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PubMed1992

Sexual function in men after radical cystectomy with or without urethrectomy.

Sexual function was evaluated in 21 patients with bladder carcinoma who had undergone radical cystectomy either with (n = 9) or without (n = 12) excision of the urethra. All patients received preoperative radiotherapy, and the cystectomy was done by a nerve-sparing surgical technique. At follow-up all patients reported normal sexual desire and tactile sexual activity. Eight of the 12 patients in whom the urethra was preserved could achieve penile erection and orgasm to tactile stimulation, and five of them had sufficient strength and duration of erection for sexual intercourse. Two of the nine patients in whom the urethra was removed-had weak erections insufficient for intercourse; three could experience orgasm. These results show that when cystectomy is done by a nerve-sparing technique and without urethrectomy there is more chance of preserving sexual function than when simultaneous urethrectomy is done.

Aged↗
PubMed1998

Sexological problems after cystectomy: bladder substitution compared with ileal conduit diversion. A questionnaire study of male patients.

A questionnaire study was carried out to compare the postoperative sexological problems after cystectomy and bladder substitution using the urethral Kock reservoir or the ileocecal reservoir with that following ileal conduit diversion. A total of 76 male patients with bladder cancer completed the questionnaire: 49 patients had a bladder substitution and 27 an ileal conduit diversion. Median follow-up was 1.3 years (range 0.5-6.4) and 4.8 years (range 2.4-14.7), respectively. Only 9% of all patients could achieve an erection at least every second time, in comparison to 82% preoperatively. Thirty-eight percent of all patients were able to achieve orgasm, and 26% were coitally active to some degree. Reasons for decrease or cessation of coitus were loss of potency among 77% and 96% respectively (p = 0.04), while those reporting decreased libido (29%), partner refusal (13%), and feeling less sexually attractive (20%) showed no between-group differences. Regression analysis showed no influence of type of operation, while age above 68 years influenced orgasmic ability and coital activity, and radiation treatment influenced whether the patient felt less sexually attractive than before surgery.

Adult↗
PubMedDate not supplied

Cognitive distraction and women's sexual functioning.

Past research on the role of cognitive distraction in sexual dysfunction typically has focused on males and has been conducted in the laboratory using artificial stimuli. In the current study, young adult women (N = 74) with coital experience completed questionnaires regarding cognitive distraction and their sexuality. Those women who reported greater cognitive distraction during sexual activity with a partner also reported relatively lower sexual esteem, less sexual satisfaction, less consistent orgasms, and higher incidence of pretending orgasm even after the women's general affect, sexual desire, general self-focus, general sexual attitudes, and body dissatisfaction were statistically controlled. Results are discussed with regard to directions for future research and implications for sex therapy.

Adolescent↗
PubMed1976

Some aspects and implications of coital physiology.

A review of some experiments in human coital physiology in the home setting considers their possible value to the sex therapist. Blood pressure changes are described in normal subjects with reference to their relevance in patients with heart disease or high blood pressure. Respiratory patterns and intravaginal and intrauterine pressure changes are described during coitus, and their significance in different types of female orgasm are discussed. It now appears that a specific deeply satisfying and terminative female orgasm is associated with a particular type of respiratory pattern and intrauterine pressure change. The use of radiotelemetry devices to measure pressure and pH changes during coitus makes home studies possible. Further projects and areas for future study are considered.

Blood Pressure↗
PubMed1982

The treatment of anorgasmia: long-term effectiveness of a short-term behavioral group therapy.

A long-term follow-up of 19 women who participated in short-term group therapy for anorgasmia using masturbation and assertiveness training showed that the majority of women maintained treatment gains and progressed further in orgasm response and other aspects of sexual functioning, including assertiveness and liberalness of sexual attitudes. However, several women regressed, and four additional women who dropped out of treatment also improved dramatically in orgasm response, suggesting that other patient characteristics and factors affect apparent treatment outcome. Independent evaluations, standardized assessment scales, long-term, in-person follow-ups and multidimensional assessment are useful in evaluating treatment effectiveness.

