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Although diabetes plays a significant role in causing impotence in the diabetic male, its effects on female sexuality have only recently been studied. Surprisingly, no demonstrable effect on the capacity for sexual arousal or orgasm has been found in the diabetic female. This paper compares male and female anatomy, physiology, and neurology, and speculates about reasons for this sex difference.
OBJECTIVE: To review the psychology and physiology of female sexual dysfunction (FSD) and explore current strategies for prevention and treatment. DATA SOURCES: Articles identified through a MEDLINE search using the term female sexual dysfunction. Additional references were identified from the bibliographies of retrieved articles. STUDY SELECTION: Investigational studies, clinical trials, and review articles examining female sexual dysfunction. DATA SYNTHESIS: FSD is a widespread problem that can arise from disorders of any component of female sexual response. These disorders are classified as problems with sexual desire, arousal, orgasm, and sexual pain. The dysfunction that characterizes these disorders may stem from a variety of factors, including psychologic issues surrounding sex and the effects of medications on female sexual response. Although pharmacists are unlikely to be involved in counseling patients about the psychologic aspects of sexual dysfunction, they can play a vital role in screening for and managing sexual adverse effects of medications. A variety of nonprescription, prescription, and investigational products may be of benefit for addressing the various types of disorders. CONCLUSION: Pharmacists who have a thorough understanding of female sexual response, potential causes of dysfunction, and accepted treatment strategies can help detect FSD and advise women about their options for managing this common problem.
We report on a woman with temporal lobe epilepsy and "orgasm sensation" like an epileptic aura. Literature is controversial about pleasure and ecstasy as an epileptic aura. Aura of pleasure in this case is confirmed, by clinical investigation, electroencephalogram and seizures remission with treatment (phenytoin).
The sexual response is a form of exercise which has strong biological and evolutionary components. Few studies have focused upon sexual behaviour as exercise and the reasons for this are considered. Current information and leads for future study come from animal research. Some historical precursors to modern sex researchers did more to mislead than to advance knowledge but Kinsey and Masters & Johnson set the stage for modern knowledge and applications. There are parallels between the orgasmic response and exercise. Physiological bases of the sexual response help to explain individual differences in sexual behaviour and the well-being that often accompanies states of passionate love, addiction and exercise. Studies suggest that sexual activity is associated with well-being and longevity, yet many health and exercise professionals fail to take account of sexual activity in advancing exercise programmes and executing studies; that is, the so-called Ostrich Effect persists. Investigators need to separate the passionate love stage of relationships which are biologically based and last 3 to 4 years from the later stages of long term committed partnerships in which sexual activity continues as a form of exercise, competence expression and fun.
Sexual dysfunction secondary to antidepressant drugs is an under-recognized clinical problem, and likely an important factor in noncompliance with treatment. We report two patients with anhedonic ejaculation (ejaculation without orgasm) associated with initiation of treatment with desipramine.
OBJECTIVE: We review the adverse effects on genitourinary and sexual function associated with antidepressants, neuroleptics, lithium, and benzodiazepines, and suggest treatment strategies that may be used for their management. METHOD: This article is based on systematic review of the existing literature, including more than 130 relevant articles on genitourinary and sexual effects of psychotropic medications. RESULTS: We find that genitourinary function, including effects on continence and flow, and sexual function, including libido, erection, ejaculation and orgasm, may be altered by psychotropic administration. Many of these effects may be consequent to the impact of these medications on neurophysiologic systems. CONCLUSIONS: Genitourinary and sexual adverse effects associated with psychotropic therapy are important areas of study and clinical concern that may affect patient comfort and compliance with treatment.
The effects of pregnancy and childbirth on sexuality were studied in 50 women. Dyspareunia was more common in primiparae, but in other respects the same reactions and changes in behaviour were reported by multiparous and primiparous women. Coital frequency and orgasmic capacity decreased during pregnancy. The period of abstinence from coitus before and after delivery varied considerably. During pregnancy 72% of the women experienced a waning of sexual desire. Three months after childbirth 20% of the women still had little desire for and a further 21% had a complete loss of desire for or aversion to sexual activity. Sexual desire increased for a few women both during pregnancy as well as after childbirth. Pre-disposing factors in relation to diminished desire are discussed. The role of Maternity Clinic staff in providing information and advice is emphasized.
