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PubMed1996

Impact of Bariatric Surgery on Body Image Perception and Sexuality in Morbidly Obese Patients and their Partners.

BACKGROUND: This study was undertaken to determine whether surgery for morbid obesity affects sexual attitudes and performance in patients and their partners. METHODS: Questionnaires concerning sexuality were sent to 94 patients who underwent gastric restriction procedures and their partners. Twenty-eight patients at least 1 year postoperatively (range of 1-11 years, mean 4.2 years +/- 3.24 SD) and 16 of their partners responded. The blinded questionnaires addressed the enjoyment and frequency of sexual intercourse, orgasms, body image, number of partners, abuse, sexual problems and masturbation. Comparisons were made before and after surgery. Patient answers were compared with their partners. RESULTS: Preoperatively, 64% of patients stated that they enjoyed sexual intercourse. Postoperatively, 50% of patients and 78% of partners stated that they enjoyed sex more. Improved orgasms were noted by 44% of patients and 40% partners after surgery. Improvement in body image was also achieved. Only 27% of patients felt they were attractive before surgery, while 80% felt they were more attractive after surgery; 94% of their partners agreed. While 48% of patients undressed in darkness in front of their partners before surgery, only 27% did so after surgery. CONCLUSIONS: Weigh loss attained though bariatric surgery improves body image and sexuality. Sexual intercourse and orgasms are improved postoperatively both for patient and partner.

Journal Article↗
PubMed2004

Sexual dysfunction after conventional and endovascular AAA repair: results of the DREAM trial.

PURPOSE: To assess sexual function in the first postoperative year after elective endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA). METHODS: In the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, 153 patients (141 men; mean age 71 years, range 53-85) were randomly allocated to EVAR (n=77) or OR (n=76). Sexual functioning was evaluated preoperatively and at 5 times in the first postoperative year (3, 6, 13, 26, and 52 weeks) using a questionnaire derived from the Medical Outcomes Study. The proportions of patients reporting sexual dysfunction for any of 5 aspects (interest, pleasure, engagement, orgasm, and erection) and any increase in the magnitude of dysfunction were compared between EVAR and OR. RESULTS: Preoperatively, the proportion of patients reporting sexual dysfunction in at least 1 aspect was 66% for the OR group and 74% in the EVAR group (p=NS). Surgery had a clear impact on sexual dysfunction. The proportion of patients reporting sexual dysfunction on at least 1 aspect increased to 79% in the OR group and 82% in the EVAR group. The magnitude of sexual dysfunction increased in both groups on all 5 aspects at 3 weeks postoperatively, but this was more pronounced in the OR group (interest: OR p=0.038 vs. EVAR p=0.071; pleasure: OR p=0.009 vs. EVAR p=0.065; engagement: OR p=0.006 vs. EVAR p=0.054; orgasm OR p=0.023 vs. EVAR p=0.112, and erection: OR p=0.046 vs. EVAR p=0.030). At 6 weeks, the OR group still reported a significant increase in 3 aspects (pleasure p=0.031, engagement p=0.010, and orgasm p=0.003), whereas the EVAR group no longer showed a significant difference. From 3 months on, both groups had returned to baseline. CONCLUSIONS: EVAR and open elective AAA repair both have an impact on sexual function in the early postoperative period. After EVAR, recovery to preoperative levels is faster than after open repair, but at 3 months, sexual dysfunction levels are similar in both groups.

Aged↗
PubMed2004

[Sexual function in males undergoing liver transplantation].