Adolescent↗
PubMed1983

Sexual fantasy and activity patterns of females with inhibited sexual desire versus normal controls.

Until recent years, female sexual fantasy was generally associated with psychopathology or negative qualities. Sexual fantasy is now regarded by the cognitive-behavioral schools as a normal occurrence serving adaptive functions. No investigation has been made comparing the sexual fantasy and activity patterns of women with a specific sexual dysfunction and women with a satisfactory sexual adjustment. This study compared responses to a fantasy questionnaire completed by 30 women reporting a satisfying sex life and 25 women who came to a sexual dysfunction clinic with a complaint of inhibited sexual desire. This study confirms that females with inhibited sexual desire fantasize less during foreplay, coitus, masturbation and general daydreaming than the controls. The content of fantasies in both groups is similar. The females with inhibited sexual desire do not masturbate less often and do not have fewer orgasms through masturbation than the controls. The females with inhibited sexual desire have fewer orgasms through intercourse alone.

Adolescent↗
PubMed1984

Sexual behavior, responsiveness, and attitudes among women: a test of two theories.

This study tests two theories regarding the attitude and behavioral determinants of women's coital and masturbatory orgasmic responsiveness. Data from 115 sexually active women were analyzed using latent-variable structural equation models. Twenty-one variables are used to represent seven latent constructs: Parent Sexual Attitudes, Sexual Latency, Sexual Behavior, Dating Competence, Social Assertiveness, Subjective Masturbatory Responsiveness, and Subjective Coital Responsiveness. Two specific theories are tested with these constructs. Each theory predicts a different structural arrangement among these latent factors with the fundamental difference being whether behavior predicts responsiveness or vice-versa. Two alternate models were found to reflect the data adequately. In both instances, attitudes predicted behavior and, in general, orgasmic responsiveness tended to be a function of behavior.

Adolescent↗
PubMed1986

Perspectives of sex therapy outcome: a survey of AASECT providers.

Randomly selected AASECT members who reported that they conduct sex therapy (N = 289) responded to a questionnaire about their sex therapy caseloads. Desire discrepancies between partners was the most common problem (31%). Least commonly reported problems were vaginismus (5%), ejaculatory inhibition (5%), and primary erectile dysfunction (2%). Highest success rates (client satisfaction with sexual functioning) were for premature ejaculation (62%), secondary orgasmic dysfunction (56%), and desire discrepancies (53%). Primary erectile dysfunctions had the lowest success rate (25%). The most commonly used treatment methods were a focus on communication skills, general sex education, homework assignments, and a focus on the sexual interaction; sensate focus, and the discussion of nonsexual individual and/or relationship issues also were quite commonly used. From a discriminant function analysis, the combined Therapists and Multiple-certified provider groups reported focusing on sexual interactions more than the combined Counselors and Educators; the Educators were the least likely providers to use a focus either on sexual interactions or on homework assignments. The Counselors were the most likely, and the Educators the least likely, to use communication skills. Therapists and the Multiple-certified providers estimated higher treatment success rates than Counselors and Educators for premature ejaculation, secondary erectile dysfunction, vaginismus, primary orgasmic dysfunction, sexual avoidance, ejaculatory inhibition, and sexual arousal problems. The Educators were the least successful with dyspareunia. Educators and Counselors were similar in reporting the fewest clients with sexual arousal problems. Therapists and Multiple-certified providers reported spending more treatment hours with desire discrepancies and desire problems. The implications of the findings for clinical practitioners and researchers are discussed.

Communication↗
PubMed1986

The epidemiology of the DSM-III psychosexual dysfunctions.

