human
***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: INTRODUCTION Female sexual dysfunction ( FSD ) is a common problem that may be encountered in the interruption of normal sexual functioning in the sexual response cycle . Women with a pelvic floor disorder who scored low on the Female Sexual Function Index ( FSFI ) showed an improvement in their sexual life following treatment by vaginal electrical stimulation ( VES ) . AIM The aim of this trial was to evaluate the effectiveness of VES in women with FSD without a predominant pelvic floor disorder or urinary incontinence . METHODS Forty-two women with FSD were r and omly allocated to VES and placebo groups . Pelvic floor muscle ( PFM ) assessment and the FSFI question naire were performed at baseline and after the completion of sessions . VES treatment was administered using a vaginal probe . The probe was inserted , and a medium-frequency ( 50 Hz ) alternating current was administered for a duty cycle of 5 seconds on followed by a 5-second rest . MAIN OUTCOMES MEASURES Primary outcome measure was the improvement in FSFI score . PFM assessment s were performed according to the PERFECT scheme . RESULTS Total FSFI scores improved significantly in both the VES group and the control group . Results show that in the VES group , there was an improvement in total score and FSFI domains that improved including arousal , desire , orgasm , and satisfaction . Similarly , control group domains that improved were desire , arousal , and orgasm . But there was no significant increase in satisfaction scores in the placebo group . No significant changes in pain or lubrication domains were seen in either group . Power , endurance , fast contractions , and repetitions were significantly improved in the VES group . CONCLUSIONS The lack of significant differences between the placebo and VES groups , except the satisfaction domain , puts into question the effectiveness of electrical stimulation as a monotherapy in treating primary FSD without pelvic floor disorder PURPOSE We assessed the tolerability , safety and efficacy of sildenafil for the treatment of women with sexual dysfunction secondary to multiple sclerosis , as well as the role of somatosensory evoked potential neurophysiological testing . MATERIAL S AND METHODS We performed a double-blind , r and omized , placebo controlled , crossover study investigating the effects of sildenafil in women with multiple sclerosis and sexual dysfunction . Assessment s were done by vali date d question naires . Pudendal and tibial evoked potentials were also recorded . RESULTS A total of 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase . Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase . There was no overall change in quality of life after sildenafil . There was a significant correlation between the latency of tibial and pudendal evoked potentials . CONCLUSIONS Sildenafil only appeared to produce limited benefit in certain individuals with female sexual dysfunction . Some measure of the extent of neurological deficit in these patients could be ascertained from the latency of tibial evoked potentials , which correlated with pudendal evoked potentials . However , it could not predict the extent of sexual dysfunction . Sildenafil is unlikely to help all patients with neurogenic female sexual dysfunction Abstract Purpose To investigate the effects of onabotulinum toxin type A ( Onabot/A ) intravesical injections on urinary and sexual function in a group of patients affected by multiple sclerosis ( MS ) . Methods We enrolled 31 MS female patients with symptoms of overactive bladder and detrusor overactivity . All patients underwent urodynamics and were administered 3-day voiding diary , Incontinence Quality of Life ( I-QoL ) question naire , Female Sexual Function Index ( FSFI ) question naire , Hamilton Anxiety Rating Scale ( HAM-A ) and Hamilton Depression Rating Scale ( HAM-D ) before and 3 months after Onabot/A intravesical injection . Results Onabot/A injection significantly improved urinary symptoms as shown by the 3-day voiding diary , I-QoL question naire and the urodynamic variables . In addition , it also significantly improved sexual functioning in continent patients and psychological status as demonstrated by the increase in FSFI , HAM-A and HAM-D scores . Conclusions The Onabot/A-induced positive effect on sexual dysfunction in our MS patients is likely due to an indirect effect exerted by the overall urological clinical improvement on sexual function at both the psychological and emotional levels . The positive effect exerted