BACKGROUND: Sexual dysfunction is very common in liver transplantation candidates. Our objective is to determine the sexual life quality of males before and after liver transplantation. METHODS: Questionnaire was sent to 56 males over 18 years of age with at least six-month survival after orthotopic liver transplantation. The self-administered questionnaire contained 15 questions with 5 or 6 alternatives to determine the male sexual function which may be divided into 5 domains: 1) erectile function; 2) orgasmic function; 3) sexual desire; 4) intercourse satisfaction; and 5) overall satisfaction with sexual life. Each answer received a score. Domains scores were computed by summing the scores for individual answers and they were compared before and after the liver transplantation. RESULTS: Twenty-five patients answered the questionnaire completely. All 5 sexual function domains improved after liver transplantation. The score of the erectile function increased from 21.12 +/- 8.07 to 26.52 +/- 5.22 (p=0.004), of the orgasmic function from 7.28 +/- 3.05 to 9.36 +/- 1.47 (p=0.008), of the sexual desire from 6.64 +/- 2.58 to 8.68 +/- 1.35 (p=0.005), of intercourse satisfaction from 9.16 +/- 3.83 to 12.52 +/- 2.65 (p<0.0001) and of overall satisfaction from 7.12 +/- 2.64 to 9.24 +/- 1.65 (p=0.002). CONCLUSIONS: Sexual dysfunction is common in males with severe chronic liver disease and liver transplantation improves all sexual function domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction.

Adult↗
PubMed2002

Sexuality and quality of life after hematopoietic stem cell transplantation.

BACKGROUND: The quality of sexuality is significantly affected by physical changes following hematopoietic stem cell transplantation (HSCT) and the dissatisfied and/or dysfunctional sexuality may cause deterioration in the quality of life (QOL). METHODS: With two models of questionnaires, we interviewed thirty-eight patients who remained in the disease-free status after HSCT and had sex partners, to assess: 1) the changes in sexuality, 2) QOL in physical, psychological, social and spiritual domains and 3) the correlation between sexuality and QOL. RESULTS: The common physical changes that may affect sexuality in women were secondary amenorrhea (69.2%), loss of sexual interest (53.8%), diminished vaginal secretion (50%), menopausal syndrome (34.6%), dyspareunia (30.8%) and failure to orgasm (23.1%), while men complained of impotence (41.7%) and difficulty in ejaculation (16.7%). For sexuality, satisfaction of sexual activity, attainment of orgasm and frequency of intercourse decreased significantly after HSCT as compared with the pre-transplant levels. A score measuring, QOL after HSCT marked 5.91 on a full score of 10; social domain ranked the lowest (5.01) while physical domain the highest (6.70). Among the items of sexuality, only sexual desire was significantly correlated with QOL; satisfaction, orgasm and frequency were not significantly correlated with QOL. CONCLUSION: Although sexuality is affected by the physical changes following HSCT, we should not overlook the psychological and social effects on the sexuality of post-transplant patients. Therefore, educational and counseling programs are very important to restore and improve their sexuality.

Adult↗
PubMed1997

Double-blind comparison of bupropion sustained release and sertraline in depressed outpatients.

BACKGROUND: A sustained-release formulation of bupropion (bupropion SR), developed with an improved pharmacokinetic profile to permit less frequent dosing than the immediate-release form, has not been evaluated in active comparator trials. This randomized, double-blind, parallel-group trial was conducted to compare the efficacy and safety of bupropion SR and sertraline. METHOD: Outpatients with moderate to severe major depressive disorder (DSM-IV) received bupropion SR (100-300 mg/day) or sertraline (50-200 mg/day) for 16 weeks. Psychiatric evaluations, including the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Clinical Global Impressions scale for Severity of Illness (CGI-S), and for Improvement (CGI-I) were completed, and adverse events were assessed in the clinic periodically throughout treatment. Patients' orgasm function was also assessed. RESULTS: Mean HAM-D, HAM-A, CGI-I, and CGI-S scores improved over the course of treatment in both the bupropion SR group and the sertraline group; no between-group differences were observed on any of the scales. Orgasm dysfunction was significantly (p < .001) more common in sertraline-treated patients compared with bupropion SR-treated patients. The adverse events of nausea, diarrhea, somnolence, and sweating were also experienced more frequently (p < .05) in sertraline-treated patients. No differences were noted between the two treatments for vital signs and weight. CONCLUSION: This double-blind comparison of bupropion SR and sertraline demonstrates that bupropion and sertraline are similarly effective for the treatment of depression. Both compounds were relatively well tolerated, and orgasm dysfunction, nausea, diarrhea, somnolence, and sweating were reported more frequently in sertraline-treated patients.

