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Benign adenomas of the major vestibular gland are very rare. Presented is a case of bilateral vestibular gland adenomas in a woman whose chief complaint was vulvar pain occurring with sexual arousal and orgasm. Surgical removal of the adenomas relieved the symptoms. The development of pain during sexual response in this case appears to be mediated by vascular engorgement.
OBJECTIVES: The evaluation of sexual life after hysterectomy is still controversial. DESIGN: The aim of the study was to analyse the impact of hysterectomy on frequency and quality of the woman's sexual life. MATERIAL AND METHODS: The total of 539 women operated in II Department of Obstetrics and Gynecology in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after abdominal hysterectomy. RESULTS: Sexual desire after operation decreased. The rate of dyspareunia dropped. Frequency of sexual intercourse and orgasm decreased non-significantly. The percentage of women non reporting vaginal dryness decreased significantly from 18.5% to 37.3% after hysterectomy. CONCLUSION: Sexual activity overall improved after hysterectomy.
BACKGROUND: The loss of sexuality observed in the climacteric period is difficult to evaluate. An important advance has been the development of the Female Sexual Function Index (FSFI), a test based on the norms of the International Consensus Development Conference on Sexual Female Dysfunctions. AIM: To study the effects of hormone replacement therapy (HRT) on sexuality, applying the FSFI. MATERIAL AND METHODS: The FSFI was applied to 300 healthy women between 45-64 years, sexually active, beneficiaries of the Southern Metropolitan Health Service. RESULTS: The mean age of the sample studied was 51 +/- 5 years, 27% were HRT users, 21% had had an hysterectomy and 98% had a stable couple. The total score of the FSFI decreased from 27.3 +/- 5.8 in women between 45 and 49 years of age to 19.3 +/- 7.0 in women between 60 and 64 years (p < 0.01). A significantly better sexuality was observed in HRT users, with FSFI scores of 28.1 +/- 5.5 and 24.6 +/- 6.8 in HRT users and non users, respectively (p < 0.01). Women on HRT obtained a higher score in all of the test domains, especially in lubrication, orgasm and sexual satisfaction. CONCLUSIONS: Female sexuality decreases with aging. HRT users have a better sexual function than non users.
OBJECTIVES: Sexual life after supracervical or total hysterectomy is still controversial. DESIGN: The aim of study was to compare the impact of hysterectomy on frequency and quality of a woman's sexual life in women after supracervical vs total hysterectomy with nonmalignant conditions. MATERIAL AND METHODS: A total of 539 women after total hysterectomy performed in Department of Gynecology in Gdansk and 65 women after supracervical hysterectomy operated in the hospital in Kartuzy in 1990-2000 were interviewed about symptoms as well as advantages and disadvantages after hysterectomy. RESULTS: There was no statistical difference between those groups comparing: sexual desire, dyspareunia, frequency of sexual relation, orgasm, vaginal dryness after operation. CONCLUSION: Total hysterectomy is recommended in benign conditions of uterine because of risk of cancer in the cervical stump after supracervical hysterectomy.
Sexual behavior in connection with drug use and its implications for the risk of sexual transmission of human immunodeficiency virus (HIV) among intravenous drug users (IVDUs) was investigated in a pilot study of 29 men (who injected drugs more than once a week for at least 6 months) at the Remand Prison in Stockholm from November, 1989, to January, 1990. A structured interview focusing on sexual history and current sexual behavior with and without drugs was employed. The median age of the subjects was 32 years. Six were HIV-seropositive. The main drugs presently used were amphetamine (18 men), heroin (9 men) and cocaine (2 men). Of the 29 men, 27 had experience of sexual activity while using amphetamine. Of these, 23 reported that they became more sexually excited when on amphetamine, 21 reported intensified orgasms, and 23 reported that the drug prolonged intercourse. All 29 men had been sexually active, but only 6 of the amphetamine users had had more than 10 partners during the last 3 years. Condom use was very low; it was reported by only 3 men during their last intercourse with a causal partner. The findings suggest that sexual HIV transmission among IVDUs is a clear risk, especially among amphetamine users, and that education about condom use is urgent.
