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PubMed2003

Alteration of sexual function after classic intrafascial supracervical hysterectomy and total hysterectomy.

STUDY OBJECTIVE: To investigate possible advantages of classic intrafascial supracervical hysterectomy (CISH) over total hysterectomy with respect to sexual function. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: Department of obstetrics and gynecology at a university teaching hospital. PATIENTS: One hundred eight women who had undergone CISH and 125 who had total hysterectomy. INTERVENTION: A standard questionnaire sent to all 233 patients a minimum of 12 and maximum of 24 months after hysterectomy. MEASUREMENTS AND MAIN RESULTS: Data obtained on sexual function were classified by changes (improved, no change, deteriorated) before and after hysterectomy. No significant difference was found between groups in mean time interval between surgery and first intercourse. Overall, over two-thirds of women experienced either no change or improvement in sexual function regardless of which procedure was performed, with no statistically significant differences in changes in libido, frequency of coitus, frequency of orgasm, and degree of orgasm. CONCLUSIONS: Women who underwent CISH and total hysterectomy had no statistically significant differences with regard to postoperative sexual function.

Adult↗
PubMed2006

Pharmacologic treatment strategies for sexual dysfunction in patients with epilepsy and depression.

Sexual dysfunction is a frequently encountered comorbid condition in patients with many medical and psychiatric conditions, such as epilepsy and depression. Most depressed patients experience some type of sexual dysfunction, decreased sexual desire being the most common. The association of sexual dysfunction with epilepsy is less clear. Changes in sex hormone levels are common in patients with epilepsy and may be attributable to the disease or to antiepileptic drugs (AEDs). Sexual dysfunction associated with depression or epilepsy is generally treated according to standard guidelines for the management of sexual disorders, since data from special populations are not available. The most common forms of female sexual dysfunction are lack of sexual desire and difficulty achieving orgasm. There are no approved pharmacotherapies for female hypoactive sexual desire disorder or female orgasmic disorder. Female sexual arousal disorder is treated with estrogen replacement therapy when indicated or vaginal lubricants. The most common male sexual dysfunction disorders are premature ejaculation and erectile dysfunction. Phosphodiesterase type-5 inhibitor drugs are now the first-line treatment for erectile dysfunction, and selective serotonin reuptake inhibitors and topical anesthetic creams are nonapproved but effective treatments for premature ejaculation. Testosterone and aromatase inhibitors have been used investigationally to treat sexual dysfunction in men taking AEDs. Patient education and follow-up appointments are essential to ensure optimal outcomes of pharmacologic treatments for sexual dysfunction.

Anticonvulsants↗
PubMed2001

Prevalence of sexual dysfunctions: results from a decade of research.

Ten years of research that has provided data regarding the prevalence of sexual dysfunctions is reviewed. A thorough review of the literature identified 52 studies published in the 10 years since an earlier review by Spector and Carey (Arch. Sex. Behav. 19(4): 389-408, 1990). Community samples indicate a current prevalence of 0%-3% for male orgasmic disorder, 0%-5% for erectile disorder, and 0%-3% for male hypoactive sexual desire disorder. Pooling current and 1-year figures provides community prevalence estimates of 7%-10% for female orgasmic disorder and 4%-5% for premature ejaculation. Stable community estimates of the current prevalence of other sexual dysfunctions remain unavailable. Prevalence estimates obtained from primary care and sexuality clinic samples are characteristically higher. Although a relatively large number of studies has been conducted since the earlier review, the lack of methodological rigor of many studies limits the confidence that can be placed in these findings.

Humans↗
PubMed1999

The reported sex and surgery satisfactions of 28 postoperative male-to-female transsexual patients.

