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PubMed1997

Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline.

OBJECTIVE: To investigate patient reported prosexual side effects of the aminoketone antidepressant bupropion (INN, amfebutamone) and to compare directly the sexual side effects of bupropion and the selective serotonin reuptake inhibitor (SSRI) antidepressants fluoxetine, paroxetine, and sertraline. METHODS: One hundred seven psychiatric outpatient respondents receiving current treatment with one of the above antidepressants anonymously completed questionnaires that allowed reporting of both decreases and increases in sexual function. The main outcome measures were antidepressant-associated changes in libido, arousal, duration of time from arousal to orgasm, intensity of orgasm, and duration of orgasm relative to that experienced before the onset of the patients' psychiatric illnesses. RESULTS: Bupropion-treated patients reported significant increases in libido, level of arousal, intensity of orgasm, and duration of orgasm beyond levels experienced premorbidly. The three SSRIs to an equal degree significantly decreased libido, arousal, duration of orgasm, and intensity of orgasm below levels experienced premorbidly. Overall, 27% of the SSRI-treated patients had no adverse sexual side effects; in contrast, 86% of patients treated with bupropion had no adverse sexual effects, and 77% of bupropion-treated patients reported at least one aspect of heightened sexual functioning. CONCLUSIONS: SSRI-induced adverse sexual effects appear to be the rule rather than the exception and may be substantially underreported unless patients are specifically asked about the effects of these medications on various aspects of sexual function. In contrast, prosexual effects were reported by the majority of patients treated with bupropion. The findings are reviewed in light of the neurochemistry of these agents and the sexual response.

1-Naphthylamine↗
PubMedDate not supplied

Sex and death: are they related? Findings from the Caerphilly Cohort Study.

OBJECTIVE: To examine the relation between frequency of orgasm and mortality. STUDY DESIGN: Cohort study with a 10 year follow up. SETTING: The town of Caerphilly, South Wales, and five adjacent villages. SUBJECTS: 918 men aged 45-59 at time of recruitment between 1979 and 1983. MAIN OUTCOME MEASURES: All deaths and deaths from coronary heart disease. RESULTS: Mortality risk was 50% lower in the group with high orgasmic frequency than in the group with low orgasmic frequency, with evidence of a dose-response relation across the groups. Age adjusted odds ratio for all cause mortality was 2.0 for the group with low frequency of orgasm (95% confidence interval 1.1 to 3.5, test for trend P = 0.02). With adjustment for risk factors this became 1.9 (1.0 to 3.4, test for trend P = 0.04). Death from coronary heart disease and from other causes showed similar associations with frequency of orgasm, although the gradient was most marked for deaths from coronary heart disease. Analysed in terms of actual frequency of orgasm, the odds ratio for total mortality associated with an increase in 100 orgasms per year was 0.64 (0.44 to 0.95). CONCLUSION: Sexual activity seems to have a protective effect on men's health.

Age Factors↗
PubMed2004

Effects of sexual arousal on lymphocyte subset circulation and cytokine production in man.

OBJECTIVE: Sexual arousal and orgasm induce an increase in sympathetic activity as well as in catecholamine and prolactin plasma concentrations. However, the effects of sexual arousal and orgasm on immune functions in man are unknown. Thus, this study investigated the effects of masturbation-induced orgasm on lymphocyte circulation and cytokine production in healthy young males. METHODS: In a crossover design, 11 volunteers completed an experimental condition in which they were asked to masturbate until orgasm and to participate in a control condition without sexual activity. Blood was drawn continuously for determination of endocrine parameters. In addition, leukocyte and lymphocyte subsets were analyzed via flow cytometry, and the production of lipopolysaccharide-induced interleukin 6 and tumor necrosis factor alpha was measured before and then 5 and 45 min after the orgasm. RESULTS: The results confirmed transient increases in adrenaline and prolactin plasma concentrations. Sexual arousal and orgasm increased the absolute number of leukocytes, in particular natural killer cells (CD3-CD16+CD56+), in the peripheral blood. In contrast, T cell (CD3+) and B cell (CD3-CD20+) subpopulations as well as the production of interleukin 6 and tumor necrosins factor alpha remained unaffected by sexual activity. CONCLUSION: These findings demonstrate that components of the innate immune system are activated by sexual arousal and orgasm.

