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Sexual adjustment and feminine attractiveness among spinal cord injured women.

Responses to semistructured interviews with 31 spinal cord injured women yielded sexual adjustment scores and material concerning sexual compensation and orgasm, bowel and bladder programs, and methods of enhancing attractiveness. Sexual adjustment scores were unrelated to time since injury. Few subjects reported the need to make special provision to control elimination during sexual activity. Openness and honesty with mates were stressed. Those with high sexual-adjustment scores compensated for lost sensation and mobility. Orgasm descriptions and most attractiveness-related behaviors resembled those of able-bodied women; some attractiveness behaviors specifically compensated for disability.

Adolescent↗

Sex and the human female reproductive tract--what really happens during and after coitus.

The scientific study of the interaction of human genitals during coitus and after ejaculation with and without female orgasm has always been difficult and controversial with ethical, technical and social problems. The present brief review examines critically the results from these studies. Early observations utilised changes induced in sexually self-aroused subjects or by coitus with artificial (transparent) penes with few objective measurements. These culminated in the synthesis of the useful unitary descriptive, EPOR (excitation, plateau, orgasm, resolution)-model by Masters and Johnson (1966). Later investigations by other workers developed or employed instrumentation to record objectively the changes induced in the motility and pressures of genital muscles, in genital blood flow, in the ion and fluid movements creating the neurogenic transudate of vaginal lubrication, in its pH and pO2 and in the disposition of the ordered spurting ejaculate with subsequent sperm transport. More recently, studies have begun to use endoscopy and ultrasound imaging to picture what really happens especially during penile thrusting. While the newer techniques have often confirmed selected features of the original EPOR model they have also shown that the characterisation of the coital changes just by a unitary model is inappropriate. New observations suggest a plurality in the changes that can occur. Coital mechanisms are dynamic and our investigations and descriptions of them should match their dynamism. The knowledge gained will be more than helpful in the treatment of infertility, genital dysfunctions and disease transmission.

Cervix Uteri↗

Neurophysiological basis of sympathetic nerve-preserving surgery for lower rectal cancer--a canine model.

BACKGROUND/AIMS: The relative contribution and interrelated compensation of sympathetic signals among sympathetic components in pelvic plexus remain undefined. This study was designed to investigate the genitourinary function in response to autonomic nerve preservation and severance using a canine model. METHODOLOGY: Eighteen mongrel dogs were randomly divided into 3 groups which received severance of the hypogastric nerves on either the right side, left side, or on both sides. The hypogastric nerves and sacral sympathetic trunks were electrically stimulated and the contraction pressure of the internal urethral orifice was measured immediately, at 1- and 3-month intervals. The ejaculation function and the length of time required to reach sexual orgasm were evaluated by manual penis-stimulation. RESULTS: The difference between the left and right sides of the normal hypogastric nerve in contribution to sympathetic signals was insignificant. Compared with the hypogastric nerve, the bilateral sacral sympathetic trunks were functionally trivial in controlling the closure of the internal urethral orifice. The preserved side of the hypogastric nerve compensated for the loss of sympathetic signals of the severed side within 1 month and, thereafter, remained stationary. In contrast, the functional compensation of bilateral sacral sympathetic trunks for the severed bilateral hypogastric nerves was insignificant. When the hypogastric nerve was preserved in one or both sides, all dogs maintained normal antegrade ejaculation. If bilateral hypogastric nerves were severed, 50.0% (3/6) of the dogs lost both emission and ejaculation function; 33.3% (2/6) presented with retrograde ejaculation; and, 16.7% (1/6) presented with combined retrograde ejaculation and reduced antegrade ejaculation. The time required to reach sexual orgasm was not affected by the severance of the hypogastric nerve. CONCLUSIONS: The normal genitourinary function could be maintained only when at least one side of the hypogastric nerve was preserved.

Animals↗

Treatment of sexual dysfunction: a review of outcome studies.

Studies that have reported the outcome of treatment of various sexual dysfunctions are reviewed. While the number of published studies is limited, the results are remarkably consistent. By use of a variety of techniques, the prognosis for successful treatment of primary orgasmic dysfunction in women and premature ejaculation in men is quite good. The treatment of secondary or situational orgasmic dysfunction is more difficult and results in much lower success rates. Variables that affect treatment outcome and implications for future research and treatment are discussed.