From 1980 to July 1997 sixty-one male-to-female gender transformation surgeries were performed at our university center by one author (A.M.). Data were collected from patients who had surgery up to 1994 (n = 47) to obtain a minimum follow-up of 3 years; 28 patients were contacted. A mail questionnaire was supplemented by personal interviews with 11 patients and telephone interviews with remaining patients to obtain and clarify additional information. Physical and functional results of surgery were judged to be good, with few patients requiring additional corrective surgery. General satisfaction was expressed over the quality of cosmetic (normal appearing genitalia) and functional (ability to perceive orgasm) results. Follow-up showed satisfied who believed they had normal appearing genitalia and the ability to experience orgasm. Most patients were able to return to their jobs and live a more satisfactory social and personal life. One significant outcome was the importance of proper preparation of patients for surgery and especially the need for additional postoperative psychotherapy. None of the patients regretted having had surgery. However, some were, to a degree, disappointed because of difficulties experienced postoperatively in adjusting satisfactorily as women both in their relationships with men and in living their lives generally as women. Findings of this study make a strong case for making a change in the Harry Benjamin Standards of Care to include a period of postoperative psychotherapy.

Adaptation, Psychological↗
PubMed2002

Central nervous system based neurogenic female sexual dysfunction: current status and future trends.

The amount of information available regarding the impact of various central nervous system disorders on female sexual function has greatly increased. In this article, the most recent information regarding brain and spinal cord disorders in human females is reviewed. Evidence from women with spinal cord injuries (SCIs) supports findings in able-bodied females that the sympathetic nervous system provides regulation of psychogenic sexual arousal. In women with SCIs, the ability to achieve orgasm persists in approximately 50%; however, there is a relative inability to achieve orgasm with complete disruption of the sacral reflex arc. These natural effects of injury should be considered when educating patients about neurogenic sexual dysfunction and when developing treatment protocols. Published research protocols aimed at improving sexual responsiveness and future possibilities for treatment of neurogenic sexual dysfunction are also discussed.

Brain Injuries↗
PubMed2002

Psychologic treatments for female sexual dysfunction: are they effective and do we need them?

Most successful treatments for sexual dysfunction are psychophysiological, in that physiological change circularly interacts with a psychological change. The topic of this article is female sexual dysfunction treatments that are psychologic, defined as interventions whose primary vector of action is initiated through psychological mechanisms in contrast to physiologic treatments initiated through a physical act on the body. In the enthusiasm for new physiologic approaches, there has been a strong tendency to overlook or dismiss the evidence that does exist for efficacious or promising psychologic treatments. Each diagnostic category of desire, arousal, orgasm, and pain disorders is briefly reviewed with respect to efficacious or effective criteria. The review shows there to be limited controlled research, with only orgasmic disorders meeting the more stringent "well established" criteria, promising but uncontrolled results for vaginismus and dyspareunia, minimal effectiveness data for hypoactive sexual desire disorder, and no available efficacy data on female sexual arousal disorder and sexual aversion. It is concluded that (a) since a psychologic treatment can and does impact sexual physiology, we need to continue to develop and test psychologic approaches both out of intellectual interest and out of respect for the choices patients require or prefer, (b) the prescription of a physiologic treatment which ignores the fact that human sexuality is infused with individual meaning may invite further interference with sexual functioning, and (c) future research would do well to test the efficacy of the psychologic and physiologic treatments, both separately and in combination, for female sexual dysfunction.

Female↗
PubMed2002

Patient-rating of distressful symptoms after treatment for early cervical cancer.

BACKGROUND: More refined information on sources of symptom-induced distress in a patient population can improve the quality of pretreatment information, make follow-up visits more efficient and guide research priorities in the efforts to modify treatments. METHODS: In a population-based epidemiological study covering all of Sweden, data were collected 1996-97 by means of an anonymous postal questionnaire. We attempted to enroll all 332 patients with stage IB-IIA cervical cancer registered in 1991-92 at the seven departments of gynecological oncology in Sweden. RESULTS: A total of 256 cases (77%) completed the questionnaire. After surgery, alone or in combination with intracavitary radiotherapy, several symptoms related to sexual dysfunction are the primary sources of symptom-induced distress (reduced orgasm frequency: much distress 23% (surgery alone) and 23% (intracavitary radiotherapy and surgery), respectively, overall intercourse dysfunction: much distress 17% and 20%, respectively, followed by lymphedema (much distress 14% and 14%, respectively). Dyspareunia (much distress 24%) and defecation urgency (much distress 22%) are two leading causes of distress after surgery and external radiotherapy. After treatment with radiotherapy alone, loose stool and dyspareunia were the two most distressful symptoms (much distress 19% each). When a symptom occurs, fecal leakage and reduced orgasm frequency are the two most distressful ones (measured as much distress, 38% each). CONCLUSIONS: The observed symptoms are distressful and should, if one focuses on patient satisfaction, be given priority.

