[Proceedings: Marital conflicts and their psychosomatic effects].
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Adult↗
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Results for “Sexual Dysfunction, Physiological”
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[Proceedings: Psychogenesis and therapy of functional sexual disorders].
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Female↗
Sexual rehabilitation in a cancer center: diagnosis and outcome in 384 consultations.
A program of sexual rehabilitation in a cancer center evaluated 308 men and 76 women, using a structured interview. The site of the malignancy was pelvic or genital in 79% of men and 58% of women. Most patients (73%) had one or two sessions of sexual counseling, but therapy was more intensive for about a quarter of patients. Partners were included in counseling by 28% of women and 56% of men. Although cancer patients and spouses of patients reported similar rates of sexual dysfunction before cancer diagnosis, after cancer treatment husbands and wives of patients maintained stable sexual function, while dysfunctions increased dramatically in all categories except premature ejaculation for patients. Patients who were older or had pelvic/genital tumors were more likely to develop arousal-phase sexual dysfunctions. Psychological distress was correlated with rates of low sexual desire and dyspareunia in both men and women. The success of treatment in reversing sexual dysfunction was rated by the therapist in 118 cases. Patients who were younger, who were not clinically depressed, and who had less conflicted marriages had more positive outcomes. Good outcome was also associated with a longer duration of treatment.
Adult↗
Sexual function following restorative proctocolectomy in women.
PURPOSE: This study was undertaken to identify the incidence and type of sexual dysfunction experienced by women after undergoing restorative proctocolectomy. METHODS: A questionnaire was sent to 262 females who underwent restorative proctocolectomy by a single surgeon from 1984 to 1993. The response rate was 35 percent (92/262). Additional information was gained from our pelvic pouch data base. Mean follow-up was 43 (6-130) months. RESULTS: Following surgery, a significant increase was found in vaginal dryness, dyspareunia, pain interfering with sexual pleasure, and limiting of sexual activity because of concerns of stool leakage. There was no significant change in sexual desire, arousal, sensitivity, frequency of intercourse, or satisfaction with sexual relationship. CONCLUSION: Potential sexual dysfunction following restorative proctocolectomy in women merits discussion in preoperative counseling with the patient.
Adult↗
[Psychotherapy for sexual dysfunctions and desire disorders].
Sexual problems do not always require specific psychotherapy. If missing or wrong sexual information is the main cause, sexual counselling can be sufficient. We define "sex-psychotherapy" as the methods which are based on Masters and Johnson as well as other symptom-focused and experience- oriented (exercise) psychotherapeutic methods for sexually disturbed couples and singles. These methods have significantly improved the treatment of sexual dysfunctions. In group- and in couple-settings they have proven to be effective in reducing sexual symptoms and improving sexual satisfaction and partnership-satisfaction. Long-term studies showed that sex-psycho- therapy leads to a stable improvement in sexual satisfaction, whereas the reduction of sexual symptoms is less stable. Therefore sex-psychotherapy should be combined with "relapse-prevention" methods. A number of sexual disorders are caused by psychological and organic factors; they need both psychotherapy and medical treatment. This is of special importance in elderly men and in women with symptoms of dyspareunia.
Humans↗
[Sexuality and pharmacotherapy. Medication-induced disorders of sexual response and pharmacotherapeutic options for the treatment of sexual dysfunctions].
This contribution addresses two different areas of the complex relationship between pharmacotherapy and sexual function and dysfunction in men and women. As many impairments of sexual function are caused by side effects of medications, particularly psychotropic drugs, the first part of the paper describes substances and mechanisms often related to sexual dysfunction with a special focus on antidepressants and neuroleptics. While serotonin reuptake inhibitors entail a high risk of sexual dysfunction, it is often difficult to differentiate the negative impact of the drug from the impairment caused by the mental disorder itself. Ways to deal with these dysfunctions and remedial measures are discussed. In the second section, current pharmacological treatments for female and male sexual dysfunctions are reviewed. While there is no approved pharmacotherapy with established efficacy for female sexual dysfunction with the possible exception of the transdermal testosterone patch for surgically menopausal women, effective pharmacological therapies are available for male erectile disorders. In addition, testosterone substitution is the treatment of choice for hypoactive sexual desire disorders caused by hypogonadism. As sexual dysfunctions are often caused by a mixture of psychological and organic factors, treatment strategies combining pharmacological options and sex therapy are advocated.