Fetal heart rate and uterine activity were monitored during sexual intercourse in three otherwise normal gravid women at varying gestational ages. Increased uterine activity and a variety of fetal heart rate changes, some of which are traditionally identified as ominous, were seen in most instances immediately following orgasm. An increase in fetal activity was also commonly reported by the mothers. It is postulated that coitus is equivalent to an unmonitored contraction stress test.
OBJECTIVE: To investigate the predictive value of sacral nervous function, result of pelvic examination and hormonal status on sexuality before and after subtotal hysterectomy. MATERIAL AND METHOD: One hundred and four women were examined and interviewed one month before and one year after hysterectomy for non-malignant diseases. Genital examination, sacral nervous function testing including vibrotactility were performed, and sex hormone levels were estimated at each occasion. The results were evaluated and compared using multivariate analyses. RESULTS: Postoperative experience of multiple orgasm was negatively correlated to three out of five measured factors for pelvic sacral function: i.e. vibrotactility of the clitoris, the external anal reflex and the levator muscle strength. No correlations were found between tests for sacral nervous function and a latent factor for sexuality before and after the operation. Preoperative uterine size did not show correlation to either preoperative or postoperative sexual parameters nor did uterine pain during vaginal examination. The preoperative sex hormone levels, and the result of histopathological examination showed no correlation to sexual variables. CONCLUSION: Preoperative somatic findings including sacral nervous function and pelvic muscular strength cannot be used as predictors for sexuality after subtotal hysterectomy.
OBJECTIVE: To study the predictive value of the history of genital pain, psychiatric complaints and menstrual symptoms on a woman's sexual life before and after subtotal hysterectomy. MATERIAL AND METHOD: One hundred and four premenopausal women were interviewed one month before and one year after surgery. A latent variable for pre- and postoperative sexuality was constructed from the intercorrelation between the measured parameters of frequency of desire for sex, coital frequency, cyclicity of desire and existence of multiple orgasm, and other variables for genital pain, psychiatric morbidity and menstrual symptoms were compared to the latent factors for sexuality. RESULTS: No difference was seen in postoperative sexuality in women with and without a history of psychiatric complaints. The regular use of analgetics, a need to stay home from work because of menstruation, and the occurrence of dyspareunia were positively correlated to the latent factors for sexuality before and after the operation. A history of the need to use psychopharmaceuticals, such as sedatives or antidepressants, had a negative influence on preoperative, but not on postoperative sexuality. Dysmenorrhea had a positive influence on postoperative, but not on preoperative, sexuality. CONCLUSION: Among variables studied, dysmenorrhea was the best predictor for postoperative sexuality. That is: women with dysmenorrhea do not only invariably experience relief from the pain, but also have a chance to improve their sexual lives after removal of their malfunctioning uterus. Presence of psychiatric problems had, in general, little influence on sexuality.
Some of the known neuroanatomy and neurophysiology relevant to male sexual responses is briefly reviewed. A theory is presented which attempts to explain many of their properties. In particular, increases in chemical concentrations of neuroexcitatory chemicals due to stimulation of genital receptors leads by wave-like spread to ejaculation with orgasm as a concomitant. Threshold phenomena and refractoriness are natural consequences of the theory.
The objective of the study was to determine whether coitus during menstruation in perimenopausal women is associated with increased menstrual flow defined as either heavier flow, more days of flow, or both. Initial interviews for the Stanford Menopause Study were conducted locally with 160 perimenopausal women. Six weeks later, additional data were gathered from 121 women. At a third interview, 6-10 weeks later at Stanford University, 56 of 57 subjects (mean age 48.8 +/- 3.9 SD) provided data on menstrual flow and coital behavior. At both the first and third interview, more than half of the women reported a pattern of increased menstrual flow. At the third interview, 83% of those reporting increased menstrual flow also reported a behavioral pattern of coitus during menses. Only 10% with diminished flow acknowledged such a pattern. Women who abstained from sex during menses were not less regular in coital activity at other times nor did the data reveal them to be less orgasmic than women who did not abstain. Our data reveal an association between coitus during menstruation and longer and/or heavier menstrual flow. The etiology of such increased flow is usually believed to be hormonal, but coitus during menstruation may be another important variable.