Adult↗
PubMed1986

Vaginal erotic sensitivity by sexological examination.

We studied vaginal erotic sensitivity by vaginal sexological examinations as part of the evaluation and treatment process of couples complaining of female coital anorgasmia but readily orgasmic at female self--or partner-performed external genital stimulation. The existence on the anterior vaginal wall of an anatomically clearly definable erotically triggering entity, termed "The G Spot", was refuted by our findings. The entire anterior vaginal wall, including the deeper situated urinary bladder, periurethral tissues and Halban's fascia, rather than one specific spot, were found to be erotically sensitive in most of the women examined, and 64% of them learned how to reach orgasm by direct specific digital and/or coital stimulation of this area. All other parts of the vagina had poor erotic sensitivity. This supports our conceptualization of a 'clitoral/vaginal sensory arm of orgasmic reflex' including the clitoris, the entire anterior vaginal wall as well as the deeper situated tissues. Instead of looking for a 'vaginal (coital) orgasm' distinctly different from a 'clitoral orgasm', this concept speaks towards a 'genital orgasm' potentially achievable by separate or, most effectively, combined stimulation of those different trigger components of the genital sensory arm of the orgasmic reflex. The format and technique of the vaginal sexological examination are described, and its possible applications and limitations are discussed.

Adult↗
PubMed2005

Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison.

OBJECTIVE: To examine changes in sexuality after total vaginal hysterectomy (TVH) or transvaginal sacrospinous uterine suspension (SSUS)for uterine prolapse. STUDY DESIGN: One hundred fifty-eight women with moderate to severe uterine prolapse undergoing TVH (78) or SSUS (80) were included in a prospective study from January 2001 to June 2002. All women were <50 years old and sexually active within the last 6 months before surgical intervention. None had major medical disorders. Sexual functioning before and 6 months after surgery was examined via a face-to-face questionnaire. Sexual interest, sexual satisfaction, frequency of sexual intercourse and frequency of orgasm were measured using an analogue scale. RESULTS: Of women undergoing TVH, 5.1% had decreased sexual interest, and 21% had less frequent orgasms postoperatively. For women undergoing SSUS, 13% had decreased sexual interest, and 20% had less frequent orgasms postoperatively. Frequency of orgasm was the only parameter that changed significantly after surgery in the 2 groups. All women with less frequent orgasms said that they were afraid of wound disruption or disease recurrence and so refrained from vigorous or exciting sexual intercourse. About four-fifths of the women in both groups accepted or were satisfied with their sexuality after surgery. For women undergoing TVH, 2.6% had increased frequency of orgasm, and 5% had better overall sexual satisfaction postoperatively. For women undergoing SSUS, 10% had increased sexual satisfaction postoperatively. There was a 2.5% and 2.6% increase in postoperative sexual interest in the SSUS and TVH groups, respectively. The sexual functioning scores were not different before or after surgical intervention in either group. CONCLUSION: There is a decrease in thefrequency of orgasm after both TVH and SSUS. However, there is no significant difference in postoperative sexual functioning between women with and without preservation of the uterus in correcting uterine prolapse.

Adult↗
PubMed1978

Subjective sexual experience in college women.

A random sample of 100 undergraduate women were interviewed about their subjective sexual experience. Sexual sensations during masturbation, oral sex, intercourse, and intercourse with concurrent clitoral massage were summarized and differentiated. Sensations labeled "orgasm" by a majority of the subjects were identified, and the suggestion was made that experiences other than that outlined by Masters and Johnson may be considered orgasmic by women in a more general population. Some support was found for Singer and Singer's typology of orgasm at a subjective level. Most subjects who experienced multiple orgasms found them no more satisfying than single ones. Clitoral and vaginal orgasms may be distinguished subjectively, but no clear preference for one or the other emerged from a consensus of the subjects. Orgasm rate was significantly related (p less than 0.001) to satisfaction during intercourse and oral sex, but not during masturbation. Some evidence was found supporting the role of social learning in developing sensitivity in the clitoris and vagina and possibly the breasts.