by Onabot/A on the anxiety and depression scale also suggests that urinary symptoms have a negative impact on the psychological status of the patients Background : Sexual dysfunction ( SD ) affects up to 80 % of multiple sclerosis ( MS ) patients and pelvic floor muscles ( PFMs ) play an important role in the sexual function of these patients . Objectives : The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS . Methods : Thirty MS women were r and omly allocated to one of three groups : pelvic floor muscle training ( PFMT ) with electromyographic ( EMG ) biofeedback and sham neuromuscular electrostimulation ( NMES ) ( Group I ) , PFMT with EMG biofeedback and intravaginal NMES ( Group II ) , and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation ( TTNS ) ( Group III ) . Assessment s , before and after the treatment , included : PFM function , PFM tone , flexibility of the vaginal opening and ability to relax the PFMs , and the Female Sexual Function Index ( FSFI ) question naire . Results : After treatment , all groups showed improvements in all domains of the PERFECT scheme . PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II . All groups improved in arousal , lubrication , satisfaction and total score domains of the FSFI question naire . Conclusion : This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD BACKGROUND Multiple Sclerosis ( MS ) is a chronic and disabling disease result ing in disabilities in young and middle-aged persons . In this study , research ers explored the effect of yoga techniques on physical activities and sexual function among some Iranian women with MS . MATERIAL S AND METHODS In this study , 60 Iranian women with multiple sclerosis ( MS ) were placed in two equally divided control and case groups through r and om selection to assess pre- and post-effects of yoga exercises on their physical activities and sexual satisfaction levels . Women in case group were offered a series of yoga training and exercises for 3 months , which consisted of 8 sessions per month for 60 to 90 minutes at each session . Yoga training program included the 3 principles of slow motions ( Hatayoga ) , respiratory exercises ( Pranayama ) and central ization to control mind via meditation , expansion and stasis ( Rajayoga ) . After 3 months both groups were surveyed using the initial question naire to evaluate and compare findings with the base-line data . RESULTS Research ers found significant statistical difference in physical activity and sexual satisfaction levels among the women in case group ( P=0.001 ) . Women in case group showed improvement in physical ability while women in control group manifested exacerbated symptoms .  CONCLUSION Yoga techniques may improve physical activities and sexual satisfaction function of women with MS OBJECTIVE This study was conducted to evaluate the effectiveness of sexual counseling based on the Permission , Limited Information , Specific Suggestion , Intensive Therapy ( PLISSIT ) model on the Sexual Dysfunction ( SD ) of married sexually active women who suffer from Multiple Sclerosis ( MS ) . This is the first sexual intervention applied by a midwife as a health professional on MS patients in Iran where the cultural and religious limitations are important challenging issues . STUDY DESIGN This r and omized clinical trial was carried out in Iranian Community of Support for MS Patients in Tehran , Iran . The participating women who had a definite diagnosis of MS and SD , Exp and ed Disability Status Scale ( EDSS ) scores < 7 , and aged 18 - 55 years were r and omly assigned to experimental ( EG , n=43 ) and control group ( CG , n=45 ) . Participants in the EG group received 4 weekly sexual counseling sessions based on the PLISSIT model ( 90 - 120min per session ) . MAIN OUTCOME MEASURES Sexual function was assessed three times ( before the intervention , and 2 months and 3 months after the intervention ) using the Female Sexual Function Index ( FSFI ) . Chi-square test , Fisher 's exact test , and Repeated Measures ANOVA were employed to analyze the data . RESULTS The mean total FSFI score of the women in EG improved at 2 and 3 months after the intervention when it was compared with the FSFI score before the intervention ( p<0.05 ) . There was no significant difference in the total FSFI score when the data of 3 evaluations was compared in CG . A significant increase in the mean score of 6 subgroups was seen in EG ( p<0.05 ) but not in CG . CONCLUSION According to this study , utilizing the PLISSIT model as a framework for sexual counseling can improve sexual function in women