Adult↗
PubMed2002

Sexual disabilities are not singularities.

This report is based on a survey (performed 1996) of sex life in a nationally representative sample of Swedish women (n=1335) and men (n=1475) aged 18-74 y. From that survey we have previously reported on prevalence of sexual disabilities and problems caused by them (1). The main object of this article is to describe intra- and inter-gender concurrence of sexual disabilities and problems in sexually active subjects. Furthermore, the relative risk of low level of sexual well-being as predicted by sexual disabilities and distress is addressed. Respondents (59% of target sample) participated in an investigation which combined structured interviews with questionnaires/checklists. Main results are that within and across genders sexual disabilities concur to significant degrees. Of the women 48 and 26% reported at least one own and partner sexual disability or distress caused by them, respectively. For the men the corresponding proportions were 26 and 17%, respectively. Odds ratios showed that for the women low sexual interest, difficulties in obtaining orgasm and partner's early ejaculation were significant predictors of low level of sexual well-being. For the men low level of interest and partner's difficulties in obtaining orgasm were the only, but equally powerful, predictors. It is concluded that in clinical practice and for those who have a partner, sexual disabilities and distress caused by them should be regarded from the partner relationship perspective.

Adult↗
PubMedDate not supplied

Sexual dysfunction in women partners of men with erectile dysfunction.

We evaluated 113 female partners of men with erectile dysfunction (ED) attending a sexual dysfunction clinic in order to define sexual dysfunction among these women. In all, 51 (45%) women denied having any sexual dysfunction. The other 62 (55%) responded to questions classifying their complaint(s) according to the international classification of female sexual dysfunction (FSD) in the following topics (40/62, 65%, reported having more than one problem): decreased sexual desire (n=35, 56%), sexual aversion (none), arousal (n=23, 37%) and orgasmic disorders (n=39, 63%), dyspareunia (n=19, 31%), vaginismus (n=3, 5%), and noncoital sexual pain (none). Many female partners of men with ED report having some form of sexual disorder, mostly orgasmic problems and decreased sexual desire. Therefore, for optimal outcome of ED treatment, evaluation and treatment of male and FSD should be addressed as one unit within the context of the couple, and be incorporated into one clinic of sexual medicine.

Erectile Dysfunction↗
PubMedDate not supplied

Prevalence and factors of sexual problems in Chinese males and females having sex with the same-sex partner in Hong Kong: a population-based study.

A cross-sectional, anonymous telephone survey was conducted to examine sexual problem (SP) among sexually active, Chinese homosexual adults in Hong Kong. Of the homosexual respondents, 49.1% of males and 75.6% of females reported at least one SP, of whom 36.0 and 65.7% of the males and females, respectively, felt very bothered by the SP. The prevalence of SP ranged from 3.6% (pain) to 21.8% (premature orgasm) for men and from 16.9% (anxiety) to 39.3% (lubrication problems) for females. Female homosexuals were less likely to be satisfied with their sex life and more bothered by an SP than heterosexual females and homosexual males. There were few significant differences between homosexual and heterosexual males. Female homosexuals were also more likely than male homosexuals to experience lack of orgasm and pain during intercourse. Being bothered by SP was associated with erectile dysfunction among homosexual men and lubrication problems and lack of pleasure among the homosexual women.

Adolescent↗
PubMed2006

Influence of weight reduction by sibutramine on female sexual function.