1-Naphthylamine↗
PubMed2001

Comparison of sexual dysfunction in male schizophrenic patients maintained on treatment with classical antipsychotics versus clozapine.

BACKGROUND: Antipsychotic treatment is frequently associated with sexual dysfunction. The objective of the present study was to evaluate and compare sexual function and behavior in male schizophrenic patients who regularly take either classical neuroleptic drugs or the prototypical atypical antipsychotic agent, clozapine. METHOD: Participants included 60 schizophrenic male patients (DSM-IV criteria); 30 maintained on treatment with classical antipsychotics and 30 on treatment with clozapine. The patients were evaluated with a detailed 18-item sexual function questionnaire. RESULTS: Both groups reported sexual dysfunction, although scores were significantly higher, indicating better functioning, in the clozapine-treated group in the domains of orgasmic function (number of orgasms per month, p = .037; frequency of orgasm during sex, p = .046), enjoyment of sex (p = .013), and sexual satisfaction (p = .0004). Equivocal results were obtained for the desire parameters. CONCLUSION: Maintenance therapy with the atypical neuroleptic clozapine may be associated with a lesser degree of sexual dysfunction than the classical antipsychotics in male outpatients with chronic schizophrenia.

Adult↗
PubMed2003

The neurophysiology of the sexual cycle.

The cycle of sexual activity in men and women occurs in 4 phases--excitation, plateau, orgasm, resolution--which are guided by sexual desire. Male sexual activity is characterized by erection, seminal emission and ejaculation (orgasm), whereas female sexual activity is characterized by vaginal lubrication, erection of the clitoris and orgasm. These responses are under the control of numerous central and peripheral neural systems. The central supraspinal systems are mainly localized in the limbic system (olfactory nuclei, medial preoptic area, nucleus accumbens, amygdala, hippocampus etc.), in the hypothalamus and its nuclei (paraventricular and ventromedial nuclei). Neural information travels through the brain stem, the medulla oblongata, the spinal cord and the autonomous nervous system to the genital apparatus. While we have very detailed knowledge of the neural mechanism, which controls the function of the male and female genital organs, in particular those mediating erection, very little is known of the central mechanism involved. Nevertheless, several neurotransmitters and neuropeptides, such as dopamine, glutamic acid, nitric oxide, oxytocin, ACTH-MSH peptides, are known to facilitate sexual function, while serotonin, gamma-aminobutyric acid (GABA) and opioid peptides reduce it. At the level of the paraventricular nucleus a group of oxytocinergic neurons projecting to extra-hypothalamic brain areas, including the spinal cord, have been identified, which facilitate erectile function and copulation when activated and reduce both when inhibited. Although the majority of results, which have clarified the mechanisms involved, have been performed in males, it is believed that similar mechanisms are also operative in females.

Central Nervous System↗
PubMedDate not supplied

Sexual dysfunction, Part II: Diagnosis, management, and prognosis.

BACKGROUND: Sexual problems are common but infrequently diagnosed. They are classified into four major categories: (1) sexual desire disorders, (2) sexual arousal disorders, (3) orgasmic disorders, and (4) sexual pain disorders. METHODS: MEDLINE files from 1966 to the present were searched using the specific sexual dysfunctions as key words along with the general key word "sexual dysfunction" to review the published literature. Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: The key to diagnosis often rests on the physician's willingness to raise the issue with patients. A rational protocol can be followed to identify causative organic and psychogenic factors using the psychosexual and medical history, a comprehensive physical examination, psychological assessment instruments, laboratory tests, and special procedures. Current psychological treatment includes one or more of the following components: sensate focus exercises, cognitive-behavioral therapy, relaxation training, hypnosis and guided imagery, and group therapies. Specific techniques, such as directed self-stimulation, the stop-start and squeeze techniques, the sexological examination, systematic desensitization, and Kegel exercises, are added therapy when appropriate. Marital therapy to improve communication and resolve conflict is also part of standard therapy. Medical management can include pharmacologic agents to correct endocrine dysfunctions or to alter the progression of the sexual response. Surgical management can involve arterial revascularization, venous ligation, and penile implants. A noninvasive vacuum constriction device is also used to treat erectile disorders. The long-term prognosis of the sexual dysfunctions varies with the type of disorder and its causes. Generally good results (80 to 95 percent satisfaction) are obtained when treating vaginismus, dyspareunia, male erectile disorders, and female orgasmic dysfunctions. Long-term results are modestly successful (40 to 80 percent) when treating inhibited male orgasm and premature ejaculation. Long-term success is poorest at present for treating sexual desire disorders.