Female↗

Effect of body image and self-image on women's sexual behaviors.

OBJECTIVES: To evaluate the relationship between women's body image, self-image, and sexual behaviors; to determine the effect of body image on personal and sex variables; and to identify factors that contribute to more frequent and greater comfort with sex. METHOD: A magazine survey that included items about body image, self-image, and sexual behaviors was completed by 3,627 women. RESULTS: Women more satisfied with body image reported more sexual activity, orgasm, and initiating sex, greater comfort undressing in front of their partner, having sex with the lights on, trying new sexual behaviors, and pleasing their partner sexually than those dissatisfied. Positive body image was inversely related to self-consciousness and importance of physical attractiveness, and positively related to relationships with others and overall satisfaction. Body image was predictive only of one's comfort undressing in front of partner and having sex with lights on. Overall satisfaction was predictive of frequency of sex, orgasm, and initiating sex, trying new sexual behaviors, and confidence in giving partner sexual pleasure. DISCUSSION: Results indicate that overall self-image and body image are significant predictors of sexual activity. Directions for future research are discussed.

Adolescent↗

Short-term sexual function after prostate brachytherapy.

Sexual function was evaluated in 34 patients with low-risk prostate cancer (PSA < or = 10, Gleason score < or = 6, clinical stage T1/T2) undergoing brachytherapy in a phase III prospective randomized trial comparing iodine-125 ((125)I) to palladium-103 ((103)Pd). The mean and median International Index of Erectile Function (IIEF) scores for the entire group were 14.2 and 16.5, respectively, and there was no difference between these scores when stratified by isotope. IIEF scores < 6, 6 to 11, and > or = 12 were recorded in 35% (12/34), 6% (2/34), and 59% (20/34) of patients, respectively. Hematospermia, orgasmalgia (pain at the time of orgasm), and alteration in intensity of orgasm were documented in 26% (9/34), 15% (5/34), and 38% (13/34) of patients, respectively, but these side effects were of limited duration for most patients. There was no relationship between radiation dose to the neurovascular bundles (NVB), which averaged 209% of the prescribed prostate dose, and the development of postbrachytherapy impotence. All four impotent patients who used sildenafil responded favorably. With a median follow-up of 13 months, 65% of patients undergoing prostate brachytherapy maintained sexual function without pharmacologic support. Including sildenafil responses, 76.5% of patients sustained erections sufficient for sexual intercourse.

Aged↗

Sexual interviewing, evaluation, and therapy: psychoanalytic emphasis on the use of sexual fantasy.

Sexual fantasy in initial interviews and during psychotherapy and psychoanalysis is explored for its contribution to understanding psychopathology, both sexual and nonsexual. The focus is on distinguishing between the sexual and the seemingly sexual. "Sexual" behavior and fantasy are regarded as having sexual pleasure and orgasm as the predominant goal. Seemingly sexual behavior and fantasy have a predominant goal that is not sexual, even though a sexual mode is used. Predominant goals in the seemingly sexual are emphasized such as coping with intense aggression and problems of self-esteem, self-definition, self-cohesion, and the maintenance of object relations. Sexual fantasy and behavior can be especially useful for repairing negative self- and object images and the associated intensely negative affects. This does not imply that all more primitive patients are incapable of experiencing intense sexual pleasure and orgasm. On the contrary, borderline patients, with extensive use of splitting mechanisms at the level of dyadic object relating, may have intact sexual functioning.

Affect↗

Male sexual function after autonomic nerve-preserving operation for rectal cancer.

PURPOSE: Sexual dysfunction after surgery of the rectum is a serious complication to male patients. Autonomic nerve-preserving operation for rectal cancer has been performed within the recent ten years to maintain urinary and male sexual functions without spoiling of therapeutic radicality. To clarify male sexual function as the degree of autonomic nerve-preserving operation, the function was outlined through clinical interview. METHOD: In a series of 134 male patients who were undergoing autonomic nerve-preserving operation for rectal cancer, a detailed history of postoperative sexual function was obtained by interviews. RESULTS: In 87.7 and 66.9 percent of patients, erectile and ejaculatory potencies were maintained, respectively, which were higher rates than those after extended and conventional pelvic dissections. According to the preserving extent of autonomic nerve, patients undergoing complete preserving operations showed higher rates of maintained erectile (92.9 percent) and ejaculatory functions (82.5 percent), sexual intercourse (89.9 percent), and orgasm (93.9 percent) compared with those undergoing hemilateral autonomic nerve-preserving (82.3, 47.1, 52.9, 64.7 percent) or partial pelvic plexus-preserving operation (61.1, 0, 26.3, 22.2 percent). CONCLUSION: Pelvic plexus preservation is necessary to maintain erectile potency, and both hypogastric nerve and pelvic plexus preservation are necessary to maintain ejaculate function and orgasm. To maintain satisfactory sexual function, complete autonomic nerve-preserving operation is suitable.