Adolescent↗
PubMed1984

Physiologic assessment of sexual response in women: the unfulfilled promise.

With the exception of work by Semmens (1979), the clinical value of physiologic measures of female sexual response has not been demonstrated; it almost seems that controlled attempts to apply measures of vaginal muscular tone or blood flow to clinical settings has been jinxed. Hence, this author takes issue with Hatch (1980), who gives the impression that physiologic measures can now be used in clinical applications. The reasons for failure in sex therapy or biofeedback are uncertain, but it may be useful to speculate briefly. Sexual arousal in women is too personal a phenomenon to be objectively assessed during waking states in an "artificial" laboratory context. Orgasmic response is not related to genital muscle tone, but to other unknown anatomic, learning-history, and psychological components. The circumstances under which there is agreement between physiologic and either psychometric or self-reports of arousal or pleasure are complex and interactive. Therefore, physiologic measures of female sexual response may not reflect the subjective experience of women and, taken alone, may be misleading. This conclusion should not surprise anyone, for human beings are truly a "cognitive" species with representational imagery and language. Sexuality is very much "in the frontal lobes," and what we perceive eroticism to mean in a given context is probably much more important than the physiologic and behavioral aspects of actual sexual expression. Despite these problems of employing physiologic measures of female response in clinical settings, research into more basic issues has been quite profitable and heuristic. For example, several common assumptions about female sexuality are now open to question: women are more arousable just prior to menses; Kegel exercises improve orgasm consistency; sex therapy for inhibited arousal and desire is efficacious; there is usually agreement between the physiologic intensity of sexual response and a patient's subjective estimate of that intensity. On the other hand, there is evidence that vaginal engorgement in women remains at a high level after an initial orgasm, thus setting the physiologic stage for consecutive orgasmic responses; sexual arousal can be measured physiologically with acceptable degrees of reliability and specificity; muscle contractions in women during orgasm can be measured with high levels of precision; women respond to direct representations of erotic activity much the way men do; there are cortical "physiologic" signatures of orgasmic response in men and women. Obviously, a number of clinical research issues in female sexuality can now be investigated with physiologic measures.(ABSTRACT TRUNCATED AT 400 WORDS)

Biofeedback, Psychology↗
PubMed2004

Self-assessment of genital anatomy, sexual sensitivity and function in women: implications for genitoplasty.

OBJECTIVE: To assess the perceptions of healthy women of their genital anatomy and sexual sensitivity, and to provide suggestions for genitoplasty based on this information, as the success of genitoplasty has historically relied upon the surgeon's perception of the patient's anatomy and function, rather than the patient's perception of outcome in terms of appearance and erotic sensitivity. SUBJECTS AND METHODS: Fifty healthy, sexually active, adult women (aged 20-56 years) with no history of genital surgery completed the female version of the Self-Assessment of Genital Anatomy and Sexual Function. This self- report questionnaire comprises written text and images enabling women to rate the appearance, size and position of clitoris and vagina, as well as the intensity of orgasm and effort required for achieving orgasm in specified areas around the clitoris and within the vagina. Anatomical locations were compared for these ratings by repeated-measures analysis of variance. RESULTS: Anatomically, 46% of women described their clitoris as 'moderate-sized and raised', 42% as 'small and raised', and 78% reported that their vaginal opening was adequate for sexual penetration. The women reported the strongest orgasm and least effort to obtain an orgasm with stimulation of the area on and above the clitoris. For vaginal sensitivity, scores for orgasm intensity increased, and for orgasm effort decreased, with increasing vaginal depth, and they indicated less sexual sensitivity for the vagina than for the external genitalia. CONCLUSION: The skin above the clitoris, and the clitoris itself, appeared to be the most sexually sensitive. During genitoplasty, attention to preserving skin-flap integrity in this area seems appropriate.

Adult↗
PubMed2003

Acute neuroendocrine response to sexual stimulation in sexual offenders.