BACKGROUND: It is well known that selective serotonin reuptake inhibitors (SSRIs) can cause sexual dysfunction, so it is possible that sibutramine, a serotonin and norepinephrine reuptake inhibitor, could induce sexual dysfunction. DESIGN AND SUBJECTS: The effect of sibutramine on sexual function was evaluated in 46 overweight and obese (body mass index (BMI) > or = 23 kg/m2) but otherwise healthy married women (28-44 years). Participants were randomly assigned at baseline to either the sibutramine or control group. The Female Sexual Function Index (FSFI) questionnaire was used to assess sexual function at baseline and after treatment with behavioral therapy plus sibutramine 10 mg once daily or behavioral therapy alone (control) for 8 weeks. RESULTS: Mean weight loss from baseline to week 8 was -6.03% in sibutramine group and -0.38% in the control group. There was significant improvement of FSFI total score, arousal domain score and lubrication domain score in the sibutramine group (P<0.05), and significant differences in arousal, orgasm, satisfaction domain score and total score (P<0.05) in favor of sibutramine. Decreases in body weight and BMI were correlated with the improvement of arousal (r = -0.44 and r = -0.48, respectively) and orgasm (r = -0.45 and r = -0.46, respectively) domains. CONCLUSION: Treatment with sibutramine plus behavioral therapy did not induce sexual dysfunction and sibutramine-induced weight reduction appeared to have a positive impact on sexual function in this small group of overweight and moderately obese women. The degree of improvement in sexual function was correlated with the degree of weight reduction.

Adult↗
PubMed2001

Assessment of male sexual function.

Sexuality is a complex entity involving several aspects, including desire, libido, pleasure, sexual life, intercourse, erection, ejaculation, orgasm, happiness and bother. Sexuality can be assessed through patient-doctor interviews as well as through self-completing questionnaires. A number of these have been validated and translated into several languages. It is important that such questionnaires are simple and easy for the patient to complete. One commonly used instrument is the International Index of Erectile Function (IIEF), which involves 15 questions on five domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. This has recently been simplified to five questions (IIEF-5). A number of questionnaires, such as the modified Danish Prostatic Symptom Score (DAN-PSS) and International Continence Society sex (ICSsex), take into account the bother caused by sexual dysfunction. There is expected to be an increasing number of sexually active men consulting with lower urinary tract symptoms (LUTS) as the population ages. Evidence suggests that the severity of LUTS is linked with sexual dysfunction and consequently this significant aspect of life for men of all ages should be taken into consideration in the management of LUTS associated with benign prostatic hyperplasia (BPH).Prostate Cancer and Prostatic Diseases (2001) 4, S7-S11

Journal Article↗
PubMed2001

Efficacy, safety and predictive factors of therapeutic success with sildenafil for erectile dysfunction in patients with different spinal cord injuries.

STUDY DESIGN: Multicenter, open, prospective, before-after study. OBJECTIVE: To assess the efficacy and safety of sildenafil therapy for erectile dysfunction in patients with spinal cord injury, and the association between the response to sildenafil and factors such as causes and levels of spinal cord injury, grade of ASIA deficit, time since injury, orgasmic perception, and degree of baseline erection. SETTING: Homes of outpatients of 16 spinal cord injury units in Spain. METHOD: One hundred and seventy patients with erectile dysfunction secondary to spinal cord injury, from whom baseline data were collected on their sexual function, and who started treatment with sildenafil 50 mg. An efficacy assessment was made by the patient and his partner, and the score of the International Index of Erectile Function (IIEF) was recorded. RESULTS: It was reported by 88.2% of the patients and 85.3% of their partners that treatment with sildenafil had improved their erections, regardless of the baseline characteristics of the spinal cord injury and erectile function. In responders, this improvement was confirmed by an increase from 12.5 to 24.8 points (P<0.001) of the Erectile Function Domain of IIEF. A significant improvement was also seen in patients' satisfaction with sexual activity and general satisfaction derived from sexual life. Preservation of orgasmic perception and a baseline degree of erection of 3 or 4 (P=0.006) were predictors of therapeutic success. No serious adverse events occurred. CONCLUSION: Sildenafil is an effective, well-tolerated treatment for erectile dysfunction caused by spinal cord injury, regardless of the cause, neurological level, ASIA grade, and time since injury. SPONSORSHIP: Spanish Society of Paraplegia.

Adult↗
PubMed2005

Sexual issues in a sample of women with spinal cord injury.

