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PubMed1996

Sexual arousal and the quality of semen produced by masturbation.

The influence of sexual arousal on the quality of semen produced by masturbation was investigated. One group of 29 patients referred to our andrology outpatient clinic (group A) and one group of 14 healthy potential sperm donors filled out a questionnaire after having produced two semen samples, at least 1 month apart, by masturbation. Changes in questionnaire scores between first and second visit were compared with changes in semen characteristics between those two occasions to identify statistically significant correlations. A second group of 23 subfertility patients (group B) were asked to produce a semen sample by masturbation in a designated room at the hospital without additional sexual stimulation, and a second sample while viewing a sexually explicit video. Differences in questionnaire scores and semen characteristics obtained with visual erotic stimulation (VES) and without VES were analysed. In group A, the change in sexual arousal and change in intensity of orgasm correlated with change in semen volume (r = 0.38, P < 0.05; r = 0.48, P < 0.01 respectively). In healthy donors and group B, however, no such correlation was found. With VES in group B, significantly higher scores were given for 'feeling at ease/relaxed' (P < 0.01), 'sexual arousal' (P < 0.001), 'quality of erection' (P = 0.01), 'intensity of orgasm' (P < 0.05), 'satisfaction after orgasm' (P < 0.05), and 'ease with which orgasm was achieved' (P < 0.001) with VES compared to without VES. There was no statistically significant improvement in semen quality with VES compared to without VES. It is concluded that sexual arousal has no significant influence on the quality of an ejaculate produced by masturbation. On the other hand, providing a patient with a sexually stimulating video is obviously a facilitative factor when the patient 'has to' produce a semen sample for analysis. The use of visual erotic stimulation is recommended when patients and donors have to produce a semen sample in the university surroundings of a fertility clinic.

Erotica↗
PubMed2006

Sexual dysfunctions and blood hormonal profile in men with focal epilepsy.

PURPOSE: To evaluate the incidence of sexual dysfunction in men with focal epilepsy and to establish their hormonal profiles. METHODS: We prospectively analyzed sexual functions and hormone blood levels in 40 male patients (age ranged from 18 to 44 years, with an average age of 27.6+/-5.6 years) with refractory focal epilepsy. We used the Czech version of the structured questionnaire entitled International Inventory of Erectile Function (IIEF) to assess the patients' sexual functions. The subscales of this questionnaire separately evaluate erectile function (IIEF I), orgasmic function (IIEF II), sexual desire (IIEF III), intercourse satisfaction (IIEF IV), and overall satisfaction with sex life (IIEF V). In all of the patients, the following blood tests were performed: quantitative assessment of blood levels of prolactin (PRL), total testosterone (total-T), free androgen index (FAI), sexual hormone-binding globulin (SHBG), estradiol (E2), dehydroepiandrosterone sulfate (DHEAS), progesterone (PRG), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). All these quantitative laboratory data were correlated with other clinical variables and with the results of the IIEF. chi2 and Wilcoxon tests were used for the statistical analysis. A p-value<0.05 was considered to be statistically significant. RESULTS: At least one of the types of sexual dysfunction, as defined by IIEF (IIEF I, II, and III), was found in 22 (55%) of the 40 patients (55%). Erectile dysfunction (IIEF I) was found in six (15%) of 40 patients, orgasmic dysfunction (IIEF II) in six (15%) of 40 patients, and loss of sexual desire (IIEF III) in 16 (40%) of 40 patients. According to other subscales of IIEF, 22 (55%) of 40 patients were not satisfied with sexual intercourse (IIEF IV), and 20 (50%) of 40 patients were not satisfied with their sex livee (IIEF V). None of the subscales of IIEF was significantly correlated with the age of the patients or with the duration of epilepsy. In patients with at least one of the sexual dysfunctions (IIEF I, II, and III), we found a statistically significant increase of FSH and SHBG, and a decrease of DHEAS and FAI in comparison with those in the patients with normal sexual functions. In patients with erectile dysfunction, we found the same changes and a significant increase of E2. In patients with orgasmic dysfunction, we found a statistically significant decrease of DHEAS. In patients with dysfunction of sexual desire, we noticed a significant increase of SHBG and a decrease of DHEAS and FAI. All patients with orgasmic dysfunction were being treated with carbamazepine (CBZ) in monotherapy or combination therapy. In patients with at least one type of sexual dysfunction (IIEF I, II, and III), we found a higher proportion of valproate treatment in monotherapy or combination therapy in comparison with CBZ. CONCLUSIONS: Our study showed a relatively high incidence of sexual dysfunction and dissatisfaction with sexual intercourse and sex life, as defined by the IIEF I-V questionnaire, in men with refractory focal epilepsy. The most frequent dysfunction in these patients is the impairment of sexual desire. However, our study indicates some specific hormonal changes related to various types of sexual dysfunction that are not related to antiepileptic drug treatment.

