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PubMed2005

Clinical biologic pathophysiologies of women's sexual dysfunction.

INTRODUCTION: Data concerning the biologic pathophysiology of desire, arousal, and orgasm in women are limited. AIM: To gain knowledge of biologic pathophysiology of female sexual function. METHODS. To provide state-of-the-art knowledge concerning female sexual dysfunction, representing the opinions of seven experts from five countries developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURE: An International Consultation in alliance with key urological and sexual medicine societies convened over 200 multidisciplinary specialists from 60 countries into 17 consultation committees. The aims, goals and intentions of each committee were defined. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee dialogue, open presentation, and debate. RESULTS: Three critical physiologic requirements, including intact sex steroids, autonomic/somatic nerves, and arterial inflow/perfusion pressure to women's genital organs play fundamental roles in maintaining women's sexual function. Despite this, there are nominal data supporting a direct pathophysiologic involvement of abnormal sex steroid values, and/or damage/injury to neurologic and/or blood flow integrity in women with problems in sexual desire, arousal, and/or orgasm. This summary details the available literature concerning hormonal, neurologic, and vascular organic pathophysiologies of women's sexual dysfunctions. CONCLUSIONS: Additional research on clinical pathophysiologies in women's sexual dysfunction is needed. This chapter encompasses data presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.

Antidepressive Agents↗
PubMed2005

Persistent sexual arousal syndrome: a descriptive study.

INTRODUCTION: Persistent sexual arousal disorder (PSAS) is a poorly documented condition characterized by persistent genital arousal in the absence of conscious feelings of sexual desire. AIM: To determine whether there are replicable features associated with PSAS, to describe salient characteristics of women reporting this condition, and to determine predictors of distress. METHODS: A 46-item Internet survey containing demographic information, symptom description, triggers, exacerbation and relief measures, distress ratings, and life and sexual satisfaction was placed on a secure server. MAIN OUTCOME MEASURES: Frequency analyses of descriptive data, and stepwise multiple regression analysis to identify independent predictors of level of distress. RESULTS: Of the 103 respondents, most were in good health, well educated, and in long-term relationships. Ninety-eight percent of respondents met at least one criterion for PSAS and 53% met all five criteria. Involuntary genital and clitoral arousal persisting for extended time periods, genital arousal unrelated to subjective feelings of sexual desire, and genital arousal not relieved with orgasms were the most frequently endorsed features associated with this syndrome. Symptom triggers included sexual stimulation, masturbation, stress, and anxiety. Distress about the condition was low in 25%, moderate in 35%, and high in 40% of respondents. The strongest predictors of distress were intrusive and unwanted feelings of genital arousal (P < 0.0001), continuous symptoms (P < 0. 001), feelings of unhappiness (P < 0.03), shame (P = 0.0001) and worry (P = 0.01), reduced sexual satisfaction (P < 0.004), enjoyment of symptoms some of the time (P = 0.01), and relationship status (P < 0.004). CONCLUSIONS: The results of this research support the description of a condition (persistent sexual arousal) involving involuntary genital and clitoral arousal unrelated to subjective feelings of sexual desire which persists despite one or more orgasms and which usually feels intrusive and unwanted. Varying levels of distress were identified with this condition as well as a variety of primarily negative emotional reactions.

Adolescent↗
PubMed1995

Sexual function in women with advanced multiple sclerosis.

Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eight (59.6%) of the women reported decreased sexual desire. Seventeen (36.2%) reported decreased lubrication. Five (10.6%) others did not know if they lubricated or not. Eighteen women (38.3%) reported diminished orgasmic capacity and six (12.8%) others had never had an orgasm. Sensory dysfunction in the genital area was experienced by 61.7% of the women and 76.6% had weakness of the pelvic muscles. Sixty six per cent had bowel problems and 89.4% had bladder dysfunction. The changes in sexual function correlated both with neurological symptoms from the sacral segments, such as weakness of the pelvic floor and bladder and bowel dysfunction, and to other symptoms such as ataxia and vertigo as well as with age and the occurrence of amenorrhoea. A significant correlation was found between expanded disability status scale (EDSS) score and cohabitation. Problems with sexual function were reported significantly more often by women with lower EDSS scores. Most women (83%) found the interview a positive experience.

Adult↗
PubMedDate not supplied

Toronto Alexithymia Scale in outpatients with sexual disorders.