Aged↗

Effects of Herbal vX on libido and sexual activity in premenopausal and postmenopausal women.

This study investigated the possibility of an alternative to chemical medication in the treatment of sexual dysfunction in healthy women. The efficacy of a unique herbal formulation of Muira puama and Ginkgo biloba (Herbal vX) was assessed in 202 healthy women complaining of low sex drive. Various aspects of their sex life were rated before and after 1 month of treatment. Responses to self-assessment questionnaires showed significantly higher average total scores from baseline in 65% of the sample after taking the supplement. Statistically significant improvements occurred in frequency of sexual desires, sexual intercourse, and sexual fantasies, as well as in satisfaction with sex life, intensity of sexual desires, excitement of fantasies, ability to reach orgasm, and intensity of orgasm. Reported compliance and tolerability were good. These initial findings support the strong anecdotal evidence for the benefits of Herbal vX on the female sex drive. A double-blind study is planned to further research these results.

Adult↗

The impact of pelvic organ prolapse on sexual function in women with urinary incontinence.

The aim of the study is to evaluate the impact of pelvic organ prolapse (POP) on sexual function in women with urinary incontinence (UI). In this retrospective, case-cohort study, we reviewed the medical records of all women evaluated for UI between March and November 2003. All patients completed the short forms of the Urogenital Distress Inventory, Incontinence Impact Questionnaire, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. Women with stage two or greater POP, as determined by the pelvic organ prolapse quantification (POPQ) system, were compared to women with stage 0 or 1 POP. Sixty-nine women with POP and 47 women without POP were included. Patient demographics did not differ between the two groups. Women with POP were significantly more likely to report absence of libido (53% versus 30%, P=0.02), lack of sexual excitement during intercourse (46% versus 27%, P=0.05), and that they rarely experienced orgasm during intercourse (49% versus 30%, P=0.05). In conclusion, women with POP in addition to UI are more likely to report decreased libido, decreased sexual excitement, and difficulty achieving orgasm during intercourse when compared to women with UI alone.

Adult↗

The role of mechanical devices in treating female sexual dysfunction and enhancing the female sexual response.

Female sexual dysfunction (FSD) is a common medical problem estimated to affect about 40 million American women. In 1998, the American Foundation of Urologic Disease (AFUD) Consensus Panel classified FSD into four different categories: sexual desire disorder, sexual arousal disorder, orgasmic disorder, and sexual pain disorder. This article will focus on the role of mechanical devices to treat sexual arousal and orgasm disorders and to enhance the female sexual response. Mechanical devices may work through vibratory stimulation or by causing clitoral vascular engorgement using a vacuum system. While a number of vibratory stimulating devices are available, only one U.S. Food and Drug Administration cleared-to-market device is available by prescription to treat FSD, the Eros Therapy device (UroMetrics, Inc., St. Paul, Minn., USA). The Eros Therapy is a small, battery-powered device used to gently apply direct vacuum over the clitoris causing the clitoral erectile chambers and labia to fill with blood. This article will review the rationale and benefits of using mechanical devices to treat FSD.

Clitoris↗

Potential future options in the pharmacotherapy of female sexual dysfunction.

Female sexual dysfunction (FSD) is considered a common medical problem estimated to affect millions of women in the westernized countries. FSD has been classified into four different categories including sexual arousal disorder (FSAD), sexual desire disorder (HSDD), orgasmic disorder and sexual pain disorder. The focus of this article is the potential role of pharmacological compounds currently under development, in the treatment of sexual arousal and orgasmic disorders in order to enhance the sexual response in adult females. While a number of potential therapeutic options are available to date, not one of the pharmacological treatment regimens has been yet considered the Gold standard in the management of symptoms of FSD. This article reviews the rationale and potential benefits of using distinct drug formulations in the treatment of FSD.