Clinical Protocols↗
PubMed1987

Sexual complications after abdominoperineal resection.

The sexual activity was studied in 28 males and 18 females, one year after abdominoperineal resection for low rectal carcinoma, using a questionnaire. Sexual desire, potentia coeundi and ejaculation, capacity for orgasm and sexual satisfaction in the male, and sexual desire, possibility of vaginal coitus, dyspareunia, orgasm capacity and sexual satisfaction in the female were analyzed. Among the female patients (18 cases), sexual desire was judged to be decreased in 77.77% (15 cases) and decreased capacity for orgasm occurred in 5.5% (1 case). Loss of sexual satisfaction and dyspareunia were present in 44.4% (8 cases) and 33.6% (6 cases) respectively. Among the male patients (28 cases), sexual desire decreased in 75% (21 cases), incomplete erection but sufficient for copulation occurred in 17.85% (5 cases), such as retrograde ejaculation in 10.71% (3 cases) and no ejaculation in 7.14% (2 cases) and impotentia coeundi in 25% (7 cases). In couples that reported a satisfying sexual activity, the first coitus occurred 6 months after surgery (range: 4 to 15 months). In no case was there separation of the couple after surgery.

Adult↗
PubMed1999

Sexual functioning in depressed outpatients taking mirtazapine.

OBJECTIVES: One-third of patients with untreated depression have sexual difficulties manifested by decreased libido, erectile dysfunction or delayed ejaculation. This dysfunction may be exacerbated by stimulation of post-synaptic serotonin 5HT2 receptors, a side-effect of most widely-used antidepressant medications, especially the selective serotonin reuptake inhibitors (SSRIs). Mirtazapine is an atypical antidepressant with alpha 2 adrenergic antagonist and serotonin 5-HT2 and 5-HT3 receptor-blocking activity. In theory, it should not worsen and perhaps may improve sexual function. This pilot study investigated sexual functioning and antidepressant activity in depressed patients taking mirtazapine. EXPERIMENTAL DESIGN: Twenty-five (F = 18, M = 7) sexually active adult outpatients with a DSM-IV-diagnosis of major depressive episode entered a 12-week, flexible-dosing, open-label pilot study. The Arizona Sexual Experiences Scale (ASEX) assessed sexual functioning and the Hamilton Depression Rating Scale (HAM-D) assessed depressive symptoms on a bimonthly basis. PRINCIPAL OBSERVATIONS: Desire, arousal/lubrication, and ease/satisfaction of orgasm improved (by 41%, 52%, and 48%, respectively) in the depressed women. In men, desire, arousal/erection, and ease/satisfaction of orgasm also improved (by 10%, 23% and 14%, respectively) but much more modestly. HAM-D, Clinical Global Impression (CGI) Sheehan Disability Scale (SDS), and Symptom Checklist-90 (SCL-90) scores improved in both groups. There was a 50% dropout rate among women before six weeks of treatment. However, the ASEX and HAM-D scores of the groups terminating before and after six weeks of treatment showed similar rates of improvement. CONCLUSIONS: Mirtazapine has a beneficial effect on sexual functioning in both depressed women and men. Longer-term double-blind research assessing sexual function during the administration of mirtazapine as well as other antidepressants is recommended.