who are sexually active and suffer from SD due to MS Study design : Double-blind , placebo-controlled , flexible-dose study . Objective : To evaluate the efficacy , safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI ( paraplegia/tetraplegia ) . Setting : The study was conducted at clinical practice sites in North America ( n = 23 ) , 11 European countries ( n = 23 ) , Australia ( n = 4 ) and South Africa ( n = 2 ) . Methods : 129 women were r and omized and treated with sildenafil or matching placebo . A 4-week baseline period was followed by 12 weeks of treatment , which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period , depending on efficacy and tolerability . By use of an event log , sexual activity was monitored between screening and the end of treatment . The Sexual Function Question naire , the Sexual Quality of Life Question naire – Female , a global efficacy question and Sexual Distress Question were also assessed . Results : Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study , with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline . There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures . The most common adverse events included headache and vasodilatation . Conclusion : The results of this study are similar to other reports regarding a lack of clinical ly meaningful benefit of sildenafil in other population s of women . Sponsorship : This study was sponsored by Pfizer AIM Evaluate whether symptoms of vaginal dryness , low libido , less intense or delayed orgasm could be improved in women with multiple sclerosis who took part in an education or education plus counselling programme .  BACKGROUND Sexual dysfunction , a prevalent symptom in women with multiple sclerosis , can negatively affect quality -of-life . METHODS Women attending a large multiple sclerosis clinic were invited and 62 were r and omized into one of two groups . Group 1 received written material s on primary , secondary and tertiary sexual dysfunction in multiple sclerosis as well as additional re sources ( books , websites , list of local psychologists specializing in sexual counselling ) . Group 2 received the same written material s as well as three counselling sessions from the clinic nurse , the latter two by telephone . The primary outcome measures were the exp and ed disability status scale and the multiple sclerosis intimacy and sexuality question naire-19 . Repeated- measures analysis of variance was used to evaluate sexual dysfunction score over time and to compare two groups . RESULTS At baseline , total exp and ed disability status scale scores were not correlated with primary , secondary or tertiary sexual dysfunction . Total multiple sclerosis intimacy and sexuality question naire-19 score was correlated with use of anti-cholinergic medications [ r ( 54 ) = 0.28 , P < 0.05 ] , but no other medications , alcohol or tobacco use . Both groups had equivalent and significant reductions in primary sexual dysfunction [ F ( 1 ) = 14.79 , P < 0.001 ] postintervention . There was a trend towards an interaction effect for tertiary sexual dysfunction [ F ( 1 ) = 2.88 , P = 0.096 ] , in the direction of group 2 ( education and counselling ) . Subjectively , women welcomed the opportunity to discuss sexual concerns and noted that the written information allowed a framework for initiating discussion with their spouses . CONCLUSION Relatively straightforward interventions provided by a clinic nurse may help women cope with the symptoms of sexual dysfunction associated with multiple sclerosis . Women who do not benefit from basic interventions could then be referred to an expert sexual dysfunction practitioner . RELEVANCE TO CLINICAL PRACTICE Women with multiple sclerosis experience many disease-related physical and emotional challenges of which sexuality is only one . Sensitivity to sexual dysfunction and being willing to approach the topic is appreciated by women with multiple sclerosis . Nurses do not require in-depth expertise to offer some basic suggestions which may significantly improve life quality and assist the woman with multiple sclerosis to talk about or cope with sexuality issues OBJECTIVE To examine the safety and efficacy of using a clitoral vacuum suction device ( CVSD ) versus vibratory stimulation ( V ) to treat orgasmic dysfunction in women with multiple sclerosis ( MS ) or spinal cord injury ( SCI ) . DESIGN R and omized clinical trial . SETTING Two academic medical centers . PARTICIPANTS Women ( N=31 ) including 
    Output:
    
agent