BACKGROUND: Reports of fluoxetine-induced sexual dysfunction have described orgasmic and erectile difficulties but have neglected possible changes in sexual desire. This prospective study was undertaken to determine the percentages of patients experiencing different types of sexual dysfunction after successful antidepressant treatment with standard doses of fluoxetine. Additionally, an open trial of the alpha 2-adrenoceptor blocker yohimbine as a potential treatment for fluoxetine-induced sexual dysfunction was conducted in nine patients. METHOD: Over a 2-year period, outpatients who had fulfilled DSM-III-R criteria for major depression and subsequently responded to treatment with fluoxetine 20-40 mg were asked to report and describe changes in sexual function. A small number of consecutive nongeriatric patients complaining of new onset sexual dysfunction were invited to participate in an open trial of yohimbine 5.4 mg t.i.d. RESULTS: Fifty-four (34%) of 160 outpatients reported the onset of sexual dysfunction after successful treatment with fluoxetine: 16 (10%) of the 160 patients reported decreased libido, 21 (13%) patients reported decreased sexual response, and 17 (11%) patients reported declines in both areas. Eight of nine patients reported improvement in sexual function with yohimbine, although five patients reported side effects that led to discontinuation in two cases. CONCLUSION: These findings suggest that (1) fluoxetine-induced sexual dysfunction may include decreased sexual desire as well as decreased physical functioning and may occur more frequently than previously appreciated and (2) fluoxetine-induced sexual dysfunction may be treatable with yohimbine.
A study of female sexuality based on 91 interviews with women aged 50 to 91 years (birth-cohorts: 1895 to 1936) is presented. 53% of the interview-partners in this study are sexually active (intercourse: 34%; masturbation: 30%; lesbian sexuality: 1%). 65% report sexual interest. During the past year 58% of the women experienced sexual dreams, 43% sexual fantasies. 26% of the interview-partners had never experienced orgasm. Several age- and cohort-differences are reported. Quotations illustrate the variability of female sexual experiences.
A comprehensive review of the results of descriptive studies on female sexuality in middle and old age (50 to 100 years) is presented. Central dimensions are "sexual activity", "interest", "enjoyment", and "orgasm". The review integrates studies from several European countries, as well as those conducted throughout the USA. Recent U.S. studies present results which appear to be quite different from the European ones. The former describe their subjects as being considerably more interested in sexuality and more sexually active. Several methodological questions are discussed (sampling, the way of collecting data, neglected variables, and others).
To define sexual interest, ability, and activity before and after heart transplantation, we surveyed all discharged, male heart transplant recipients from our institution. Of the 115 potential subjects, 71 (62%) responded. Respondents were predominantly (89%) white, had a mean age of 47.9 years (24 to 64 years), and most (74%) were living with their spouses. Pretransplant libido was strong and remained unchanged after heart transplantation. Transplant recipients reported their partner's libido to be strong, and even stronger after transplantation than before (p = 0.033). In contrast, erectile rigidity and orgasmic ability were impaired before, and declined further after, the transplant procedure. Respondents perceived this gap between libido and sexual ability to be a problem, and interest in evaluation and treatment was high.
The basic parameters, connected with spontaneous realization of sexual intercourse in 411 women workers and employees, chosen at random, are studied. Various regularities are established: the lubrication is connected with difficulties in women with inflammatory changes in the internal sexual organs. The feeling of sexual excitation during sexual intercourse is stronger in women with larger number of sexual partners since the beginning of their sexual life. Disturbances in the occurrence of orgasm are more frequent in employees. Dyspareunia is connected mainly with organic changes in genitals, but it is determining factor for the success of sexual life. The frequency of the experienced pleasure is influenced by various social and biological factors comparatively slightly.
Of the first 60 patients treated at our clinic with the antidepressant fluoxetine, 5 (8.3%) developed treatment-emergent sexual dysfunction (anorgasmia and/or delayed orgasm). Three of those 5 patients had a history of treatment-emergent sexual dysfunction while receiving other antidepressant agents. Clinicians should be aware of this side effect of fluoxetine.