The Toronto Alexithymia Scale (TAS-26) was administered to patients with sexual disorders (n = 112) and to healthy control subjects (n = 94). The clinic sample was divided into three subgroups according to DSM-III-R criteria: patients with hypoactive sexual desire disorder (n = 41), patients with orgasm disorders (n = 51) and patients with male erectile disorder (n = 20). TAS scores were significantly higher for male and female patients with hypoactive sexual desire disorder, and with male erectile disorder than controls. The TAS scores in the orgasm disorder patients were not significantly different from those of controls. These results are interesting because they show an association betweeen alexithymia and some sexual symptoms.

Adult↗
PubMed2004

The prevalence of female sexual dysfunction and potential risk factors that may impair sexual function in Turkish women.

OBJECTIVES: To detect the prevalence of sexual dysfunction, and also to investigate possible risk factors that may cause sexual dysfunction in the Turkish women. MATERIALS AND METHODS: The study consisted of 179 women between the ages of 18 and 66 years living in households from different sociocultural areas. The women were divided into 5 groups according to their ages: 18-27 years (n = 23), 28-37 years (n = 55), 38-47 years (n = 43), 48-57 years (n = 44) and 58-67 years (n = 14). Female sexual function was evaluated with a detailed 19-item questionnaire to assess desire, arousal, lubrication, orgasm, satisfaction and pain. The prevalence of sexual dysfunction was calculated for each domain and compared among the groups. In addition, demographic characteristics and medical risk factors were assessed in all women, and the findings were compared between the women with and without sexual dysfunction. RESULTS: Based on total sexual function score, 84 (46.9%) out of 179 women had sexual dysfunction. The prevalence of female sexual dysfunction was 21.7% in the ages of 18-27 years, 25.5% in the ages of 28-37 years, 53.5% in the ages of 38-47 years, 65.9% in the ages of 48-57 years and 92.9% in the ages of 58-67 years. The prevalence of sexual dysfunction for each domain also increased with age. To investigate various factors that may cause female sexual dysfunction, no significant differences were detected in smoking history (p = 0.14), marriage age (p = 0.7), the presence of previous pelvic surgery (p = 0.09), and contraception methods used (p = 0.31). However, sexual dysfunction was observed as significantly higher in the presence of older age (p = 0.001), lower educational level (p = 0.012), unemployment status (p = 0.017), chronic disease (p = 0.032), multiparity (p = 0.0027) and menopause status (p = 0.0001). CONCLUSIONS: The prevalence of female sexual dysfunction including desire, arousal, lubrication, orgasm, satisfaction and pain problems increases with age. In addition, the presence of a lower educational level, unemployment status, chronic diseases, multiparity and menopause status are important risk factors that may cause sexual dysfunction.

Adolescent↗
PubMed1980

[Sex life after radical operations for cervical cancer].

75 sexual active women with invasive cervical carcinoma up to 55 years of age were treated by radical hysterectomy, part of them also with postoperative irradiation. Of primary interest were interviews with those 57 women (87,7%) whose marital relationship was not disturbed in the postoperative phase. No harmony in the partnership was found in 7,7%, manifestation occurred within 1 year after treatment. The causes were in many cases of psychosomatic nature. Reduced libido was found in 60,8%, 62,0% had their first sexual relationship within 3 months after treatment. No orgasm was reported before operation by 7,6%, by 23% after operation. 57,7% had sexual climax always or mostly after treatment. Reduced orgasm was rare in those women, whose partnership was not disturbed. Frequency of cohabitations was reduced. 11,5% reported preoperative painful coitus, 50,8% postoperative. The interviews of women by means of standardized questionnaires should become a routine measure within the rehabilitation and postoperative control program of gynecologic cancer patients. The establishment of self-help groups is recommended in order to control also the psychosocial components of the disease.

Adult↗
PubMed1987

On desire, excitement, and impotence in modern sex therapy.

The widely accepted DSM-III classification of sexual dysfunctions has reinforced the idea that it concerns easily distinguishable deficiencies in the 'normal' phases of the sex response cycle: desire, excitement, and orgasm. For each of these deficiencies sex therapists offer a standard treatment package by which clients can learn to restore the 'natural' response pattern. As such, treatment has become a matter of techniques and so has sexuality itself. Acting as psychotechnologists, many sex therapists show an almost insatiable 'desire' to improve their clients' sexual performance and they experience the 'excitement' of their therapeutic work in counting the number of orgasms their clients are able to reach. But facing the problem of inhibited sexual desire, a lot of sex therapists must admist their 'impotence' in this matter. What they do not seem to realize is that their performance-oriented approach enhances a sociocultural climate in which people lose interest in preprogrammed sex, because sexual lust has turned from a taboo into a 'must'.