Combined Modality Therapy↗
[Sexual dysfunctions from a neuropsychiatric perspective].
Sexual dysfunctions are widespread and have an enormous effect on quality of life. To understand them, it is necessary to look at both somatic and psychosocial factors, especially those concerning partnership. Psychiatric and neurologic disorders play an important role. Normally, treatment consists of qualified sex counseling and, if necessary, intensive sex therapy. Somatic treatment options exist as well.
Humans↗
[The impact of spinal cord injury on sexuality and reproduction].
Spinal cord injury is known to have a major impact on human sexual function. The disturbances depend on the level and completeness of the lesion. The majority of people affected by spinal cord injury are young and in their reproductive years. In these cases sexuality reflects an important aspect of personality, and therefore special attention needs to be given to this issue during rehabilitation. Sexual rehabilitation encompasses both comprehensive information and consultation as well as diagnosis and treatment of disturbed sexual functions. Successful rehabilitation and integration depend also on restoration of sexual function or adequate therapy of sexual dysfunction. This review will consider the present knowledge about the impact of spinal cord injury on female and male sexual function, the currently available treatment options as well as the aspects of fertility and reproduction in this patient population.
Female↗
[Sexual disorders in the aging male].
Sexual dysfunction in the aging male has only recently found widespread attention. As apposed to enduring conceptions of "asexual" elderly, recent representative surveys show that the majority of men maintain sexual wishes and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing morbidity. Sexual dysfunctions in aging result from physical, psychological, partner-related changes and lifestyles. These should be considered in the diagnosis and treatment of sexual dysfunctions in the aging male.
Adolescent↗
[Diagnosis and therapy of sexual disorders. An interdisciplinary challenge].
In view of the changes in moral values as a consequence of sexual liberation, the high incidence of sexual dysfunction and the existence of effective pharmacological treatment for erectile dysfunction, sexual disorders should be a common issue in the medical practice. This is, however, not the case. A reason could be that physicians are not prepared to talk about sexuality in a clinical setting. Moreover, clinical practice reveals that to focus simply on "fixing the function" could fail the needs of the patient and his or her partner.
Algorithms↗
Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey.
The purpose of the study was to evaluate practice patterns of members of the American Urogynecologic Society (AUGS) with respect to female sexual dysfunction (FSD). A brief self-administered survey of 20 questions was mailed to 966 physician members of the AUGS in the United States of America and Canada; 471 surveys were returned (49% response rate). The majority of responders see urogynecology (19%) or urogynecology and general gynecology patients (43%). Sixty-eight percent of physicians were familiar with questionnaires to assess FSD; however, only 13% said they use these for screening purposes. Most said they believed screening for FSD was somewhat (47%) or very important (42%). Despite having these beliefs, only 22% of the responding physicians stated they always screen for FSD, while 55% do so most of the time and 23% admitted they never or rarely screen. Similar results were obtained regarding screening following urogynecologic surgery. Several barriers to screening for FSD existed, the most common being lack of time. The majority of respondents (69%) underestimated the prevalence of FSD in their patient population. Finally, although more than half of responders had received post-residency training in urogynecology (59%), 50% of them stated the training with respect to FSD was unsatisfactory, while only 10% were satisfied. Overall, many urogynecologists do not consistently screen for FSD, underestimate its prevalence, and feel they received unsatisfactory training.
Attitude of Health Personnel↗
Sexual function in patients presenting to a urogynecology practice.
The purpose of this study was to evaluate sexual function in women referred to a urogynecology practice. All new patients were mailed an optional female sexual function index (FSFI) in conjunction with their history forms; other sexual function information was obtained during the physician interview. Over 6 months, four hundred fifty new patients were enrolled. Of these, 243 (54%) were not sexually active. Reasons listed for sexual inactivity included partner problems/no partner (32%), low desire (14%), prolapse (10%), and pain (10%). There were several differences between sexually active and non-sexually active participants; however, after a multivariate analysis, only age, marital status, and stage/grade 1-2 of prolapse remained significant. One hundred nine sexually active patients completed the FSFI; the majority was sexually active two to four times per month. Female sexual dysfunction was noted in 70 (64%) patients. Lowest scores were noted for the domain of desire, followed by arousal, orgasm, lubrication, satisfaction, and pain. Reduced frequency of intercourse was the only factor significantly associated with dysfunction. Ninety-four percent were not embarrassed by the survey. Overall, sexual inactivity is common in patients presenting for urogynecologic care. Those that are sexually active report low rates of sexual activity and high rates of sexual dysfunction. Most sexually active patients will accept a sexual function questionnaire as part of their routine assessment.