The findings of 22 general population sex surveys are reanalyzed to assess the prevalence and distribution of the Psychosexual Dysfunctions as defined by DSM-III. Methodological shortcomings of the studies and problems with utilizing data originally collected for other purposes are discussed. Prevalence is estimated to be: Inhibited Female Orgasm, 5-30 + %; Inhibited Male Orgasm, 5%; Premature Ejaculation, 35%; Inhibited Sexual Excitement, 10-20% for men, indeterminate for women; Inhibited Sexual Desire, 1-15% for men, 1-35% for women. The author discusses the usefulness of epidemiological data for clinical, research, and public health undertakings.

Cross-Sectional Studies↗
PubMed1988

Client attributions for sexual dysfunction.

This investigation examined attributions for sexual dysfunctions made by 63 individuals and 21 of their partners who presented at a sex therapy service for the following problems: erectile dysfunction, premature ejaculation, and female orgasmic dysfunctions. All participants completed measures of marital adjustment, locus of control, depression and a questionnaire which assessed: attributions of responsibility for the sexual problem, perceived control over sexual functioning, distress, effort made to improve the sexual relationship, and expectations about the efficacy of sex therapy for the problem. Results indicate that both identified patients and their partners, regardless of the dysfunction, blamed the sexual problem on the "dysfunctional individual" rather than on the circumstances or the partner. With respect to the partners, husbands of women with orgasmic dysfunction were more likely to blame themselves than the circumstances, while the opposite was true for wives of males with erectile difficulties. Individuals experiencing the dysfunction perceived themselves and their partners as having little, but equal control over the identified patient's sexuality. Correlational analyses indicate that in identified patients, the better the quality of the marital relationship, the greater the self-blame and the lower the partner blame. Those with happy marriages also made greater efforts to improve their sexual relationship and had higher expectations of success with therapy. The implications of the results for research on the role of attributions in sexual dysfunction and for assessment of cognitive factors in sexually dysfunctional individuals and their partners is discussed.

Adult↗
PubMed1991

The role of assertiveness in female sexuality: a comparative study between sexually assertive and sexually nonassertive women.

To examine the role of assertiveness in female sexuality, a nonclinical population of married women (ages 18-31 years) were stratified as above or below the median score (73) on sexual assertiveness, as measured by the Hurlbert Index of Sexual Assertiveness (HISA), and matched accordingly for demographics, resulting in two samples: sexually assertive and sexually nonassertive, each group consisting of 50 women. Comparative assessments were made between the two matched samples on frequency of sexual activity, number of orgasms, subjective sexual desire, and both marital and sexual satisfaction. The t-test was used to test the equality of means between samples. Pearson's r was used for correlational data. ANOVA methods were employed to examine race, religion, and employment status. Using t-test, significant differences between the two groups appeared on all five measures. Sexually assertive women reported higher frequencies of sexual activity and orgasms, rated themselves as having greater subjective sexual desire, and reported greater marital and sexual satisfaction.

Adult↗
PubMed1993

Key variables to understanding female sexual satisfaction: an examination of women in nondistressed marriages.

Using a step-wise multiple regression analysis, this study examined the role, in nondistressed marriages, of such sexual variables as frequency of sexual activity, number of orgasms, sexual desire, and sexual excitability in the prediction of female sexual satisfaction as compared to the role of such personality and relationship variables as sexual assertiveness, sexual attitudes (erotophobia-erotophilia), and relationship closeness. The findings suggest that individual and relationship variables (sexual assertiveness, erotophilia, and relationship closeness) aid in the prediction of female sexual satisfaction over and above what can be learned from knowing about the frequency of sexual activity, the number of orgasms a woman has, her level of sexual excitability, and how much she desired the sexual activity. Findings, methodological advances in the use of sex diaries, and limitations of the study are explored.

Adult↗
PubMed2003

Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men.