Arousal↗
PubMed2001

Efficacy of sildenafil citrate for the treatment of erectile dysfunction in men taking serotonin reuptake inhibitors.

OBJECTIVE: This study was an evaluation of whether sildenafil citrate is effective for the treatment of erectile dysfunction in men taking concomitant serotonin-reuptake-inhibiting antidepressants. METHOD: A retrospective subanalysis of combined data from 10 phase II/III double-blind, placebo-controlled, fixed- and flexible-dose trials (12-26 weeks) identified a group of men with erectile dysfunction receiving 5 to 200 mg/day of sildenafil (N=65) or placebo (N=33) and concomitant serotonin-reuptake-inhibiting antidepressants. Efficacy was measured by responses to questions from the International Index of Erectile Function on ability to achieve erection, ability to maintain erection, ejaculation frequency, orgasm frequency, and sexual desire. RESULTS: Patients with erectile dysfunction receiving sildenafil and concomitant serotonergic antidepressants had significantly greater improvements in ability to achieve and maintain an erection, frequency of ejaculation, and orgasm frequency than did patients receiving placebo, without increased sexual desire. CONCLUSIONS: Sildenafil significantly improved erectile dysfunction in patients taking concomitant serotonergic antidepressants.

Major Depressive Disorder↗
PubMed1994

Sexual disorders in Huntington's disease.

This study assessed the frequency and type of sexual disorders associated with Huntington's disease (HD) in an unbiased sample. Of 39 HD patients and 32 of their partners, 82% and 66%, respectively, had one or more sexual disorders by DSM-III-R criteria. The most frequent for both groups was hypoactive sexual disorder. Significantly more patients who had both inhibited orgasm and increased sexual interest also had paraphilic disorders. Findings support the hypotheses that sexual disorders are frequent among HD patients and their partners and that sexual disorders among HD patients may take the form of increased sexual interest or paraphilias. The association between inhibited orgasm, increased sexual interest, and paraphilic disorders will require further investigation but suggests a possible etiology for some paraphilias.

Adult↗
PubMed1981

The role of breast-feeding in psychosexual development and the achievement of the genital phase.

1. The role of the neurohormone oxytocin is a physiological factor in the reproductive cycle of coitus, birth, breast-feeding, the milk-ejection reflex, nipple erotism, and female sexual responsiveness. 2. The capacity for "motherliness," the attributes of empathy, consideration, confidence, and love are dependent on the level of psychosexual, ego, and superego maturity of the mother as well as on the pattern of mothering she experienced as a child. 3. The satisfaction of the oral hunger-satiation cycle is essential. Without it, even the most satisfactory maternal environment proves insufficient and results in serious ego constriction. 4. Bottle-feeding, as breast feeding, may offer a relatively satisfactory solution to the basic, physiological, hunger-satiation cycle and may fulfill, to a limited extent, the libidinal requirements of the crucial oral phase, depending on the psychosexual maturity and ego and superego development of the mother. 5. However, breast-feeding alone provides the experience of the original primal scene on which the later primal scene is based. 6. The breast-feeding capacity in itself is no more an indication that psychosexual maturity and the genital phase have been achieved than is the ability to achieve vaginal orgasm (or genital orgasm, in the male). 7. Sherfey's (1966) findings notwithstanding, Freud's (1925) statement that the elimination of clitoral primary (not participation) is essential for the development of femininity remains valid.

Breast Feeding↗
PubMed1975

Psycho-sexual disorders and their treatment: Part II.

In a previously published part of this review the historical and aetiological aspects of sexual inadequacy were considered and an account given of vaginismus. The main problems found in patients with erective and orgasmic dysfunction were also discussed. In this second part, the author considers the conditions of premature ejaculation and ejaculatory incompentance as well as discussing erective and orgasmic incompetence in more detail. Behavioural and other psychotherapeutic measures are considered and a brief review is made of the use and value of drug therapy in patients with sexual dysfunction.

Adolescent↗
PubMed1998

Definition and classification of female sexual disorders.