STUDY DESIGN: Semistructured interview. OBJECTIVES: To assess the degree of participation in sexual intercourse of a sample of women with spinal cord injury (SCI) in our community, to establish to what extent their sexual lives have been affected in comparison to before the injury, and to search for those factors that may have a major influence on both aspects. SETTING: Spinal Cord Injuries Unit, A Coruna, Spain. PARTICIPANTS: A total of 37 women, average age 40 years, time since onset average 10 years. RESULTS: In all, 62% claimed regular sexual activity after the injury. The women who suffered the injury before reaching the age of 18 years run a higher risk of not having physical relationships than those who were above that age when they incurred the SCI (P=0.04, OR 4.75). We discovered a significant drop in the frequency of intercourse (P=0.003) and the ability to reach an orgasm (P=0.008), after the injury. Of these women, 69% were satisfied with their current sexual activity and 77.4% considered the information they received from their doctors on the changes the SCI would cause in their sexuality to be either insufficient or nonexistent. CONCLUSIONS: There is a noticeable decrease in the frequency of intercourse as well as a significant reduction in the capability of reaching orgasm. Despite these changes and problems that ensue during intercourse as a result, most show satisfaction with their current sexual lives. On the other hand, the occurrence of the injury before the age of 18 years may imply a greater risk of not having an active sex life in adult years. We consider it is essential to provide the appropriate sexual information during the process of rehabilitation, aimed at helping women with SCI to adapt to their new situation.

Adaptation, Psychological↗
PubMed2006

Phosphodiesterase inhibitors in the treatment of erectile dysfunction in spinal cord-injured men.

STUDY DESIGN: Open, before-after study. OBJECTIVE: To assess the efficacy and safety of phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction (ED) in spinal cord-injured (SCI) patients. SETTING: Home- and clinic-based assessments in the outpatient department at the Centre Bouffard Vercelli, Cerbère France. METHODS: Clinic trials with Sildenafil (Viagra) on 120 patients, Tadalafil (Cialis) on 54 patients and Vardenafil (Levitra) on 66 patients were performed. Flexible doses of PDE5 inhibitors were given depending on efficacy and tolerability, from 50 to 100 mg for Sildenafil, and from 10 to 20 mg for Vardenafil and Tadalafil. Each trial was performed after a week's interval. The efficacy was self-assessed by the patients on a six-point quantitative scale assessment. The response to treatment was assessed at home in 90 patients (57 patients on Sildenafil, 12 patients on Vardenafil and 21 patients on Tadalafil) using the International Index of Erectile Function (IIEF). RESULTS: In clinic trials, PDE5 inhibitors were effective (rigidity enough for penetration) in 85% of the patients on Sildenafil, 74% of the patients on Vardenafil and 72% of the patients on Tadalafil. The mean duration of erection was 34, 28 and 26 min, respectively. Adverse effects were mild, usually attenuated with continued dosing. More than 70% of the patients on Vardenafil and Tadalafil required higher doses of 20 mg, whereas 50 mg of Sildenafil was effective in 55% of the patients. Two-thirds of our patients on Tadalafil reported a duration of action longer than 24 h. The presence of an upper motor neuron lesion was significantly associated with therapeutic success, lower motor neuron lesions and cauda equina patients were poor responders. Other variables such as completeness of lesion had no impact. In the follow-up visits, the IIEF global scores and three IIEF domains (erectile function, intercourse satisfaction and overall satisfaction) were significantly improved in all patients. Patients on Sildenafil showed a significant improvement of orgasmic function, ejaculation (Question 9) and orgasm (Question 10). CONCLUSION: Sildenafil, Vardenafil and Tadalafil are all effective and well-tolerated treatments for ED in SCI patients. Although no statistical analysis could be applied on these data, these results might indicate that Sildenafil is more effective in treating ED. Clinic trials are important for proper dose titration and appropriate education of the patients.

Adult↗
PubMed2001

Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery.