Adult↗
PubMed1978

Group vs. couple treatment of sexual dysfunctions.

Results of a study comparing the effectiveness of two formats for treating men with premature ejaculation and their female partners with orgasmic dysfunctions are described. In one treatment format, a couple was treated by a male and female cotherapy team once a week for 12 sessions. In the second treatment format, which also consisted of 12 weekly sessions, three or four couples were treated simultaneously in a group led by a cotherapy team. The five couples treated alone and the ten couples treated in the group format all received a standardized therapy program consisting of sex education, attitude restructuring, and specific suggestions for acquiring ejaculatory control for the men and an increased range of orgasmic response for the females. The results showed significant improvement for couples in both treatment formats. The group format initially showed a slight tendency toward more rapid progress than did the couple format, but by the 2-month follow-up there were no significant differences. The study demonstrates that couple group treatment is a cost-effective means for treating common male and female sexual problems.

Adult↗
PubMed1983

Estimating the duration of sexual behavior: a laboratory analog study.

Estimate of male orgasm latency, a common parameter of the sex history, is hypothetically subject to retrospective distortion. This investigation attempted to assess the degree and direction of the distortion using a laboratory analog procedure. Groups of sophomore medical students were shown a movie depicting a couple engaging in continuous foreplay and coitus. About half were asked to estimate the length of the foreplay and coitus periods in minutes. The other half were required to judge whether time periods were average, below average, or above average in duration for people of their own age. Subjects tended to overestimate the length of the coitus period in the film, but not the foreplay period. Females tended to estimate both periods as significantly longer than males. Nearly half of the group judged the foreplay period to be average, and over 60% judged the coital period to be average. Less than 23% thought that the coital period was below average. Married subjects tended to regard both time periods as above average, compared to single subjects. A possible inference from this investigation is that the mean young adult male orgasm latency is probably in the range of 2-3 minutes.

Adult↗
PubMed1990

Attitudinal and experiential correlates of anorgasmia.

Twenty-four orgasmic and 10 anorgasmic women, ages 21-40, provided continuous self-report measures of sexual arousal while viewing explicit videotape segments depicting a variety of sexual activities. They also completed several questionnaires designed to assess sexual attitudes, knowledge, and guilt. As compared to the orgasmic women, the anorgasmic women reported (i) greater discomfort in communicating with a partner regarding only those sexual activities involving direct clitoral stimulation, (ii) more negative attitudes toward masturbation, (iii) greater endorsement of sex myths, and (iv) greater sex guilt. Contrary to expectations, the groups failed to differ significantly on either the frequency of use of any of the sexual activities depicted or on arousal to viewing these activities. The theoretical and clinical implications of these findings are explored.

Adult↗
PubMed1980

Thermographic measurement of sexual arousal: a methodological note.

A thermographic measure of sexual arousal in terms of the four stages of sexual stimulation (excitement phase, plateau phase, orgasm phase, and resolution phase) articulated by Masters and Johnson (1966) is described. A male and female masturbated to orgasm; the results are presented in terms of interpretations of both the thermographic image and the quantitative temperature profile. Possible future research applications are suggested, including sexual dysfunctions, sexual arousal, and gender differences.

Arousal↗
PubMed1986

Sexual experience and drinking among women in a U.S. national survey.