***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: INTRODUCTION Female sexual dysfunction ( FSD ) is a common problem that may be encountered in the interruption of normal sexual functioning in the sexual response cycle . Women with a pelvic floor disorder who scored low on the Female Sexual Function Index ( FSFI ) showed an improvement in their sexual life following treatment by vaginal electrical stimulation ( VES ) . AIM The aim of this trial was to evaluate the effectiveness of VES in women with FSD without a predominant pelvic floor disorder or urinary incontinence . METHODS Forty-two women with FSD were r and omly allocated to VES and placebo groups . Pelvic floor muscle ( PFM ) assessment and the FSFI question naire were performed at baseline and after the completion of sessions . VES treatment was administered using a vaginal probe . The probe was inserted , and a medium-frequency ( 50 Hz ) alternating current was administered for a duty cycle of 5 seconds on followed by a 5-second rest . MAIN OUTCOMES MEASURES Primary outcome measure was the improvement in FSFI score . PFM assessment s were performed according to the PERFECT scheme . RESULTS Total FSFI scores improved significantly in both the VES group and the control group . Results show that in the VES group , there was an improvement in total score and FSFI domains that improved including arousal , desire , orgasm , and satisfaction . Similarly , control group domains that improved were desire , arousal , and orgasm . But there was no significant increase in satisfaction scores in the placebo group . No significant changes in pain or lubrication domains were seen in either group . Power , endurance , fast contractions , and repetitions were significantly improved in the VES group . CONCLUSIONS The lack of significant differences between the placebo and VES groups , except the satisfaction domain , puts into question the effectiveness of electrical stimulation as a monotherapy in treating primary FSD without pelvic floor disorder PURPOSE We assessed the tolerability , safety and efficacy of sildenafil for the treatment of women with sexual dysfunction secondary to multiple sclerosis , as well as the role of somatosensory evoked potential neurophysiological testing . MATERIAL S AND METHODS We performed a double-blind , r and omized , placebo controlled , crossover study investigating the effects of sildenafil in women with multiple sclerosis and sexual dysfunction . Assessment s were done by vali date d question naires . Pudendal and tibial evoked potentials were also recorded . RESULTS A total of 19 women completed the 2 arms of the double-blind phase and 12 completed the optional open label extension phase . Statistically significant improvement following sildenafil was only reported in the lubrication domain of sexual function during the double-blind phase . There was no overall change in quality of life after sildenafil . There was a significant correlation between the latency of tibial and pudendal evoked potentials . CONCLUSIONS Sildenafil only appeared to produce limited benefit in certain individuals with female sexual dysfunction . Some measure of the extent of neurological deficit in these patients could be ascertained from the latency of tibial evoked potentials , which correlated with pudendal evoked potentials . However , it could not predict the extent of sexual dysfunction . Sildenafil is unlikely to help all patients with neurogenic female sexual dysfunction Abstract Purpose To investigate the effects of onabotulinum toxin type A ( Onabot/A ) intravesical injections on urinary and sexual function in a group of patients affected by multiple sclerosis ( MS ) . Methods We enrolled 31 MS female patients with symptoms of overactive bladder and detrusor overactivity . All patients underwent urodynamics and were administered 3-day voiding diary , Incontinence Quality of Life ( I-QoL ) question naire , Female Sexual Function Index ( FSFI ) question naire , Hamilton Anxiety Rating Scale ( HAM-A ) and Hamilton Depression Rating Scale ( HAM-D ) before and 3 months after Onabot/A intravesical injection . Results Onabot/A injection significantly improved urinary symptoms as shown by the 3-day voiding diary , I-QoL question naire and the urodynamic variables . In addition , it also significantly improved sexual functioning in continent patients and psychological status as demonstrated by the increase in FSFI , HAM-A and HAM-D scores . Conclusions The Onabot/A-induced positive effect on sexual dysfunction in our MS patients is likely due to an indirect effect exerted by the overall urological clinical improvement on sexual function at