Adolescent↗
PubMed2004

Bladder and sexual function among women with multiple sclerosis.

OBJECTIVE: Genitourinary dysfunction is common in women with multiple sclerosis (MS), yet few studies have evaluated the association between bladder and sexual dysfunction in these women. The aim of this study was to determine factors, including demographic and bladder function, associated with sexual dysfunction in a sample of women with MS. METHODS: One hundred and thirty-three women with MS completed questionnaires related to overall heath status, bladder function and sexual function. Response frequencies and percentages were calculated for questionnaire responses. Multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Sixty-one per cent of the sample indicated that they had a problem with bladder control. Forty-seven per cent of respondents indicated that their neurological problems interfered with their sex life. Over 70% of the sample reported that they enjoyed, felt aroused and experienced orgasm during sexual activity. Not having a sexual partner and the indication of bothersome neurological problems were the best predictors of sexual dysfunction. Interestingly, patients bothered by their urge incontinence had higher levels of orgasm compared to women not bothered by urge incontinence. CONCLUSIONS: Although over half of the women reported voiding symptoms, most still enjoyed, felt aroused and could experience orgasm. Neurological symptoms and lacking a sexual partner emerged as the best predictors of sexual dysfunction. Urge incontinence may not be a risk factor for an orgasm. Our findings elucidate the complex nature of sexual dysfunction in women with MS.

Adult↗
PubMed2003

Effects of acute prolactin manipulation on sexual drive and function in males.

The neuroendocrine response to sexual activity in humans is characterized by a pronounced orgasm-dependent increase of plasma levels of prolactin. In contrast to the well-known inhibitory effects of chronic hyperprolactinemia on sexual drive and function, the impact of acute prolactin alterations on human sexual physiology is unknown. Therefore, this study was designed to investigate the effects of acute manipulation of plasma prolactin on sexual behavior. Ten healthy males participated in a single-blind, placebo-controlled, balanced cross-over design. Prolactin levels were pharmacologically increased to high levels (protirelin, 50 micro g i.v.) or reduced to low physiological concentrations (cabergoline, 0.5 mg p.o.). Sexual arousal and orgasm were then induced by an erotic film and masturbation. In addition to continuous neuroendocrine and cardiovascular recordings, the quality and intensity of the acute sexual drive, arousal, orgasm and refractory period were assessed by extensive psychometric measures. Administration of cabergoline decreased prolactin levels and significantly enhanced all parameters of sexual drive (P<0.05), function (P<0.01) and positive perception of the refractory period (P<0.01). Administration of protirelin increased prolactin concentrations and produced small, but not significant reductions of sexual parameters. The sexual effects observed from cabergoline were completely abrogated by coadministration of protirelin. Although different pharmacological sites of action of prolactin-altering drugs have to be considered, these data demonstrate that acute changes in prolactin plasma levels may be one factor modulating sexual drive and function. Therefore, besides a neuroendocrine reproductive reflex, a post-orgasmic prolactin increase may represent one factor modulating central nervous system centers controlling sexual drive and behavior. These findings may offer a new pharmacological approach for the treatment of sexual disorders.

Adult↗
PubMed1994

[Coital anorgasmia in marriage].

Out of a sample of 2,425 gynecological patients aged 21-40 and married for at least one year, three groups were selected according to the frequency of coital orgasm. The first group contained 1,266 (52.2%) orgastic women, the second group included 172 (7.1%) patients who did not reach orgasm during coitus, and the third group consisted of 55 (2.3%) patients whose absent orgasms were felt by the examinees as distressing. Significant differences were found between the three groups concerning family environment and childhood, level of education and professional standing, sexual development and life, and in the incidence of psychopathological symptoms. It appears that the absent capacity of women to attain orgasm in sexual intercourse is caused by several factors of both biological and psychosocial nature.

Adult↗
PubMed1993

Sexuality after hysterectomy: a factor analysis of women's sexual lives before and after subtotal hysterectomy.