Adult↗
Retarded ejaculation in men: an overview of psychological and neurobiological insights.
Disorders of orgasm and ejaculation are erroneously mixed up in the DSM-IV classification system. Male Orgasmic Disorder to denote "delayed ejaculation" is inadequate as orgasm and ejaculation represent clinical expressions of different neurobiological phenomena. Unfortunately, the DSM-IV criteria for delayed ejaculation were accepted regardless of any research with appropriate methodology and design. The psychological approach and associated psychotherapy to solve this problem is rather disappointing. The neurobiological approach, which started with animal studies, has demonstrated various neurotransmitters with the potency to inhibit ejaculation. Indeed, several experimental drugs have been tested in rats, showing the successful acceleration of ejaculation. We propose that human research should start with the development of an operational definition of delayed ejaculation. To achieve this goal, we propose unselected epidemiological stopwatch studies which also provide information on the prevalence and incidence of delayed ejaculation in men. Currently, no effective and safe drugs are available to accelerate ejaculation time in men. The best way to treat lifelong delayed ejaculation is, thus far, to inform the patients about biological and psychological inhibiting factors which they need to avoid, and to remain critical about unrealistic expectations from psychotherapy. Psychotherapy may be useful in subgroups, particularly in the absence of effective and safe drugs.
Animals↗
The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study.
The aims of the study were to determine the prevalence of sexual dysfunction, its subtypes and associated risk factors in women with chronic pelvic pain (CPP) as compared to a general female population. We evaluated 112 women (mean age 34.73 +/- 8.07; age range 18-50) complaining of CPP with a comprehensive history including female sexual function index (FSFI) and several general assessment questions (GAQs), a complete physical examination and routine laboratory tests. A group of 108 healthy women (mean age 33.28 +/- 7.95; age range 19-52) without CPP were enrolled as cross-sectional controls. According to the general population, the incidence of female sexual dysfunction (FSD) was 67.8% in women with CPP and 32.2% in women without CPP (P < 0.0001). Among 112 CPP patients, 78 (69.6%) of them had FSD and 34 (30.4%) patients did not have FSD in the study (P < 0.0001). In that 78 patients, 42 patients (53.8%) had hypoactive sexual desire disorder, 26 patients (33.3%) had sexual arousal disorder, 17 patients (21.7%) had orgasmic disorder and finally 58 patients (74.3%) had sexual pain disorder. The FSFI scores in both groups were as follows: (patients vs. controls; median value; P value, respectively): desire: 3.31 versus 3.98 (P < 0.0001); arousal: 3.58 versus 4.35 (P < 0.0001); lubrication: 4.20 versus 4.88 (P < 0.0001); orgasm: 3.70 versus 4.48 (P < 0.0001); sexual satisfaction: 3.80 versus 4.64 (P < 0.0001); sexual pain: 2.75 versus 4.98 (P < 0.0001) and total FSFI score: 21.35 versus 27.29 (P < 0.0001). The prevalence of FSD was higher in women with CPP than in a general healthy population not complaining of CPP. Investigation of female sexuality was essential for these patients.
Adolescent↗
Sexual function in men and women after anterior surgery for chronic low back pain.
Sexual dysfunction after anterior lumbar fusion has mainly been focused on male biological function (retrograde ejaculation). The aim of the present study is to assess the effect of fusion surgery for chronic low back pain on the sex-related quality of life. Apart from routine prospective questionnaires, additional gender-specific mailed questionnaires produced retrospective data on sexual enjoyment and function after 2 years of follow-up. Patients randomised to non-surgical treatment and anterior or posterior fusion were compared. We found that surgically treated patients had a significantly better sex life than those non-surgically treated. The improved sex life was significantly associated with the reduced back pain. The improvement after anterior fusion, however, was counteracted by a trend towards disturbed orgasm and genital sensation in women, and a significant disturbance of ejaculation and genital sensation in men. In view of the increased frequency of anterior lumbar surgery with the strong promotion of disc replacement, the findings in the present small retrospective pilot study should be tested in larger prospective trials.