BACKGROUND: Several pharmacotherapeutic approaches have confirmed the influence of neuroendocrine parameters on sexual desire, function, and fantasies in men; however, the relevance of acute neuroendocrine changes in mediating heightened sexual drive remains unknown. We recently demonstrated that plasma prolactin substantially increases following orgasm in healthy men, suggesting a feedback mechanism for peripheral prolactin in the control of acute sexual arousal. Because prolactin appears to play a regulatory role in acute sexual drive, we initiated this study to see whether sexual offenders with a high sexual drive have a different neuroendocrine response to sexual arousal. This study compares the prolactin response to orgasm of sexual offenders with high sexual drive and that of healthy subjects with average sexual drive. METHODS: From a subject pool of 150 inpatients held because of sexual crimes, we recruited 10 volunteers, based on their high sexual drive according to an intensive, semistructured clinical interview. We defined sexual drive by a short refractory period and strong sexualization, or a high frequency of sexual stimulation. We analyzed the acute psychoneuroendocrine response to sexual arousal and orgasm continuously before, during, and after masturbation-induced orgasm in patients and control subjects. RESULTS: Sexual offenders demonstrated higher sexual desire (P < 0.001) and function (P < 0.001) and a more positively perceived refractory period (P < 0.05). Both groups displayed a prolonged, significant increase in prolactin plasma levels after orgasm (P < 0.001). Sexual offenders did not differ from control subjects in neuroendocrine response to sexual arousal and orgasm. CONCLUSIONS: These data demonstrate that sexual offenders with a high sexual drive do not differ from control subjects in the postorgasmic neuroendocrine response, particularly in prolactin release. This study confirms that factors other than peripheral hormones influence deviant sexual behaviour.

Adult↗
PubMed2006

Sexual activity and perceived health among Finnish middle-aged women.

BACKGROUND: An increasing awareness of the need to address sexual and orgasm experiences as part of life quality and an understanding of the great individual differences between women play roles in women's health and medical care across the specialities. Information is lacking as to how negative attitude toward self (NATS) and performance impairment (PI) are associated with sexual activity of middle-aged women. We examined the associations of sexual experience, orgasm experience, and lack of sexual desire with perceived health and potential explanatory variables of NATS and PI. METHODS: Questionnaire was mailed to 2 population-based random samples of menopausal or soon-to-be menopausal women (n = 5510, 70% response) stratified according to age (42-46 and 52-56 years). In multivariate analyses of the associations with the outcome variables, perceived health, NATS, and PI were used as covariates in 6 models in which exercise, menstrual symptoms, and illness indicators were taken into account as well. RESULTS: Sexual activity variables were associated with perceived health. When present, NATS formed associations with sexual and orgasm experiences, whereas strenuous exercise formed associations with orgasm among 42-46-year-old women alone. Strenuous exercise was not associated with orgasm experience among older women. CONCLUSION: NATS and PI are closely tied to orgasm experiences and the meaning of the roles needs to be exposed. Sexual activity deserves to be addressed more actively in patient contact at least with perimenopausal women.

Adult↗
PubMed1988

[A heated controversy--already settled today?].

In the sexuological literature there was a strong argument about the seeming inequality of clitorial or vaginal orgasms for a long time. S. Freud characterized the clitoral orgasm as immature, infantile and noted that it should be transformed into the advanced, truly vaginal orgasm. In contrast, feministically-oriented authors proclaimed the clitoral orgasm the actual, mentally more advanced one. Using a psychological "orgasm test" both hypotheses are verified in a population of 422 orgastically experienced women. The result shows that both clitoral and vaginal orgasms are not differently felt by women. Differently preferred coitus positions, either, are not supposed to have any influence on the orgastic experience of women.

Adult↗
PubMed2001

Measurement of vaginal and minor labial oxygen tension for the evaluation of female sexual function.

