapy is necessary . We hypothesized that vaginal testosterone cream could safely treat vaginal atrophy in women on AIs . METHODS Twenty-one postmenopausal breast cancer patients on AIs with symptoms of vaginal atrophy were treated with testosterone cream applied to the vaginal epithelium daily for 28 days . Ten women received a dose of 300 μg , 10 received 150 μg , and one was not evaluable . Estradiol levels , testosterone levels , symptoms of vaginal atrophy , and gynecologic examinations with pH and vaginal cytology were compared before and after therapy . RESULTS Estradiol levels remained suppressed after treatment to < 8 pg/mL. Mean total symptom scores improved from 2.0 to 0.7 after treatment ( p < .001 ) and remained improved 1 month thereafter ( p = .003 ) . Dyspareunia ( p = .0014 ) and vaginal dryness ( p < .001 ) improved . The median vaginal pH decreased from 5.5 to 5.0 ( p = .028 ) . The median maturation index rose from 20 % to 40 % ( p < .001 ) . Although improvement in total symptom score was similar for both doses ( -1.3 for 300 μg , -0.8 for 150 μg ; p = .37 ) , only the 300-μg dose was associated with improved pH and maturation values . CONCLUSIONS A 4-week course of vaginal testosterone was associated with improved signs and symptoms of vaginal atrophy related to AI therapy without increasing estradiol or testosterone levels . Longer-term trials are warranted BACKGROUND The ovaries provide approximately half the circulating testosterone in premenopausal women . After bilateral oophorectomy , many women report impaired sexual functioning despite estrogen replacement . We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause . METHODS Seventy-five women , 31 to 56 years old , who had undergone oophorectomy and hysterectomy received conjugated equine estrogens ( at least 0.625 mg per day orally ) and , in r and om order , placebo , 150 microg of testosterone , and 300 microg of testosterone per day transdermally for 12 weeks each . Outcome measures included scores on the Brief Index of Sexual Functioning for Women , the Psychological General Well-Being Index , and a sexual-function diary completed over the telephone . RESULTS The mean ( + /-SD ) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter ( 4.2+/-2.8 pmol per liter ) during placebo treatment to 3.9+/-2.4 pg per milliliter ( 13.5+/-8.3 pmol per liter ) and 5.9+/-4.8 pg per milliliter ( 20.5+/-16.6 pmol per liter ) during treatment with 150 and 300 microg of testosterone per day , respectively ( normal range , 1.3 to 6.8 pg per milliliter [ 4.5 to 23.6 pmol per liter ] ) . Despite an appreciable placebo response , the higher testosterone dose result ed in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women ( P=0.03 for both comparisons with placebo ) . At the higher dose the percentages of women who had sexual fantasies , masturbated , or engaged in sexual intercourse at least once a week increased two to three times from base line . The positive-well-being , depressed-mood , and composite scores of the Psychological General Well-Being Index also improved at the higher dose ( P=0.04 , P=0.03 , and P=0.04 , respectively , for the comparison with placebo ) , but the scores on the telephone-based diary did not increase significantly . CONCLUSIONS In women who have undergone oophorectomy and hysterectomy , transdermal testosterone improves sexual function and psychological well-being BACKGROUND The Breast Cancer Prevention Trial ( BCPT ) is a large , multicenter chemoprevention trial testing the efficacy of the antiestrogen drug tamoxifen for prevention of breast cancer and coronary heart disease in healthy women at high risk of breast cancer . The BCPT evolved from a series of prior studies in early stage breast cancer demonstrating the efficacy of tamoxifen in the prevention of systemic breast cancer recurrence and in the reduction of contralateral breast cancers . PURPOSE The purpose of this article is to describe the method ologic considerations in the collection of health-related quality -of-life ( HRQL ) data in the BCPT and to present base-line HRQL data on the first 9749 participants . METHODS An HRQL question naire that included the Center for Epidemiologic Studies -Depression Scale , a symptom checklist , the Medical Outcomes Study 36-item short form ( MOS-SF-36 ) , and the MOS sexual problems questions was completed by participants in the BCPT at base line ( prior to r and om assignment ) . Medical and demographic information , as well as projected risk of breast cancer , were collected as part of study eligibility . Descriptive and correlational data were examined for these study participants . RESULTS BCPT participants report high levels of functioning compared with U.S. general population norms but still report an average of 8.9 distinct symptoms during the past 4 weeks . Depression is less prevalent among the participants than in community sample s , which reflects the exclusion of clinical ly depressed individuals . Sixty-five percent reported being sexually active in the past 6 months , with an age-related decline in sexual activity . Younger women reported fewer sexual problems than older women . There is a strong correlation between the two mental health measures , moderate to weak correlations between HRQL scales and levels of self-reported symptoms , and only weak correlations between measures of breast cancer risk and HRQL scales . The MOS-SF-36 scores were examined for three consecutive recruitment sample s ( 0 - 6 months , 7 - 12 months , and 13 - 20 months ) , and the base-line scores were slightly better for the earliest group of participants . CONCLUSIONS This article demonstrates the feasibility of collecting HRQL data in a large , multicenter , chemoprevention trial for women at high risk of breast cancer . The successful integration of HRQL data collection into this clinical trial attests to its value as a safety-monitoring end point and as an explicit and measurable outcome for the entire trial . IMPLICATION S HRQL data are important for studies in which healthy population s are involved and in which the potential for decrements in quality of life are real or perceived Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To assess the efficacy , tolerability , and acceptance of a vaginal ring delivering the equivalent of 50 or 100 microg per day of estradiol ( E2 ) , compared with placebo , for relief of moderate to severe vasomotor symptoms and urogenital symptoms in postmenopausal women . METHODS Women with moderate to severe vasomotor symptoms ( seven or more per day or 56 per week average ) received 13 weeks of treatment with a vaginal ring delivering 50 microg per day E2 ( n = 113 ) or 100 microg per day E2 ( n = 112 ) , or a 
    Output:
    
The review found that regular and prolonged use of vaginal moisturizers was effective in improving vaginal dryness , dyspareunia , and sexual satisfaction .
Educational and counseling interventions targeting sexual dysfunction showed consistent improvement in various aspects of sexual health .
No consistent improvements in sexual health were observed with physical activity , transdermal testosterone or hot flash interventions .