The diagnosis and classification of female sexual disorders has undergone significant changes over the last fifty years as a function of changing societal expectations for female sexual conduct, available knowledge about sexual psychophysiology and actual clinical practice. Currently, female sexual disorders are conceptualized as disturbances in desire, arousal, or orgasm as well as sexual pain disorders which include dyspareunia and vaginismus. The lack of objective, empirically-grounded criteria for diagnosis as well as the comorbidity of female sexual disorders contributes to the lack of reliability in the diagnosis of female sexual complaints. At the present time, hypoactive sexual desire disorder is the most commonly diagnosed female sexual disorder followed by female orgasmic disorder. Nevertheless, the major clinical complaints among women center on their dissatisfaction with such non-genital behaviors as affection, communication, and non-genital touching as well as issues of attraction and passion. These factors should be assessed as well as genital response for greater validity in evaluating female sexual disorders in both research and clinical practice.

Female↗
PubMed2005

Methadone maintenance and male sexual dysfunction.

PURPOSE: This study reports the prevalence and types of sexual dysfunction in a sample of men on methadone maintenance for opioid dependence, and describes factors which may contribute to sexual dysfunction. METHODS: 92 opioid-dependent men were recruited from a methadone maintenance clinic and completed two questionnaires, a research interview and laboratory measures. RESULTS: Fourteen percent reported some sexual dysfunction. Erectile dysfunction (r = 0.24, p = 0.020), libido dysfunction (r = 0.30, p = 0.003), and global dysfunction (r = 0.26, p = 0.013) increased with increasing age of the patient. Methadone dose showed a significant direct correlation with increased orgasm dysfunction, both before and after adjusting for duration of treatment (p = 0.012). None of the sexual dysfunction subscales or global dysfunction were associated with plasma testosterone or plasma prolactin levels. CONCLUSIONS: The rate of global sexual dysfunction in methadonetreated men is similar to general population studies and should be evaluated using general population guidelines. Orgasm dysfunction is a special case and may respond to methadone dose reduction.

Adult↗
PubMed2003

Emerging therapies for female sexual dysfunction.

Epidemiological studies in the US, the UK and Sweden indicate that approximately 40% of women aged 18 - 59 have significant complaints about their sexual lives. The majority of complaints concern low sexual desire. Other common problems include difficulty reaching orgasm, insufficient lubrication and painful coitus. A vacuum erection device which increases blood flow to the clitoris has been approved by the US Food and Drug Administration. There are no pharmacological agents with approval for the treatment of female sexual dysfunction. Phosphodiesterase inhibitors and other drugs which cause genital vasocongestion in women appear to have minimal clinical efficacy. Although many of these agents increase the vasocongestive response to sexual stimulation, there is minimal correlation between subjective and objective measures of sexual arousal in women. Trials with androgens have clearly and convincingly demonstrated that supraphysiological doses of testosterone increase libido in postmenopausal women. The long-term safety of such doses is unclear. To date, no studies have shown lower doses of androgens to be beneficial. There have been minimal studies of drugs targeting the central nervous system to date. Bupropion may have a beneficial effect on orgasm attainment in women with hypoactive sexual desire disorder.

Androgens↗
PubMedDate not supplied

The relationship between overactive bladder and sexual activity in women.

PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by > or = 60% of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25% of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.

Adult↗
PubMed1998

Psychotropic drug-induced sexual function disorders: diagnosis, incidence and management.

The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal) and orgasm. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies sexual disorders into 4 categories: (i) primary; (ii) general medical condition-related; (iii) substance-induced; and (iv) 'not otherwise specified' sexual dysfunctions. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases. Substance-induced sexual dysfunctions are caused by the use of either substances of abuse [alcohol (ethanol), amphetamines, cocaine, opioids or sedatives/hypnotics/anxiolytics], or prescription medications which include psychotropic drugs. Patients with psychiatric difficulties tend to experience more frequent sexual function disturbances. The literature provides more than anecdotal evidence that psychotropic drugs can induce sexual function disorders in the epidemiologically vulnerable population of psychiatric patients. Sexual dysfunctions caused by psychotropic drugs can be divided into 2 groups: sexual inhibition (inhibited desire, inhibited arousal and inhibited orgasm) and increased sexual function disorders (increased sexual desire, priapism and premature ejaculation). The diagnosis of psychotropic drug-induced sexual function disorders is easy if the psychiatrist is sensitive to the existence of these adverse effects. This mostly involves careful history taking, although several questionnaires have been developed for reliable and valid quantification of sexual functioning. Diagnosis is usually established if the sexual function disorders develop when the patient is receiving a psychotropic drug and then disappear when the offending drug is discontinued. The management of psychotropic-drug induced sexual inhibition can be divided into 6 steps: inform the patient about the possibility of sexual inhibition occurring before prescribing a psychotropic agent; wait for remission or tolerance of sexual inhibition; reduce the dosage of the psychotropic drug; switch the medication to one less likely to cause sexual inhibition; if possible, adjust the concomitant nonpsychotropic drugs; and add various pharmacological agents to the existing psychotropic drug to treat the sexual inhibition. Physicians should take sexual histories as a routine practice when prescribing psychotropic drugs. Through careful management and patience on the part of both the patient and the physician, psychotropic drug-induced sexual function disorders can be improved so that the patient's compliance with medication and quality of life can be optimised.