OBJECTIVE: To study the effect of subtotal hysterectomy on a woman's sexuality. METHODS: One hundred four women were interviewed 1 month before and 1 year after surgery. Data concerning their sexuality before and after the operation were evaluated using a multivariate method. RESULTS: Half of the women reported improvement in their sexuality after surgery and 21% reported deterioration. There were only small changes in sexual variables: Frequency of cyclicity of sexual desire was reduced, coital frequency increased, and frequency of desire, frequency of orgasm, and multiplicity of orgasm were unchanged for the entire series. The best predictive factors for sexuality after surgery were presurgical coital frequency, cyclicity of arousability, frequency of desire, and frequency of orgasm. Multiplicity of orgasm, cyclicity of desire, and attitude to the sexual partner also correlated with postoperative sexuality. Preoperative deep dyspareunia had a small influence, although 83% (48 of 58) with deep dyspareunia experienced relief after the operation. Preoperative deterioration of desire and coital activity had no correlation to sexuality after surgery. CONCLUSION: Preoperative sexual activity is more important in predicting postoperative sexuality than is the occurrence of dyspareunia or deterioration of sexual activity because of uterine disease.

Adult↗
PubMed2003

Erectile function after open or endovascular abdominal aortic aneurysm repair.

Open abdominal aortic aneurysm repair has been reported to be associated with impairment of sexual function in men, most likely because of autonomic nerve injury and pelvic blood flow changes. Endovascular aneurysm repair does not involve dissection in the area of the iliac bifurcation and therefore may be associated with lower incidence of sexual dysfunction as compared to open repair. We conducted a retrospective study of males after open and endovascular abdominal aortic aneurysm repair to determine if there is a significant difference in the incidence of sexual dysfunction between the two procedures. A modified International Index of Erectile Function Questionnaire was used to access sexual function before and after aneurysm repair. The questionnaire was mailed to all male patients who underwent abdominal aortic aneurysm repair from January 1, 1999 to July 15, 2002. The questionnaire asked patients questions regarding their sexual function before and 3 months after the repair. Questionnaire scores for domains of sexual function (erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction) as well as the total questionnaire score were analyzed. The chi-square and Wilcoxon's signed ranks test were used for statistical comparisons, with p < 0.05 considered significant. Logistic regression was used to examine association. Two hundred ninety-three questionnaires were mailed and 90 were returned completed. There was no difference for the total questionnaire score or the erectile function score before the procedure. Based on the questionnaire score, erectile function worsened after open AAA repair ( p = 0.002). Orgasmic function also deteriorated after open AAA repair ( p = 0.001). Endovascular repair was not accompanied by decreased erectile or orgasmic function ( p = 0.057 and p = 0.068, respectively). Impairment of erectile function was not associated with age, diabetes, or the number of patent hypogastric arteries after aneurysm repair, but there was a significant association between impaired erectile function and open aneurysm repair ( p = 0.036). Endovascular repair of abdominal aortic aneurysms is associated with significantly less impairment of erectile and orgasmic function than that with open repair. Preservation of sexual function after endovascular as compared to open repair should be among the factors considered when weighing treatment options for an abdominal aortic aneurysm in a sexually active male.

Aged↗
PubMed2005

Prevalence of female sexual dysfunction symptoms and its relationship to quality of life: a Japanese female cohort study.

OBJECTIVES: To clarify the age prevalence of female sexual dysfunction and the factors that contribute to the varying frequency of sexual intercourse and satisfaction with sexual life in Japanese women. METHODS: Of 8956 participants (median age 57 years, range 17 to 88) in a Japanese female cohort study, 5042 (56.3%) responded. We evaluated 2095 women aged 30 to 69 years (median 48) who completed a questionnaire that queried about their sexual life. RESULTS: When women in their 30s were compared with those in their 60s, we found that the prevalence of the symptom of orgasmic disorder, sexual desire disorder, arousal disorder, and lubrication disorder had increased significantly from 15.2% to 32.2%, 27.7% to 57.9%, 29.7% to 57.9%, and 12.5% to 51.2%, respectively. Multivariate analysis showed that the rigidity of the partner's erection, orgasm, and arousal contributed significantly to sexual frequency and foreplay and orgasm to satisfaction with sexual life. CONCLUSIONS: The prevalence of female sexual dysfunction increased with age. The results of multivariate analysis indicated that favorable sexual function is important to maintain the opportunity for sexual intercourse in both men and women and that foreplay and orgasm are essential for satisfactory sexual life in women.