The present open and prospective study was performed to investigate the effect of the angiotensin II receptor blocker (ARB) valsartan on sexual function in hypertensive males. Patients who were either newly treated or who were switched from other treatment regimens received valsartan 80-160 mg/day. Blood pressure decreased from an average of 158/94 mmHg to 136/82 mmHg during the 6 months of treatment (p < 0.001). The patients' sexual function was assessed before valsartan and after 6 months of treatment using the International Index of Erectile Function (IIEF), an internationally validated 15-item questionnaire. The IIEF addresses the relevant domains of male sexual function, i.e. erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. At baseline, 75.4% of the total group of 3502 patients investigated and 65.0% of the subgroup of patients without previous antihypertensive treatment (n = 952) could be diagnosed as having erectile dysfunction (ED) according to the IIEF. Valsartan therapy markedly reduced ED in these groups to 53% and 45% (p < 0.0001), respectively. Improved ED was associated with highly significant improvements in orgasmic function, intercourse and overall satisfaction both in the total and previously untreated groups. In addition, sexual desire averaged 5.64 +/- 1.99 IIEF units in the total and 5.99 +/- 2.03 in the group without antihypertensive treatment at baseline. Valsartan markedly increased these numbers to 6.82 +/- 1.72 and 7.06 +/- 1.68 (p < 0.0001), respectively. The results of our open study suggest that the ARB valsartan improves sexual function in hypertensive males.

Adolescent↗
PubMed1997

Mianserin, a 5-HT2a/2c and alpha 2 antagonist, in the treatment of sexual dysfunction induced by serotonin reuptake inhibitors.

Sexual dysfunction is commonly encountered in patients treated with antidepressants. The exact mechanism responsible for the sexual impairment is as yet unclear, although activation of the serotonergic system has been implicated. In the present study, we examined the effect of the 5-HT2a/2c and alpha 2 antagonist mianserin in the treatment of patients with sexual dysfunction induced by serotonin reuptake inhibitors (SRIs). Mianserin 15 mg was coadministered to 15 male subjects with new-onset sexual dysfunction who were under treatment with SRIs. Four major domains of sexual activity-desire, erection, orgasm, and satisfaction-were assessed once weekly for 4 weeks. At the end of the study, 9 of the 15 subjects reported a marked improvement in their sexual functioning, 2 reported partial improvement, and only 4 subjects showed no improvement at all. The beneficial effects were prominent in the areas of orgasm and satisfaction and were usually noted within the first and second week of mianserin treatment. The addition of mianserin to the treatment regimen was not associated with either improvement or worsening of the basic psychiatric clinical status. It appears that the coadministration of low-dose mianserin may be an additional option in the treatment of sexual dysfunction induced by SRIs.

Adrenergic alpha-Antagonists↗
PubMed2004

Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients.

Surgical reconstruction of the penis is challenging because of the many cosmetic and functional (e.g., sexual intercourse and voiding) requirements that must be addressed. Since the free sensate osteocutaneous fibula flap was first described for total penile reconstruction in 1993 it has been widely accepted, with its advantages and minimal shortcomings. In this article, the authors present the longest follow-up of biologically male patients with free fibular phalloplasties. Since 1994, 18 biologically male patients with total penile losses for various reasons were treated with free sensate osteocutaneous fibula flaps. All patients were included in the study. The ages of the patients ranged between 20 and 26 years (mean, 22.2 years). The average follow-up period was 5.4 years (range, 1 to 9 years). Patient satisfaction was evaluated by a questionnaire regarding both quality of orgasm and daily activities. Conventional radiographic imaging, magnetic resonance imaging, and bone mineral densitometry were performed to evaluate the fate of the bony component of the flap. Also, sensibility was evaluated by bulbocavernous reflex and penile somatosensory evoked potentials testing in nine patients. Six patients married, and five of them had six children. Most patients and their partners reported pleasurable sexual intercourse and orgasm. Conventional radiographs of the fibular bone in neophalluses showed robust, calcified bone structure without any evidence of bone resorption or fracture. The magnetic resonance images showed the cortical substance and spongiosum of the bone marrow, which are characteristic signs of bone viability. After intravenous injection of gadolinium, the neophallus bone showed uptake of contrast medium. Viability of neophallus bone was shown even at 9-year follow-up (the longest follow-up in the literature). Dual energy x-ray absorptiometry measurements of the penile bone grafts showed that fibular components in the penis had bone mineral density values that were close to but lower than those of intact fibula in the same subjects. These results were considered as evidence of viability of bone grafts. Neural integrity was found between the nerves of the neophallus and the residual penile bodies by both bulbocavernous reflex and penile somatosensory evoked potentials tests. In conclusion, free sensate fibula flap phalloplasty provides the cosmetic and functional requirements that an ideal penis should have. All results put an end to the discussion that the fibular component of the neophallus could resorb. Constitution of neural integrity is important in terms of pleasurable sexual intercourse. The authors believe the free sensate osteocutaneous fibula flap should be considered as the standard in penile reconstruction.