Sexuality was investigated in 35 males and 25 females with chronic back pain. Prior to onset of pain orgasmic dysfunction was common in 60 per cent of the females with relatively lower level of sexual frustration. Markedly less sexual dysfunction characterized the males. With back pain sexual dysfunction increased in both sexes. Frequency of coitus was reduced in half the subjects and about 50 per cent also had altered coital positions. Fatigue and pain were common and sexual enjoyment was reduced for most subjects. In many females back pain may serve to legalize previously latent sexual dysfunction. However, for both sexes back pain per se causes sexual maladaptation. Therefore, sexual counselling should be part of the rehabilitation of the back pain sufferer.
Twelve neuroactive and neuroprotective steroids, androgens and androgen precursors i.e. 3alpha,17beta-dihydroxy-5alpha-androstane, 3alpha-hydroxy-5alpha-androstan-17-one, 3alpha-hydroxy-5beta-androstan-17-one, androst-5-ene-3beta,17beta-diol, 3beta,17alpha-dihydroxy-pregn-5-en-20-one (17alpha-hydroxy-pregnenolone), 3beta-hydroxy-androst-5-en-17-one (dehydroepiandrosterone, DHEA), testosterone, androst-4-ene-3,17-dione (androstenedione), 3alpha-hydroxy-5alpha-pregnan-20-one (allopregnanolone), 3beta-hydroxy-pregn-5-en-20-one (pregnenolone), 7alpha-hydroxy-DHEA, and 7beta-hydroxy-DHEA were measured using the GC-MS system in young men before and after ejaculation provoked by masturbation. The circulating level of 17alpha-hydroxypregnenolone increased significantly, whereas the other circulating steroids were not changed at all. This fact speaks against the hypothesis that a drop in the level of neuroactive steroids, e.g. allopregnanolone may trigger the orgasm-related increase of oxytocin, reported by other authors.
BACKGROUND: Social phobia is a type of performance and interpersonal anxiety disorder and as such may be associated with sexual dysfunction and avoidance. The aim of the present study was to evaluate sexual function and behavior in patients with social phobia compared with mentally healthy subjects. METHOD: Eighty subjects participated in the study: 40 consecutive, drug-free outpatients with social phobia (DSM-IV) attending an anxiety disorders clinic between November 1997 and April 1999 and 40 mentally normal controls. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Liebowitz Social Anxiety Scale were used to quantitatively and qualitatively assess sexual function and behavior. RESULTS: Men with social phobia reported mainly moderate impairment in arousal, orgasm, sexual enjoyment, and subjective satisfaction domains. Women with social phobia reported severe impairment in desire, arousal, sexual activity, and subjective satisfaction. In addition, compared with controls, men with social phobia reported significantly more frequent paid sex (p < .05), and women with social phobia reported a significant paucity of sexual partners (p < .05). CONCLUSION: Patients with social phobia exhibit a wide range of sexual dysfunctions. Men have mainly performance problems, and women have a more pervasive disorder. Patients of both genders show difficulties in sexual interaction. It is important that clinicians be aware of this aspect of social phobia and initiate open discussions of sexual problems with patients.
Although sexual dysfunction in the male diabetic has been recognized for many years, only recently has systematic investigation been undertaken to understand the problems involved. The marked increase of impotence in diabetes has been shown to be, to a significant extent, a result of diabetic autonomic pelvic neuropathy. However, awareness of other causes of impotence is essential for proper diagnosis and appropriate therapy. Strikingly, the marked impact of diabetes on male sexual function is not shared by the female diabetic patient, whose sex interest and orgasmic reaction are essentially unimpaired when compared with those of the nondiabetic female.
The data of patients treated for priapism in the Department of Urology of Semmelveis University Medical School between 1951 and 1971 are analyzed. Eleven patients were hospitalized and three were outpatients. After a brief survey of the literature, mechanism, aetiology and treatment of the condition are discussed. In the majority of the patients after the cessation of priapism sexual libido returned as a rule without the appearance of erection. Three cases are briefly described. In four patients after some time partial erection and orgasm was experienced under mechanical influence. Two of these patients had married and have children.
Primary anorgasmia is defined as the inability, in spite of nocturnal pollution and complete erection, ever to achieve orgasm either by masturbation or by sexual intercourse. 30 patients with primary anorgasmia were treated with an electro-vibrator, 26 of them with a positive result. The preceding unsuccessful therapeutical attempts with medicaments and psychotherapy allow the conclusion that with primary male anorgasmia time should not be wasted unnecessarily. Instead, a mechanical ipsation-aid should be employed, regardless of the etiology. Simultaneous intensive psychological guidance including instruction about normal sexual behavior is necessary. Some cases of secundary anorgasmia also react favourably to this treatment.