A 1981 national survey of 917 women provided rates of major sexual experiences and dysfunctions for the entire sample and across alcohol abstention/consumption categories. Most women drinkers (heavier drinkers most often) reported that drinking lessens sexual inhibition and helps them feel close to others; only 8% reported becoming less particular in sexual partner choice, 22% more sexually assertive, but over half (60%) had been targets of other drinkers' sexual aggression. On a sexual dysfunction index combining lifetime lack of sexual interest, lifetime lack or low frequency of orgasm with a partner, and vaginismus, moderate drinkers scored significantly lower than lighter and heavier drinkers. The heaviest drinking women had the highest rates of lifetime sexual disinterest and lack of orgasm with a partner. "Temporary abstainers" (who drank in the past 12 months but not the last 30 days) also had elevated sexual dysfunction rates, particularly those with substantial drinking histories. Several nontraditional sexual behaviors were correlated with heavier drinking, which was also related to morally liberal sexual attitudes. The study's findings may show the effects of a generalized moral value framework in which one large portion of the nation's population, especially females, is subject to pervasive proscriptions of behavioral, including their drinking and sexuality, while others vary in the freedom they find to drink and be sexual. More suppressed traditional sexuality occurs more frequently with lighter drinking and abstention, as is also true of sexual dysfunction. At heavier drinking levels suppressed and dysfunctional sexuality and heavy drinking may be both cause and consequence in a vicious circle, sometimes escaped by temporary or lasting abstention.

Alcohol Drinking↗
PubMed1989

The effect of chronological and theoretical birth order on sexual attitudes and behaviors.

A survey designed to evaluate the impact that both chronological and theoretical birth order may have on sexual attitudes and behaviors was completed by 441 respondents (221 male, 220 female). The attitudes and behaviors investigated were aggressive sexual behavior, social relationship attitudes, emotional relationship attitudes, total heterosexual behavior, and total orgasmic behavior. The data revealed no difference between male and female in terms of total sexual behavior. However, males had significantly higher sexual aggression, social attitudes, emotional attitudes, and total orgasm scores. These results suggest that while there may be equity between the sexes in terms of heterosexual behavior, there are still significant differences between the sexes in terms of specific behaviors and attitudes. No differences were found on any of the scales based on either chronological or theoretical birth order. These results suggest that sexual behavior and attitudes may be influenced to a greater degree by biological and cohort factors than by sibling position.

Adolescent↗
PubMed1994

[Total and subtotal hysterectomy--psychosexual aspects].

Surgery on genital organs is taken with anxiousness and leads generally to a temporary impairment of sexual function. Sexual life after hysterectomy is possible. Intercourse, sexual desire and orgasmic capacity are as a rule not negatively changed and in a great part even improved. Through discussion (during pre-operative consultancy and at the time of discharge and follow-up examinations) that also deals with the sexual function, lasting or chronic sexual disturbances can be largely avoided. The incidence of psychosomatic disturbances which also influence sexual behavior is then under 10%: they are projected onto the operation and have intra-psychic or psycho-social roots that are independent of it. A certain method of hysterectomy cannot have any decisive significance with regard to the capacity to experience sexual pleasure. An all-too-local/genital approach deflects us from our understanding of the orgasm, as the latter is a central experience in which extra-genital and, above all, psychological factors also play an important part.

Adaptation, Psychological↗
PubMed2006

The effect of mode of delivery on postpartum sexual functioning in primiparous women.

The objective of this paper is to evaluate the effect of mode of delivery on postpartum sexual functioning in primiparous women. A total of 248 primiparous women were recruited into this study. One hundred fifty-six delivered spontaneously with mediolateral episiotomy and 92 had elective cesarean section. Sexual function was evaluated by the Female Sexual Function Index, a validated questionnaire separately evaluating desire, lubrication, orgasm, satisfaction, and pain. Subjects were questioned relating their pre-pregnancy experiences during the first antenatal visit when the pregnancy was not more than six gestational weeks. The test was repeated 6 months postpartum. Statistical evaluation was carried out by SPSS for Windows v.11. In the vaginal delivery with mediolateral episiotomy group, there were significant decreases in the scores 6 months after delivery when compared to scores before pregnancy (p<0.001). In the cesarean section group, no difference was observed between pre-pregnancy and postpartum scores (p>0.05). When the two groups were compared, there was a significant difference between 6 months postpartum scores (p<0.001). Not only pain, but also other important aspects of sexual function, such as arousal, lubrication, orgasm, and satisfaction are affected by performing mediolateral episiotomy during vaginal delivery, well beyond the puerperal period. Concerning its effects on postpartum sexual functioning, a policy of restricting mediolateral episiotomy use should be adopted.

Adolescent↗