both the psychological and emotional levels . The positive effect exerted by Onabot/A on the anxiety and depression scale also suggests that urinary symptoms have a negative impact on the psychological status of the patients Background : Sexual dysfunction ( SD ) affects up to 80 % of multiple sclerosis ( MS ) patients and pelvic floor muscles ( PFMs ) play an important role in the sexual function of these patients . Objectives : The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS . Methods : Thirty MS women were r and omly allocated to one of three groups : pelvic floor muscle training ( PFMT ) with electromyographic ( EMG ) biofeedback and sham neuromuscular electrostimulation ( NMES ) ( Group I ) , PFMT with EMG biofeedback and intravaginal NMES ( Group II ) , and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation ( TTNS ) ( Group III ) . Assessment s , before and after the treatment , included : PFM function , PFM tone , flexibility of the vaginal opening and ability to relax the PFMs , and the Female Sexual Function Index ( FSFI ) question naire . Results : After treatment , all groups showed improvements in all domains of the PERFECT scheme . PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II . All groups improved in arousal , lubrication , satisfaction and total score domains of the FSFI question naire . Conclusion : This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD BACKGROUND Multiple Sclerosis ( MS ) is a chronic and disabling disease result ing in disabilities in young and middle-aged persons . In this study , research ers explored the effect of yoga techniques on physical activities and sexual function among some Iranian women with MS . MATERIAL S AND METHODS In this study , 60 Iranian women with multiple sclerosis ( MS ) were placed in two equally divided control and case groups through r and om selection to assess pre- and post-effects of yoga exercises on their physical activities and sexual satisfaction levels . Women in case group were offered a series of yoga training and exercises for 3 months , which consisted of 8 sessions per month for 60 to 90 minutes at each session . Yoga training program included the 3 principles of slow motions ( Hatayoga ) , respiratory exercises ( Pranayama ) and central ization to control mind via meditation , expansion and stasis ( Rajayoga ) . After 3 months both groups were surveyed using the initial question naire to evaluate and compare findings with the base-line data . RESULTS Research ers found significant statistical difference in physical activity and sexual satisfaction levels among the women in case group ( P=0.001 ) . Women in case group showed improvement in physical ability while women in control group manifested exacerbated symptoms .  CONCLUSION Yoga techniques may improve physical activities and sexual satisfaction function of women with MS OBJECTIVE This study was conducted to evaluate the effectiveness of sexual counseling based on the Permission , Limited Information , Specific Suggestion , Intensive Therapy ( PLISSIT ) model on the Sexual Dysfunction ( SD ) of married sexually active women who suffer from Multiple Sclerosis ( MS ) . This is the first sexual intervention applied by a midwife as a health professional on MS patients in Iran where the cultural and religious limitations are important challenging issues . STUDY DESIGN This r and omized clinical trial was carried out in Iranian Community of Support for MS Patients in Tehran , Iran . The participating women who had a definite diagnosis of MS and SD , Exp and ed Disability Status Scale ( EDSS ) scores < 7 , and aged 18 - 55 years were r and omly assigned to experimental ( EG , n=43 ) and control group ( CG , n=45 ) . Participants in the EG group received 4 weekly sexual counseling sessions based on the PLISSIT model ( 90 - 120min per session ) . MAIN OUTCOME MEASURES Sexual function was assessed three times ( before the intervention , and 2 months and 3 months after the intervention ) using the Female Sexual Function Index ( FSFI ) . Chi-square test , Fisher 's exact test , and Repeated Measures ANOVA were employed to analyze the data . RESULTS The mean total FSFI score of the women in EG improved at 2 and 3 months after the intervention when it was compared with the FSFI score before the intervention ( p<0.05 ) . There was no significant difference in the total FSFI score when the data of 3 evaluations was compared in CG . A significant increase in the mean score of 6 subgroups was seen in EG ( p<0.05 ) but not in CG . CONCLUSION According to this study , utilizing the PLISSIT model