Adrenergic alpha-Antagonists↗

The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study.

The aims of the study were to determine the prevalence of sexual dysfunction, its subtypes and associated risk factors in women with chronic pelvic pain (CPP) as compared to a general female population. We evaluated 112 women (mean age 34.73 +/- 8.07; age range 18-50) complaining of CPP with a comprehensive history including female sexual function index (FSFI) and several general assessment questions (GAQs), a complete physical examination and routine laboratory tests. A group of 108 healthy women (mean age 33.28 +/- 7.95; age range 19-52) without CPP were enrolled as cross-sectional controls. According to the general population, the incidence of female sexual dysfunction (FSD) was 67.8% in women with CPP and 32.2% in women without CPP (P < 0.0001). Among 112 CPP patients, 78 (69.6%) of them had FSD and 34 (30.4%) patients did not have FSD in the study (P < 0.0001). In that 78 patients, 42 patients (53.8%) had hypoactive sexual desire disorder, 26 patients (33.3%) had sexual arousal disorder, 17 patients (21.7%) had orgasmic disorder and finally 58 patients (74.3%) had sexual pain disorder. The FSFI scores in both groups were as follows: (patients vs. controls; median value; P value, respectively): desire: 3.31 versus 3.98 (P < 0.0001); arousal: 3.58 versus 4.35 (P < 0.0001); lubrication: 4.20 versus 4.88 (P < 0.0001); orgasm: 3.70 versus 4.48 (P < 0.0001); sexual satisfaction: 3.80 versus 4.64 (P < 0.0001); sexual pain: 2.75 versus 4.98 (P < 0.0001) and total FSFI score: 21.35 versus 27.29 (P < 0.0001). The prevalence of FSD was higher in women with CPP than in a general healthy population not complaining of CPP. Investigation of female sexuality was essential for these patients.

Adolescent↗

Sexuality before and after male-to-female sex reassignment surgery.

The sexual behaviors and attitudes of male-to-female (MtF) transsexuals have not been investigated systematically. This study presents information about sexuality before and after sex reassignment surgery (SRS), as reported by 232 MtF patients of one surgeon. Data were collected using self-administered questionnaires. The mean age of participants at time of SRS was 44 years (range, 18-70 years). Before SRS, 54% of participants had been predominantly attracted to women and 9% had been predominantly attracted to men. After SRS, these figures were 25% and 34%, respectively.Participants' median numbers of sexual partners before SRS and in the last 12 months after SRS were 6 and 1, respectively. Participants' reported number of sexual partners before SRS was similar to the number of partners reported by male participants in the National Health and Social Life Survey (NHSLS). After SRS, 32% of participants reported no sexual partners in the last 12 months, higher than reported by male or female participants in the NHSLS. Bisexual participants reported more partners before and after SRS than did other participants. 49% of participants reported hundreds of episodes or more of sexual arousal to cross-dressing or cross-gender fantasy (autogynephilia) before SRS; after SRS, only 3% so reported. More frequent autogynephilic arousal after SRS was correlated with more frequent masturbation, a larger number of sexual partners, and more frequent partnered sexual activity. 85% of participants experienced orgasm at least occasionally after SRS and 55% ejaculated with orgasm.

Adolescent↗

In the mood for love or vice versa? Exploring the relations among sexual activity, physical affection, affect, and stress in the daily lives of mid-aged women.

How do physical affection, sexual activity, mood, and stress influence one another in the daily lives of mid-aged women? Fifty-eight women (M age, 47.6 yrs) recorded physical affection, several different sexual behaviors, stressful events, and mood ratings every morning for 36 weeks. Using multilevel modeling, we determined that physical affection or sexual behavior with a partner on one day significantly predicted lower negative mood and stress and higher positive mood on the following day. The relation did not hold for orgasm without a partner. Additionally, positive mood on one day predicted more physical affection and sexual activity with a partner, but fewer solo orgasms the following day. Negative mood was mostly unrelated to next-day sexual activity or physical affection. Sexual orientation, living with a partner, and duration of relationship moderated some of these effects. Results support a bidirectional causal model in which dyadic sexual interaction and physical affection improve mood and reduce stress, with improved mood and reduced stress in turn increasing the likelihood of future sex and physical affection.