Adult↗
PubMed2005

Cross-sectional analysis of sexual function after prostate brachytherapy.

OBJECTIVES: To assess sexual function after prostate brachytherapy and compare outcomes in different age groups. METHODS: This cross-sectional study consisted of 96 sexually active patients (mean age 64 years) who underwent iodine-125 seed implantation between 1997 and 2003 to treat early-stage prostate cancer (Stage T1-T2). Patients completed a questionnaire adapted from the validated Rand 36-Item Health Survey and the University of California, Los Angeles, Prostate Cancer Index. RESULTS: The median follow-up was 2.5 years (range 3 months to 6.2 years). The mean value for sexual function was 54.8. The mean score for erectile function was 55.0, and the mean score for the ability to reach orgasm was 54.0. No significant relationship was found between sexual function and time since treatment (P = 0.9897). Pain on orgasm was reported after brachytherapy by 38 patients (40%) and hematospermia by 16 patients (17%). A negative correlation was observed between pain on orgasm and time since treatment (P = 0.021), but no significant relationship was found between hematospermia and time since treatment (P = 0.427). A significant difference in sexual function was observed between patients younger than 60 years and patients older than 60 years (66.3 +/- 7.0 versus 47.7 +/- 7.2; P = 0.002). CONCLUSIONS: A large variation in sexual potency is present after brachytherapy with no significant relationship to the time since treatment. Age is an indicator of sexual function after brachytherapy, with younger patients experiencing less sexual dysfunction than older patients. Other aspects of sexual function (pain on orgasm, hematospermia) are also significant side effects of brachytherapy and must be considered in the treatment decision for low-risk prostate cancer.

Aged↗
PubMed2000

Does hypertension and its pharmacotherapy affect the quality of sexual function in women?

Considerable research has been conducted into the effects of antihypertensive drugs on male sexual functioning. This remains underexplored in women, even though almost half of treated hypertensives are women. An ambulatory medical record-based, case-control study was designed to study sexual function in treated and untreated hypertensive women and healthy controls. We conducted this study at a teaching hospital with satellite clinics in upstate New York. Of 3312 medical records reviewed, 640 premenopausal white women with or without mild hypertension (defined as blood pressure [BP] > or = 140/90 and < 160/110 mmHg), in heterosexual relationships, with no other significant medical history, were eligible. Of these, 241 women agreed to participate, and 224 (35%) completed both a self-administered questionnaire and a telephone interview. Analysis was conducted on 211 women (107 healthy controls, and 104 mild hypertensives, of whom 37 were unmedicated and 67 medicated). Questions on sexuality were classified into seven composite variables and later further divided. There were no demographic differences between participants and nonparticipants. Cases and controls differed only by age (P < .01); therefore, subsequent analysis was age-adjusted. Current smokers reported a significantly lower mean score for orgasm than did nonsmokers (P = .04). Women with unmedicated and medicated hypertension did not differ significantly on sexuality scores and were subsequently combined. Using age-adjusted ANOVA, women with hypertension reported significantly decreased lubrication and orgasm and increased pain compared to nonhypertensive women. There were no significant differences by ANOVA in the quality of sexual functioning between six treatment groups. In conclusion, the quality of female sexual functioning was quantified in an ambulatory outpatient setting. Hypertensive women, regardless of type of treatment, reported age-adjusted decrease in vaginal lubrication, less frequent orgasm, and more frequent pain when compared to nonhypertensive women. Emotional aspects of sexual functioning in hypertensive women do not appear to be impaired. These areas require further investigation. An incidental finding indicated diminished orgasm reported in current smokers, compared to nonsmokers, which was not associated with age or hypertension.

Adult↗
PubMed2004

[Female sexual dysfunction: a systematic overview of classification, pathophysiology, diagnosis and treatment].

