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Regular involvement in PA and its frequency (&amp;lt;1 hour\/week: sedentary, 1\u20133 hours\/week: active, 4\u20136 hours\/week: very active, &amp;gt;6 hours\/week: extremely active) were investigated with a specific question.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>FSDs, including HSDD (Hypoactive sexual desire disorder) and FGAD (Female genital arousal disorder), were diagnosed according to a structured and clinical interview. Participants underwent a physical examination and a clitoral Doppler ultrasound, and were asked to complete the Female Sexual Function Index, Female Sexual Distress Scale-Revised, Body Uneasiness Test, and Middlesex Hospital Questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>At multivariate analysis, women engaging in PA (67.4%, n = 217) scored significantly higher in several Female Sexual Function Index domains - including desire, arousal and lubrication - and showed lower sexual distress and lower resistance of clitoral arteries, as compared to sedentary women. A significant, inverse association between PA and HSDD was observed. Mediation analysis demonstrated that the negative association between PA and HSDD was partly mediated by body image concerns (Body Uneasiness Test Global severity index), psychopathological symptoms (Middlesex Hospital Questionnaire total score) and sexual distress (Female Sexual Distress Scale-Revised score). These latter 2 factors also partly mediated the association between PA and a reduced risk of FGAD, whilst a lower BMI was a full mediator in the relationship between PA and FGAD. Finally, extreme PA was associated with significantly worse scores in several psychosexual parameters (i,e, sexual satisfaction and histrionic\/hysterical symptoms), even compared to a sedentary lifestyle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Women consulting for FSD may gain benefits on desire, arousal, lubrication and sex-related distress from regular PA; however, physicians should remain alert to the downsides of excessive exercise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths &amp; Limitations<\/jats:title>\n                    <jats:p>The main strength lies in the novelty of the findings. The main limitations are the cross-sectional nature, the clinical setting, the small sample size of the different PA groups, and the use of self-reported instruments for the evaluation of PA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>In women with FSD, PA was associated with better sexual function and clitoral vascularization, lower sexual distress and reduced odds of HSDD and FGAD; the benefits of PA on sexuality were mediated by both psychological and organic determinants; excessive PA was related with a poor overall sexual function and with a low sexual satisfaction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.jsxm.2021.04.004","type":"journal-article","created":{"date-parts":[[2021,6,5]],"date-time":"2021-06-05T04:37:54Z","timestamp":1622867874000},"page":"1217-1229","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":28,"title":["Physical Activity and Female Sexual Dysfunction: A Lot Helps, But Not Too Much"],"prefix":"10.1093","volume":"18","author":[{"given":"Elisa","family":"Maseroli","sequence":"first","affiliation":[{"name":"Department of Experimental Clinical and Biomedical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Rastrelli","sequence":"additional","affiliation":[{"name":"Department of Experimental Clinical and Biomedical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"},{"name":"Andrology, Women\u2019s Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Di Stasi","sequence":"additional","affiliation":[{"name":"Department of Experimental Clinical and Biomedical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Cipriani","sequence":"additional","affiliation":[{"name":"Department of Experimental Clinical and Biomedical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Scavello","sequence":"additional","affiliation":[{"name":"Department of Experimental Clinical and Biomedical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Todisco","sequence":"additional","affiliation":[{"name":"Andrology, Women\u2019s Endocrinology and Gender Incongruence Unit, Azienda Ospedaliero-Universitaria Careggi , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Gironi","sequence":"additional","affiliation":[{"name":"Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Castellini","sequence":"additional","affiliation":[{"name":"Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdo","family":"Ricca","sequence":"additional","affiliation":[{"name":"Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Sorbi","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Fambrini","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felice","family":"Petraglia","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Department of Biomedical, Experimental and Clinical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Maggi","sequence":"additional","affiliation":[{"name":"Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences \"Mario Serio\", University of Florence , , Florence , Italy"},{"name":"I.N.B.B. 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