PURPOSE: Female sexual dysfunction is a new, rapidly expanding area of sexual medicine. Female sexual arousal disorder may, in part, be due to decreased pelvic blood flow. Therefore, we developed a simple noninvasive reproducible technique to measure vaginal and minor labial blood flow. MATERIALS AND METHODS: The study included 12 healthy young women able to have orgasm through self-stimulation. Observations at orgasm were recorded in the 12 subjects after self-stimulation. Measurements were obtained intravaginally and on the minor labia using a modified Clark oxygen electrode to obtain partial oxygen pressure (pO(2)). RESULTS: Mean basal vaginal value was 3.8 +/- 0.9 mm Hg and mean basal pO(2) on the minor labia was 18.3 +/- 3.7 mm. Hg. As soon as self-stimulation was initiated an increase in oxygen tension occurred and continued during sexual stimulation. Just before orgasm a further increase was noted with peak values measured immediately after the orgasm began (pO(2) 28.6 +/- 3.1 mm Hg intravaginally and 47.3 +/- 4.1 labial). Labial pO(2) measurement decreased relatively rapidly soon after orgasm. The time to return to basal vaginal values after orgasm varied from 20 to 30 minutes. CONCLUSIONS: Previously, changes in female sexual arousal responses have been difficult to evaluate and quantify clinically. We developed a simple noninvasive reproducible technique to measure vaginal and minor labial blood flow. Age based and cycle dependent normograms now can be produced for vaginal and labial blood flow using this method.

Adult↗
PubMed1990

Female ejaculation: perceived origins, the Grafenberg spot/area, and sexual responsiveness.

Despite earlier contrary claims, some researchers have recently reported a possible homologous female prostate gland that is potentially involved in a sudden spurt of fluid being released at the moment of orgasm. A number of medical authorities have speculated that this fluid is urine. To alleviate concerns about the possible release of urine during orgasmic response as well as to contribute to a further understanding of physiological and psychological sexual satisfaction, we examined a series of variables thought to be associated with female ejaculation [(expulsion of fluid during orgasm and its relationship, if any, to a sensitive anatomic area (Grafenberg spot)]. An anonymous questionnaire was distributed to 2350 professional women in the United States and Canada with a subsequent 55% return rate. Of these respondents, 40% reported having a fluid release (ejaculation) at the moment of orgasm. Further, 82% of the women who reported the sensitive area (Grafenberg spot) also reported ejaculation with their orgasms. A number of variables were associated with this perceived existence of female ejaculation.

Arousal↗
PubMed1991

The female sexual response revisited: understanding the multiorgasmic experience in women.

Although it has been almost 20 years since recorded evidence of multiple orgasms among women emerged, there have been few recent investigations of this phenomenon. The purpose of this study was to understand further the female multiorgasmic experience in relationship to the method of stimulatory activity, namely, masturbation, petting, and sexual intercourse. In addition, single-orgasmic and multiorgasmic women were compared by examination of various sexual and orgasmic behaviors, the role of sex partners, and perceptions of physiological and psychological sexual satisfaction. An anonymous 122-item questionnaire was utilized to obtain the responses of 805 college-educated female nurses, chosen for their perceived ability to verbalize data regarding the anatomical structures and physiological processes associated with sexual responsiveness. The findings indicated that 42.7% of the respondents had experienced multiple orgasms and that several significant differences existed between single-orgasmic and multiorgasmic women.

Adult↗
PubMed1998

Serotonin reuptake antidepressant effects on sexual function in patients with anxiety disorders.

BACKGROUND: Serotonin reuptake inhibitor (SRI) antidepressants have been associated with sexual dysfunction, though there have been few prospective reports specifically examining this problem. The purpose of this study was to determine if three SRIs affected sexual function in anxiety disorder patients over a 3-month period. METHODS: Thirty-one patients were enrolled in a prospective study of the effect of three SRIs, fluoxetine, sertraline, and paroxetine, on five aspects of sexual function: libido, erection/lubrication, orgasm quality, orgasm delay, and sexual frequency. Measurements were made at baseline and at each month on visual analogue scales. RESULTS: For men and women, orgasm quality was lower and orgasm delay longer at months one, two, and three compared to baseline (p < .01). Erection scores were lower over time, but this change was not statistically significant. Lubrication, libido, and sexual frequency were not appreciably changed over 3 months. A higher rate of anorgasmia was noted in women at months one and two, but this did not achieve significance. CONCLUSIONS: Orgasm appears to be a primary sexual function affected by SRIs.