Adult↗
Sexual dysfunction in women: population based epidemiological study.
Sexual dysfunction is defined as a disturbance of the processes that characterise the sexual response cycle or as pain associated with sexual intercourse. The objective of this epidemiological study, conducted in a representative sample of the population of women aged 20 and older in Casablanca, Morocco, is to determine the prevalence of sexual dysfunction in women. Criteria of sexual dysfunction followed classification by DSM-IV. The mean age of the sample (n = 728) was 36.76 +/- 12.67 years; 29% had no education, 78% pursued no professional activity; and 58% were married. The main results were that 26.6% had sexual dysfunction always or often during the 6 months before the study. The most common finding was hypoactive sexual desire disorder, and age, financial dependency, number of children, and sexual harassment were positively associated. The prevalence of remaining disorders resembled that found in the literature. Even though these women were aware about their disorder and its negative impact on their lives, only 17% of them asked for help.
Adult↗
Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision.
PURPOSE: This study was designed to investigate how the quality of life of patients with rectal cancer changes with time after laparoscopic total mesorectal excision. METHODS: Patients completed the Medical Outcomes Study Short Form 36 and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and a colorectal-specific European Organisation for Research and Treatment of Cancer quality of life questionnaire before laparoscopic total mesorectal excision, on discharge from the hospital and at 3, 6, and 12 months postoperatively. Patients were treated by laparoscopic low anterior resection or laparoscopic abdominoperineal resection. RESULTS: Fifty-one patients (mean age, 64 years; 29 males (57 percent)) participated in this study, of whom 38 (75 percent) underwent laparoscopic low anterior resection and 13 (25 percent) laparoscopic abdominoperineal resection. Compared with preoperative scores on the Medical Outcomes Study Short Form 36, patients reported a deterioration in physical functioning (74 vs. 80; P = 0.009), and improved mental functioning (76 vs. 70; P = 0.007) at three months. Improvement in emotional well-being was reported both on the Medical Outcomes Study Short Form 36 (78 vs. 53; P = 0.006) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (84 vs. 69; P < 0.001). At one year, improvements in global quality of life (82 vs. 68; P = 0.001) and symptoms, such as fatigue (18 vs. 32; P < 0.001), pain (5 vs. 12; P = 0.009), and appetite loss (3 vs. 13; P = 0.01), were reported. Sexual functioning was worse from three months onward until one year after surgery (47 vs. 66; P = 0.004). Patients who underwent low anterior resection experienced less sexual dysfunction than patients after abdominoperineal resection (21 vs. 56; P = 0.004). CONCLUSIONS: One year after laparoscopic total mesorectal excision for rectal cancer, patients reported improvement in some important quality of life outcomes, including global quality of life, despite a decrease in sexual functioning.
Adult↗
Erectile and ejaculatory problems in gay and heterosexual men.
The prevalence of erectile difficulties (ED) and problems with rapid ejaculation (RE) were studied in a convenience sample of gay men (n = 1379) and an age-matched sample of heterosexual men (n = 1558). ED was reported more frequently by gay men and RE more frequently by heterosexual men. The heterosexual men were more likely to be in exclusive relationships and those in a current relationship (exclusive or non-exclusive) were more likely to report ED than those not in a relationship. Heterosexual men in an exclusive relationship were more likely to report RE than the rest. These associations were not found in the gay sample. The following personality traits were assessed as possible predictors of ED and RE: sexual inhibition proneness (SIS1 and SIS2), sexual excitation proneness, impact of mood on sexuality, and trait measures of depression and anxiety. Age and SIS1 (inhibition due to threat of performance failure) were strong predictors of ED in both gay and heterosexual men. Gay men scored higher on SIS1 whether or not they reported ED, consistent with greater concerns about performance failure in gay men. Anxiety was predictive of RE, but only in the heterosexual men. If replicated in other samples, these differences may reflect a greater importance of erectile function in the sexual lives of gay men and greater importance of ejaculatory control in heterosexual relationships.
Adult↗