Female↗
PubMed2005

[Adjustment after a hysterectomy].

PURPOSE: This study examined the relationship between sexual changes and adjustment and identified the factors which affect adjustment after a hysterectomy. METHOD: The subjects were 89 women under 50 years of age registered at gynecology departments of general hospitals in Seoul. RESULT: 60.7% of the women restarted coitus during six weeks to three months post operation. They felt a decrease in vaginal secretions (68%), and abdominal and pelvic pain (59.8%), but 2/3 of them didn't change the frequency of coitus and level of orgasm. With respect to the adaptability of the sexual life, there was a significant difference in the time to restart coitus, lack of vaginal secretions, abdominal and pelvic pain, change of frequency of coitus, experience of orgasm, importance of sex and avoidance of coitus, according to job, income, and health condition. CONCLUSION: It is appropriate to restart coitus six weeks to three months after surgery and preliminary information should be given to patients after surgery as abdominal and pelvic pain could be relieved after twelve months. Also, sexual adjustment can be improved if they can recognize the changes after surgery from sexual life before surgery.

Adaptation, Psychological↗
PubMed2006

Bupropion extended release compared with escitalopram: effects on sexual functioning and antidepressant efficacy in 2 randomized, double-blind, placebo-controlled studies.

OBJECTIVE: To compare the effects on sexual functioning and the antidepressant efficacy of once-daily bupropion extended release (XL) and escitalopram in adults with major depressive disorder (MDD). METHOD: Adult outpatients with moderate to severe DSM-IV-defined MDD and normal sexual functioning were randomly assigned to receive bupropion XL (300-450 mg/day; N = 276), escitalopram (10-20 mg/day; N = 281), or placebo (N = 273) for up to 8 weeks in 2 identically designed, randomized, double-blind, parallel-group studies (study 1 conducted from February 6, 2003, to June 10, 2004; study 2 conducted from January 21, 2003, to June 15, 2004). Data were analyzed prospectively for each study individually, and pooled data were analyzed retrospectively. RESULTS: In both the individual studies and the pooled dataset, the incidence of orgasm dysfunction at week 8 (primary endpoint) and the incidence of worsened sexual functioning at the end of the treatment period were statistically significantly lower with bupropion XL than with escitalopram (p < .05), not statistically different between bupropion XL and placebo (p > or = .067), and statistically significantly higher with escitalopram than with placebo (p < or = .001). The percentages of patients with orgasm dysfunction at week 8 in study 1, study 2, and the pooled dataset, respectively, were 13%, 16%, and 15% with bupropion XL; 32%, 29%, and 30% with escitalopram; and 11%, 8%, and 9% with placebo. The respective percentages of patients with worsened sexual functioning at the end of the treatment period were 18%, 22%, and 20% with bupropion XL; 37%, 34%, and 36% with escitalopram; and 14%, 16%, and 15% with placebo. Mean changes in Changes in Sexual Functioning Questionnaire scores for all domains at week 8 were statistically significantly worse for escitalopram compared with bupropion XL (p < or = .05). Separation from placebo could not be established at a statistical .05 level for bupropion on 17-item Hamilton Rating Scale for Depression (HAM-D-17) total score. However, escitalopram showed statistical superiority to placebo on HAM-D-17 total score in one of the 2 studies and in the pooled data. Bupropion XL did not statistically differ from escitalopram with respect to mean change in HAM-D-17 total score, HAM-D-17 response or remission rates, percentage of patients much or very much improved on Clinical Global Impressions-Improvement scale scores, or mean changes in the Hospital Anxiety and Depression (HAD) scale total score or Clinical Global Impressions-Severity of Illness scale score at week 8. CONCLUSIONS: Bupropion XL had a sexual tolerability profile significantly better than that of escitalopram with similar HAM-D-17 remission rates and HAD total scores in patients with MDD.

Adult↗