as a framework for sexual counseling can improve sexual function in women who are sexually active and suffer from SD due to MS Study design : Double-blind , placebo-controlled , flexible-dose study . Objective : To evaluate the efficacy , safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI ( paraplegia/tetraplegia ) . Setting : The study was conducted at clinical practice sites in North America ( n = 23 ) , 11 European countries ( n = 23 ) , Australia ( n = 4 ) and South Africa ( n = 2 ) . Methods : 129 women were r and omized and treated with sildenafil or matching placebo . A 4-week baseline period was followed by 12 weeks of treatment , which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period , depending on efficacy and tolerability . By use of an event log , sexual activity was monitored between screening and the end of treatment . The Sexual Function Question naire , the Sexual Quality of Life Question naire – Female , a global efficacy question and Sexual Distress Question were also assessed . Results : Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study , with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline . There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures . The most common adverse events included headache and vasodilatation . Conclusion : The results of this study are similar to other reports regarding a lack of clinical ly meaningful benefit of sildenafil in other population s of women . Sponsorship : This study was sponsored by Pfizer AIM Evaluate whether symptoms of vaginal dryness , low libido , less intense or delayed orgasm could be improved in women with multiple sclerosis who took part in an education or education plus counselling programme .  BACKGROUND Sexual dysfunction , a prevalent symptom in women with multiple sclerosis , can negatively affect quality -of-life . METHODS Women attending a large multiple sclerosis clinic were invited and 62 were r and omized into one of two groups . Group 1 received written material s on primary , secondary and tertiary sexual dysfunction in multiple sclerosis as well as additional re sources ( books , websites , list of local psychologists specializing in sexual counselling ) . Group 2 received the same written material s as well as three counselling sessions from the clinic nurse , the latter two by telephone . The primary outcome measures were the exp and ed disability status scale and the multiple sclerosis intimacy and sexuality question naire-19 . Repeated- measures analysis of variance was used to evaluate sexual dysfunction score over time and to compare two groups . RESULTS At baseline , total exp and ed disability status scale scores were not correlated with primary , secondary or tertiary sexual dysfunction . Total multiple sclerosis intimacy and sexuality question naire-19 score was correlated with use of anti-cholinergic medications [ r ( 54 ) = 0.28 , P < 0.05 ] , but no other medications , alcohol or tobacco use . Both groups had equivalent and significant reductions in primary sexual dysfunction [ F ( 1 ) = 14.79 , P < 0.001 ] postintervention . There was a trend towards an interaction effect for tertiary sexual dysfunction [ F ( 1 ) = 2.88 , P = 0.096 ] , in the direction of group 2 ( education and counselling ) . Subjectively , women welcomed the opportunity to discuss sexual concerns and noted that the written information allowed a framework for initiating discussion with their spouses . CONCLUSION Relatively straightforward interventions provided by a clinic nurse may help women cope with the symptoms of sexual dysfunction associated with multiple sclerosis . Women who do not benefit from basic interventions could then be referred to an expert sexual dysfunction practitioner . RELEVANCE TO CLINICAL PRACTICE Women with multiple sclerosis experience many disease-related physical and emotional challenges of which sexuality is only one . Sensitivity to sexual dysfunction and being willing to approach the topic is appreciated by women with multiple sclerosis . Nurses do not require in-depth expertise to offer some basic suggestions which may significantly improve life quality and assist the woman with multiple sclerosis to talk about or cope with sexuality issues OBJECTIVE To examine the safety and efficacy of using a clitoral vacuum suction device ( CVSD ) versus vibratory stimulation ( V ) to treat orgasmic dysfunction in women with multiple sclerosis ( MS ) or spinal cord injury ( SCI ) . DESIGN R and omized clinical trial . SETTING Two academic medical centers . PARTICIPANTS Women ( N=31 ) including 
    Output:
    