Adult↗
PubMed1984

Sexuality in pregnancy and premature labour.

The relation of sexual behaviour during pregnancy to the initiation of labour was investigated in 358 patients of whom 58 were delivered after premature labour and 300 were delivered spontaneously at term. In all patients the mean weekly coital frequency and the frequency of orgasm were investigated by means of a retrospective questionnaire. There was no significant difference in coital or orgasmic frequency between the women who had a premature labour and those who had a spontaneous delivery at term. This was also true when those having premature labour were divided into those starting labour with ruptured membranes and those starting with contractions.

Adult↗
PubMed2002

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria.

OBJECTIVE: To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria. DESIGN: Cross sectional study. SETTING: Women attending family planning and antenatal clinics at three hospitals in Edo State, South-south Nigeria. POPULATION: 1836 healthy premenopausal women. METHODS: The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women's sociodemographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models. MAIN OUTCOME MEASURES: Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections. RESULTS: Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26-0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51-2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11-2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54-5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09-2.49) and genital ulcers (OR = 4.38, 95% CI 1.13-17.00). CONCLUSION: Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

Adolescent↗
PubMed2004

Physiology of female sexual function: animal models.

INTRODUCTION: Data concerning the physiology of desire, arousal, and orgasm in women are limited because of ethical constraints. Aim. To gain knowledge of physiology of female sexual function through animal models. METHODS: To provide state-of-the-art knowledge concerning female sexual function in animal models, representing the opinions of seven experts from five countries developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURE: Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: Sexual desire may be considered as the presence of desire for, and fantasy about, sexual activity. Desire in animals can be inferred from certain appetitive behaviors that occur during copulation and from certain unconditioned copulatory measures. Proceptive behaviors are dependent in part on estrogen, progesterone, and drugs that bind to D1 dopamine receptors, adrenergic receptors, oxytocin receptors, opioid receptors, or gamma-amino butyric acid receptors. Peripheral arousal states are dependent on regulation of genital smooth muscle tone. Multiple neurotransmitters/mediators are involved including adrenergic, and nonadrenergic, noncholinergic agents such as vasoactive intestinal polypeptide, nitric oxide, neuropeptide Y, calcitonin gene-related peptide, and substance P. Sex steroid hormones, estrogens and androgens, are critical for structure and function of genital tissues including modulation of genital blood flow, lubrication, neurotransmitter function, smooth muscle contractility, mucification, and sex steroid receptor expression in genital tissues. Orgasm may be investigated by urethrogenital (UG) reflex, in which genital stimulation results in rhythmic contractions of striated perineal muscles and contractions of vagina, anus, and uterine smooth muscle. The UG reflex is generated by a multisegmental spinal pattern generator involving the coordination of sympathetic, parasympathetic, and somatic efferents innervating the genital organs. Serotonin and dopamine may modulate UG reflex activity. CONCLUSIONS: More research is needed in animal models in the physiology of female sexual function.

Anal Canal↗