1-Naphthylamine↗
PubMedDate not supplied

Clomipramine in the treatment of rapid (premature) ejaculation.

Twenty-three premature ejaculators (PEs) and 11 control subjects were administered 25 mg of clomipramine in a double-blind, placebo-controlled, crossover design study. During 2-week trials, subjects took either the drug or the placebo 4 to 6 hours prior to sexual activity. Daily diary data revealed that, for both groups, orgasmic latency was significantly increased when taking the clomipramine. For the PEs, the average increase in orgasmic latency during intercourse was from less than 1 minute to more than 3.5 minutes. Subjects also participated in two laboratory sessions while on the drug and placebo. During these lab sessions they were exposed to erotic videos with and without the addition of vibrotactile stimulation to the penis. Results from the laboratory data support those from the diaries. Specifically, PEs were significantly less likely to reach orgasm during the lab sessions while on the clomipramine than while on the placebo. Further, they reported a significantly greater sense of control over their orgasm while on the drug. The results of this study, along with previous research, strongly support the value of low doses of clomipramine in the treatment of premature ejaculation, specifically when taken on an as-needed basis as little as 4 hours prior to sexual activity. It is important to note, however, that the beneficial effects of the drug were not uniform across clinical subjects. In this study, those PEs with the shortest orgasmic latencies while on the placebo were the least likely to substantially improve while on the drug. Additional research is necessary to determine whether changes in the timing and dosage of the clomipramine administration can extend the benefits of the drug to those with the shortest latencies.

Adult↗
PubMed1995

Contribution of dihydrotestosterone to male sexual behaviour.

OBJECTIVE: To document the relative importance of endogenous sex steroids in modulating the frequency of orgasms, the dominant aspect of sexual behaviour in healthy eugonadal men. DESIGN: Measurement of adrenal and testicular sex steroids in a sample of army recruits and study of their relation to frequency of orgasms ascertained by questionnaire after potential confounding variables were controlled for. SETTING: Military campus and military hospital laboratories in Athens, Greece. SUBJECTS: 92 consecutively enrolled healthy male recruits aged 18-22 years. MAIN OUTCOME MEASURES: Weekly number of orgasms. Serum concentrations of testosterone, dehydroepiandrosterone sulphate, dihydrotestosterone, oestradiol, oestrone, delta-4-androstenedione, and sex hormone binding globulin. RESULTS: Serum dihydrotestosterone concentration was the only independent hormonal predictor of the frequency of orgasms; an increase in concentration of 1.36 nmol/l (about 2 SD) corresponded to an average increase of one orgasm a week. CONCLUSIONS: Differences in concentrations of circulating dihydrotestosterone within the normal range may represent a major predictor of sexual activity in healthy young men.

Adult↗
PubMed2005

[Sexual dysfunction in female patients with chronic renal insufficiency].

OBJECTIVE: To investigate the prevalence, the main manifestations and related factors of sexual dysfunction in female patients with chronic renal insufficiency (CRI). METHODS: A multi-factor cooperation cross-section study was conducted. The prevalence and severity of sexual dysfunction were assessed using SCASF Microsoft. RESULTS: The prevalence of sexual dysfunction in patients with CRI was higher than that in those without renal insufficiency (P<0.05). The main manifestations in female patients were "decreased libido, lack of orgasm and no feeling of sex pleasure". Stratified analysis on uremia showed that the prevalence and severity of sexual dysfunction of the patients on hemodialysis were similar to those on peritoneum dialysis. The women with kidney allografts suffered less "decreased-libido, lack of orgasm and no feeling of sex pleasure". Multivariate analyses demonstrated that anemia, depression, and the use of beta-blocker were risk factors for decreased libido. Ageing was a risk factor for "lack of orgasm". The use of r-HuEpo was inversely associated with "lack of orgasm". CONCLUSION: Sexual dysfunctions are common in female patients with CRI. The main manifestations are decreased libido, lack of orgasm and no feeling of sex pleasure. The replacement therapy, especially kidney transplantation, could decrease the prevalence or severity of sexual dysfunction. The genesis of sexual dysfunction is multifactorial, including age, physiological factors, psychological factors and medical conditions.

Adult↗