Sexual dysfunction is defined as "disturbances in sexual desire and in the psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty". The female sexual response cycle consists of three phases: desire, arousal, and orgasm. Various organs of the external and internal genitalia, e.g. vagina, clitoris, labia minora, vestibular bulbs, pelvic floor muscles and uterus, contribute to female sexual function. During sexual arousal, genital blood flow and sensation are increased. The vaginal canal is moistened (lubrication). During orgasm, there is rhythmical contraction of the uterus and pelvic floor muscles. Within the central nervous system, hypothalamic, limbic-hippocampal structures play a central role for sexual arousal. Sexual arousal largely depends on the sympathetic nervous system. Moreover, nonadrenergic/noncholinergic neurotransmitters (NANC), e.g. vasoactive intestinal polypeptide (VIP) and nitric oxide (NO), are involved in smooth muscle relaxation and enhancement of genital blood flow. Furthermore, various hormones may influence female sexual function. Estrogen has a significant role in maintaining vaginal mucosal epithelium as well as sensory thresholds and genital blood flow. Androgens primarily affect sexual desire, arousal, orgasm and the overall sense of well-being. The internationally accepted classification of female sexual dysfunction consists of hypoactive sexual desire disorders, sexual aversion disorders, sexual arousal disorders, orgasmic disorders and sexual pain disorders. Vascular insufficiency, e.g. due to atherosclerosis, and neurologic diseases, e.g. diabetic neuropathy, are major causes of sexual dysfunction. Additionally, sexual dysfunction may be due to changes in hormonal levels, medications with sexual side effects or of psychological origin. For the diagnosis of female sexual dysfunction, a detailed history should be taken initially, followed by a physical examination and laboratory studies. Physiologic monitoring of parameters of arousal potentially allows to diagnose organic diseases. Recordings at baseline and following sexual stimulation are recommended to determine pathologic changes that occur with arousal. Duplex Doppler sonography, photoplethysmography or the measurement of vaginal and minor labial oxygen tension may help to evaluate genital blood flow. Moreover, measurements of vaginal pH and compliance should be performed. Neurophysiological examination, e.g. measurement of the bulbocavernosus reflex and pudendal evoked potentials, genital sympathetic skin response (SSR), warm, cold and vibratory perception thresholds as well as testing of the pressure and touch sensitivity of the external genitalia, should be performed to evaluate neurogenic etiologies. Medical management of female sexual dysfunction so far is primarily based on hormone replacement therapy. Application of estrogen results in decreased pain and burning during intercourse. The efficacy of various other medications, e.g. sildenafil, L-arginine, yohimbine, phentolamine, apomorphine and prostaglandin E1, in the treatment of female sexual dysfunction is still under investigation.

Adult↗
PubMed1995

Different patterns of sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured interview of schizophrenic and neurotic patients and methadone-substituted opiate addicts.

Little is known about sexual dysfunctions associated with psychiatric disorders and psychopharmacological treatment. In the present study schizophrenic patients (n = 45, mostly under neuroleptic treatment), neurotic patients (n = 50, mostly treated without medication), methadone-substituted opiate addicts (n = 37), and normal controls (n = 41) were included. They were interviewed with the aid of a sex-differentiated semistructured questionnaire on sexual function. All the methadone-substituted opiate addicts and nearly all the schizophrenic patients suffered from dysfunctions in at least one criterion. The three clinical groups differed significantly from the controls in sexual interest, emotional arousal, physiological arousal (erectile function/vaginal lubrication), performance (ejaculatory function/vaginism, dyspareunia), and orgasm satisfaction. Characteristic patterns of dysfunction were found in the male patients. The schizophrenic patients had significantly more dysfunctions of interest, physiological arousal, performance, and orgasm than the controls. Emotional arousal, erectile and ejaculatory functions, and orgasm satisfaction were impaired more frequently in the male schizophrenics than in the neurotic patients. Reduced sexual interest, emotional arousal, and orgasm satisfaction were reported more frequently by the methadone-substituted opiate addicts than by the neurotic men. Emotional arousal was even more frequently reduced than in the schizophrenic men. There was no correlation between sexual dysfunction and particular neuroleptics or neuroleptic or methadone dosage. The results are compared with the literature and suggestions made for further investigations.

Adult↗
PubMed1977

Sexual enhancement groups for dysfunctional women: an evaluation.

Three groups of women with sexual dysfunction were evaluated pretreatment and posttreatment. Two of the groups (mixed sexual dysfunctions and primary orgasmic dysfunction) did not involve partner participation, while the third group (mixed sexual dysfunctions) included partners on two occasions. Results for all groups were similar. Of the 16 women involved, 14 became reliably orgasmic through self-stimulation. Generalization of orgasm to partner stimulation or coitus was less reliable. Although partner presence did not enhance behavioral outcome measures, highly significant findings were achieved in terms of enhanced marital and sexual satisfaction. The question of whether orgasm through coitus alone is a reasonable goal is raised and challenged.