BACKGROUND: The introduction of total mesorectal excision (TME) has been shown to improve local recurrence rates in rectal cancer. The present study investigated the impact of this more extensive and radical procedure with regard to autonomic pelvic nerve function. METHODS: Patients with resected primary rectal cancer were interviewed by means of a questionnaire asking about preoperative and postoperative urinary bladder and genital function. The results in patients after rectal cancer surgery without TME (group 1; n = 29) were compared with those obtained after introduction of the TME technique (group 2; n = 31). Patients in group 2 were older and had a lower level of anastomosis than patients in group 1. Other patient, treatment and tumour characteristics were comparable between the groups. RESULTS: : Newly acquired and permanent symptoms of bladder dysfunction after rectal excision were present as follows (group 1 versus group 2): difficulty in bladder emptying 7 versus 19 per cent; sensation of incomplete bladder voiding 17 versus 17 per cent; urgency 17 versus 14 per cent; incontinence 10 versus 3 per cent; dysuria 7 versus 7 per cent; and dribbling 14 versus 8 per cent. Male patients stated the following sexual functions before operation/after operation in group 1 versus group 2: interest in sex 80 per cent/40 per cent versus 63 per cent/37 per cent; sexually active 67 per cent/7 per cent versus 53 per cent/22 per cent; impotence 75 per cent/6 per cent versus 58 per cent/26 per cent; ability to have intercourse 75 per cent/13 per cent versus 67 per cent/29 per cent; ability to achieve orgasm 88 per cent/13 per cent versus 76 per cent/47 per cent; and orgasm with ejaculation 88 per cent/9 per cent versus 76 per cent/53 per cent. CONCLUSION: While both conventional rectal cancer surgery and TME result in similarly favourable postoperative bladder function, both techniques decrease sexual function. However, TME offers a significant advantage with regard to preservation of postoperative sexual function in men and constitutes a true advance in rectal cancer surgery compared with conventional techniques.

Aged↗
PubMed2000

Surgical conversion of genitalia in transsexual patients.

OBJECTIVE: To describe the techniques and outcome of genital and urethral reconstructive surgery during gender conversion as part of the treatment of transsexuals. PATIENTS AND METHODS: From 1992 to 1999, 82 patients were surgically converted after previous sexual and hormonal therapy. Using the male genital tissue to create new female genitalia, and vice versa, 30 male and 52 female transsexuals were converted. For male-to-female transsexuals, the technique of penile skin inversion was used 29 times and sigmoidocolpoplasty five times (in one patient primarily and in four patients to correct inadequate neovaginal size after penile skin inversion). In female-to-male transsexuals, 28 meta-idoioplasties and seven neophalloplasties were performed using the groin skin-flap technique, with 42 breast reductions also included as a part of the therapy. RESULTS: Surgical gender reassignment of the male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm. Depending on the technique used in the reverse conversion, the patient maintained the ability to attain orgasm, and in many cases had a satisfactory appearance of the neopenis, with the potential to void while standing. CONCLUSIONS: The morphological proportions of each patient vary, and the different shapes and sizes of the tissues can be used for plastic operations. Thus the modelling of each individual genital in transsexuals can be considered 'original'.

Adolescent↗
PubMed2001

Erectile dysfunction in uremic dialysis patients: diagnostic evaluation in the sildenafil era.

The two words that mean sexual dysfunction, impotence and erectile dysfunction (ED), express two different concepts. Impotence is a general male sexual dysfunction that includes libidinal, orgasmic, and ejaculatory dysfunction. ED is the inability to achieve or maintain an erection sufficient to allow satisfactory sexual intercourse and is part of the general male sexual dysfunction termed impotence that includes libidinal, orgasmic, and ejaculatory dysfunction. Uremic men of different ages report a variety of sexual problems, including sexual hormonal pattern alterations, reduction in or loss of libido, infertility, and impotence, conditioning their well-being status. In evaluating and treating sexual dysfunction, a nephrologist must consider factors involved in its pathogenesis, such as hypothalamic-pituitary-gonadal axis alterations, psychological problems related to chronic disease, secondary hyperparathyroidism, anemia, autonomic neuropathy, derangements in arterial supply or venous outflow, and the normal structure of cavernous body smooth muscle cells. The introduction of sildenafil to treat impotent patients has completely changed the approach to evaluating these subjects because this drug is considered an effective well-tolerated treatment for men with ED. In the past, we proposed an algorithm that gave the opportunity to explore the previously mentioned factors using such instrumental interventions as the nocturnal penile tumescence test, penile echo color Doppler, nervous conduction velocity, and cavernous body biopsy, addressed to prescribe needed surgical or medical interventions. The complexity of the proposed algorithm requires many diagnostic procedures and much time and economic resources to localize the pathological lesions responsible for ED. Because of the new oral drug sildenafil, we propose a new algorithm to test the possibility of obtaining an erection and classify patients as responders or nonresponders to the sildenafil test.

Bromocriptine↗