Activities of Daily Living↗

Genital tract abnormalities and female sexual function impairment in systemic sclerosis.

OBJECTIVE: Our purpose was to determine the involvement of the female genital tract and its functional consequences on menstrual and sexual aspects in systemic sclerosis. STUDY DESIGN: Sixty women with systemic sclerosis and 23 age- and disease duration-matched women with either rheumatoid arthritis or systemic lupus erythematosus were surveyed with a comprehensive questionnaire addressing problems before and after disease onset. Fourteen systemic sclerosis patients also had gynecologic evaluations. RESULTS: Vaginal dryness (71%), ulcerations (23%), and dyspareunia (56%) were significantly more frequent in patients with systemic sclerosis after disease onset than before and also in comparison with control subjects. Vaginal tightness and constricted introitus were present in 5 of 60 systemic sclerosis patients. More than half of systemic sclerosis patients reported a decrease in the number (p = 0.04) and intensity (p = 0.02) of orgasms, compared to < 20% of control subjects. The desire and frequency of coitus and the sexual satisfaction index were impaired equally in each group. Skin tightness, reflux-heartburn, and muscle weakness adversely affected sexual relations more in systemic sclerosis than in control subjects. On gynecologic examination 5 of 11 systemic sclerosis patients had small-sized uteri, and 3 of them had early menopause at 29, 38, and 43 years. Seven of 16 (44%) women with systemic sclerosis, compared with 6% of normal women in the United States, attained natural menopause before age 45. CONCLUSIONS: Although impairment in various indexes of sexual function occurs in a number of autoimmune diseases, decreased orgasmic function appears to be limited to systemic sclerosis. Vaginal involvement and other systemic sclerosis-related systemic symptoms adversely influence sexual relations. Menstrual abnormalities, including early menopause, affect many patients. Genital tract involvement occurs in a substantial proportion. Prospective longitudinal studies are warranted.

Adult↗

Sexual and marital relationships after radiotherapy for seminoma.

Questionnaires on sexual function, marital status, and fertility were returned by 84 men who received radiotherapy for seminoma (Stage I, II, or III). The mean length of follow-up was ten years. Although 93 per cent were married, 19 per cent had low rates of sexual activity, 12 per cent reported low sexual desire, 15 per cent had erectile dysfunction, 10 per cent had difficulty reaching orgasm, and 14 per cent had premature ejaculation. The most common problems were reduced intensity of orgasm (33%) and reduced semen volume (49%). Twenty-one men remained childless, and 30 per cent of men worried at least occasionally about infertility. Thirteen children were conceived after cancer therapy. The data suggest that sexual dysfunction and infertility are important concerns for a subgroup of men treated for seminoma.

Adult↗

Pretreatment evaluation of sexual function in patients with adenocarcinoma of the prostate.

Forty-three patients with adenocarcinoma of the prostate and available partners were interviewed to assess qualitatively and quantitatively their levels of sexual functioning prior to radiotherapy. The mean age was 67.7 years (58-80 years). The Derogatis Interview for Sexual Functioning (DISF) was the evaluation used. The Derogatis Interview for Sexual Functioning measures five domains of sexual functioning: sexual fantasy, arousal, experience, orgasm, and drive. Twenty-seven of the 43 (62.7%) patients evaluated were considered impotent. Fifteen of the 27 patients scored low in all five domains of sexual functioning even though they could achieve erection but they were unable to maintain erection throughout the phases of the sexual response cycle. Twelve of the 27 patients had scored 0 on sexual arousal and orgasm, thus had no ability for erection. Sixteen of the 43 (37.2%) patients were considered potent. This group of patients had achieved erection throughout the phases of sexual cycle and scored adequately in all five domains of sexual functioning. Patients with DISF score less than 20 were impotent. Those with a Derogatis Interview for Sexual Functioning score of greater than 45 were potent. Only 6 of 19 patients with scores between 20 and 45 were potent. The Derogatis Interview for Sexual Functioning score was highly prognostic for impotence, (p = .002) was easy to use and could be used for follow-up of the effect of therapy on sexual function in patients with adenocarcinoma of the prostate. Patients who present for radiation therapy are older, 50% are on cardiac or antihypertensive medication, and the majority (62.7%) are already impotent prior to therapy.

Adenocarcinoma↗