Adult↗
PubMedDate not supplied

Prevalence of sexual dysfunction in women seeking services at family planning centers in Tehran.

In the present study, a modified standardized sexual function questionnaire, along with a test of knowledge about and attitude toward sexuality, was administered to 300 healthy women, ages 16 through 53, who sought services at family planing centers in Tehran, Iran. All participants were married. The greatest percentages had two children (35%) and were housewives (69%). Some 72% were well educated, and 1% were illiterate; 74% of the women had moderate knowledge about sexuality, and 53% had a conservative attitude toward sexuality. The study revealed the prevalence of inhibited desire (15%), inhibited orgasm (26%), lack of lubrication (15%), vaginismus (8%), and dyspareunia (10%); 38% of the women had at least one sexual dysfunction. The most common sexual difficulties reported were "too little foreplay before intercourse" and "partner chooses inconvenient time" (8% each). Despite these difficulties, 51% of the sample reported that their overall sexual relationship was satisfactory. Knowledge about sexuality was significantly correlated with orgasm experience, higher knowledge being associated with more orgasm experience. There were significant correlations between attitude toward sexuality and sexual function (orgasm, desire, lubrication); a conservative attitude was associated with more sexual dysfunction. Spousal sexual dysfunction had a significant negative correlation with sexual function in the woman.

Adolescent↗
PubMed1976

Psychological characteristics of women with sexual inhibition (frigidity) in six clinics.

Traditional psychiatric thought has equated the inability of a female to obtain an orgasm (particularly a vaginal orgasm during intercourse) with psychological maladjustment. The research literature generally does not support this position. The present paper describes the psychological characteristics of 44 frigid women who applied for treatment of their sexual problem at two university hospital sex clinics and 26 women selected for treatment by the same criterion, but treated in private practice. Presented for comparison are 53 female neurotics from a Temple University Hospital psychotherapy study, a sample of 65 consecutive female walk-ins of mixed psychiatric diagnosis from the Psychiatric Outpatient Clinic of Temple Hospital, and a group of 35 female college student sophomores from Temple University who comprised the normal sample. A battery of psychological tests including the MMPI, the Institute for Personality and Ability Testing--Self-Evaluation Form (IPAT), the Symptom Check List, and the Eysenck Personality Inventory were given to each group. The data indicate that female patients who apply to a sex dysfunction clinic, complaining primarily of sexual inhibition, appear as a group identical to a normal control group in terms of their psychological profile and less neurotic than psychiatric outpatients, with the exception that the normals were less depressed. When women with primary orgasmic dysfunction from the above three samples were combined and compared to those with secondary orgasmic dysfunction (using Masters and Johnson's criterion), the groups were identical, at least from a global psychological perspective. We suggest that little else can be gained by assessing global personality characteristics. Without discarding the primary and secondary classifications a potentially more fruitful approach would be to develop instruments that would measure specific dimensions, such as sexual misinformation, specific sexual anxiety or guilt, or resentment or hostility directed toward the immediate sexual partner. A scale to measure specific phobic-like sexual anxiety, in addition, would have treatment implications because of the recently demonstrated effectiveness of specific anxiety-reducing techniques, such as systematic desensitization. Specific scales can also be useful in the assessment and prediction of outcome in psychotherapy.

Adolescent↗
PubMed2005

Seminal monolateral nerve-sparing radical prostatectomy in selected patients.

INTRODUCTION: In recent years there has been a shift in prostate cancer stage with the majority of patients nowadays being operated with cT1c disease, prostate-specific antigen levels of <10 ng/ml, and a decreased rate of seminal vesicle invasion. Recent data suggest the role of preservation of the seminal vesicle in improving continence and/or potency. We describe our preliminary experience with seminal-sparing, unilateral nerve-sparing retropubic radical prostatectomy. PATIENTS AND METHODS: 21 selected patients with clinically localized prostate cancer underwent seminal unilateral nerve-sparing retropubic radical prostatectomy (seminal-sparing group, SSG). We compared the postoperative continence, erectile function and quality of orgasm results to those obtained in a control group (CG) of 21 patients who underwent unilateral nerve-sparing radical prostatectomy. Sexual function was evaluated preoperatively and 9 months postoperatively with the 5-item International Index of Erectile Function (IIEF-5) questionnaire and with other self-administered questionnaires. The quality of orgasm was evaluated 9 months postoperatively. RESULTS: 1 month postoperatively, 95 and 28% of the patients in the SSG and CG were continent (p<0.001). The median postoperative drop in IIEF-5 score was 5 points in SSG and 14.5 points in CG (p<0.0001). Nine months postoperatively, 90 and 62% of the patients in SSG and CG, respectively (p=0.05), maintained the ability to achieve orgasm. CONCLUSIONS: In our experience seminal-sparing radical prostatectomy showed good feasibility and improved early postoperative urinary continence, erectile function and quality of orgasm, without compromised cancer control.

Aged↗
PubMed2003

Female sexual dysfunction: potential for pharmacotherapy.

The act of sex includes a woman's sexual self and self-image, intimate relationships, family, society and culture. The complexities of her environment, sexual and partner history, past relationships, mental health status, current medical problems and hormonal status all play a role. An interdisciplinary consensus conference panel expanded the former Diagnostic and Statistical Manual of Mental Disorders-IV classifications of female sexual dysfunction to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders that cause personal distress. The US FDA Guidance paper details the recommendations for the clinical development of drugs for the treatment of female sexual dysfunction. In this document, great emphasis is placed on orgasm as a clinical trial endpoint and it would appear that satisfactory sexual intercourse is of secondary importance to the Agency. However, there is no evidence to suggest that the majority of women correlate their sexual enjoyment and satisfaction with numbers of orgasms or even the likelihood of orgasm during a given sexual interaction. Nonetheless, any drug coming through the regulatory agency in the US will need to follow these recommendations. Currently, there are six major pharmaceutical therapeutic paths being pursued for treatment of female sexual disorders and/or postmenopausal symptoms. These include dopaminergic agonists and related substances, melanocortin-stimulating hormones, adrenoceptor antagonists, nitric oxide delivery systems, prostaglandins, and androgens. A number of compounds that target these pathways are undergoing development for female sexual dysfunction. The array of pharmacological agents that are being developed for female sexual dysfunction must prove to be efficacious and have a good safety profile at a time when there are increasing worries that hormonal replacement with estrogen and progestogens are not safe. It is unclear if any of these pharmaceutical pathways will prove to be both safe and effective for the treatment of female sexual disorders; however, studies investigating this area will provide important scientific data for the future.

Animals↗
PubMed2005

Sexual problems of urban women in Croatia: prevalence and correlates in a community sample.

AIM: To asses the prevalence and correlates of female sexual problems in a community sample in the Croatian capital of Zagreb. METHOD: The study was based on a self-administered postal survey of 1,170 women 20-60 years old, living in Zagreb. The return rate was 48% (n=547). Participants not sexually active in the last month (n=119), and those who self-identified as homosexual or bisexual (n=31), were excluded from the analyses. The final sample consisted of 384 women. The average age of participants was 38.2 years. Four categories of sexual problems were addressed: inhibited sexual desire, inhibited sexual arousal, inhibited orgasm, and sexual pain disorders. RESULTS: Of the heterosexual women sexually active in the last month, 33.8% experienced sexual problems, with inhibited orgasm being the most frequent problem. Comorbidity was recorded among 10.7% of the participants. Older age was positively related to inhibited desire (beta=0.11, P=0.05) and inhibited arousal (beta=0.25, P=0.002), whereas it was negatively related to inhibited orgasm and sexual pain disorders (beta=-3.73, P=0.001 and beta=-6.98, P=0.01, respectively). Length of relationship was positively related to inhibited desire (beta=1.17, P=0.016). Religious morality was positively related to inhibited desire, inhibited arousal, and sexual pain disorders (beta=0.43, P<0.001, beta=0.52, P=0.001, and beta=0.11, P=0.044, respectively). Intimate communication was negatively related to inhibited desire, inhibited arousal, and inhibited orgasm (beta=-2.18, P<0.001, beta=-2.67, P<0.001, and beta=-0.21, P=0.003, respectively); and body image was negatively related to inhibited arousal and sexual pain disorders (beta=-1.17, P=0.026 and beta=-0.38, P=0.042, respectively). CONCLUSION: Sexual health disturbances among urban Croatian women are frequent. Their prevalence calls for incorporating sexual health issues in the national public health agenda. Multifaceted character of sexual problems is important for adult sexuality education and counseling.

Adult↗