In a group of 2425 gynaecological patients during their stay in the spa of Frantiskovy Láznĕ the authors examined by interviews the marital sex life of the patients. They divided them into sub-groups by decades of their birth year (1911 to 1970). In women born between 1961 and 1970 they recorded a marked rise in the number of women who experienced only rarely orgasm during coitus (26%). This change was explained by the action of stressing factors of the social environment. The authors express the view that changes in the orgastic capacity of women are rather than sexual appetence a sensitive and useful indicator of psychological influences.
By means of interviews in Frantiskovy Láznĕ data on the sexual development and life of 586 married gynaecological patients born between 1951 and 1960 and 276 women born between 1961 and 1970 were obtained. As compared with data from 1563 patients born in individual decades between 1911 and 1950, it was revealed that the acceleration of sexual development proceeded. The mean age of the first sexual intercourse declined further and in the sub-group born between 1961 and 1970 is was 17.8 years. In this sub-group, however, the percentage of women who experienced during intercourse orgasm only rarely increased markedly. The value of 26% is the highest of all decades investigated since 1911. The authors express the hypothesis that this negative change in the sexual life of contemporary young women is due to a number of stressing factors ensuing from the present social environment.
A prospective study was conducted on the sexual function of 70 patients undergoing transurethral (48 cases) or transvesical (22 cases) prostatectomy for benign prostatic hypertrophy. 22 patients with no sexual activity before operation, remained sexually inactive after surgery. Frequency of intercourse and penile erection remained generally unchanged after operation. Retrograde ejaculation was observed in 33 patients (69%). Only one patient complained of total loss of potency after operation. Orgasm was maintained in all other patients; however 25 patients considered it to be "different". 4 of the sexually active operated patients (8%) and 7 of their partners complained of lack of sexual satisfaction after operation.
The authors study the correlation between sexual activity and parity in 106 pluriparous Sicilian women divided into 3 groups with parity, respectively, of 1 (57 cases), 2 (29 cases), and greater than or equal to 3 (20 cases). Sexual desire, frequency of coitus and orgasm, type of extracoital activity, preferred position during coitus, the partner who took the first initiative in sexual activity, and the contraceptive methods used were studied. The results show that in women of parity greater than or equal to 3 there is a significantly lower frequency of very frequent coitus, higher frequency of extravaginal sexual activity, and that the male more frequently took the first initiative in sexual intercourse.
One thousand, two hundred and eighty-five men and 1,080 women being followed in the DHSS Hypertension Care Computing Project answered the questions on sexual activity included in a self-administered questionnaire. In men, both impotence and sexual inactivity were increased in patients receiving hydralazine. No gross excess of these complaints could be determined in patients receiving either beta-adrenoceptor blocking drugs or methyldopa, nor was failure of ejaculation increased with these drugs. The survey could not exclude any deterioration in sexual function occurring uniformly across all treatment groups. However, the rates of complaint were similar in men taking a diuretic alone, a beta-adrenoceptor blocking drug alone and those taking the combination of these two drug groups. In women with hypertension, frequency of sexual intercourse and the achievement of orgasm was not associated with the giving of hydralazine, beta-adrenoceptor blocking drugs or methyldopa.
The physiology of the normal sexual response, epidemiology of sexual dysfunction, and the pharmacologic mechanisms involved in antihypertensive- and antipsychotic-induced problems with sexual function are discussed, with recommendations for patient management. The physiologic mechanisms involved in the normal sexual response include neurogenic, psychogenic, vascular, and hormonal factors that are coordinated by centers in the hypothalamus, limbic system, and cerebral cortex. Sexual dysfunction is frequently attributed to antihypertensive and antipsychotic agents and is a cause of noncompliance. Drug-induced effects include diminished libido, delayed orgasm, ejaculatory disturbances, gynecomastia, impotence, and priapism. The pharmacologic mechanisms proposed to account for these adverse effects include adrenergic inhibition, adrenergic-receptor blockade, anticholinergic properties, and endocrine and sedative effects. The most frequently reported adverse effect on sexual function with the antihypertensive agents is impotence. It is seen most often with methyldopa, guanethidine, clonidine, and propranolol. In contrast, the most common adverse effect on sexual function with the antipsychotic agents involves ejaculatory disturbances. Thioridazine, with its potent anticholinergic and alpha-blocking properties, is cited most often. Drug-induced sexual dysfunction may be alleviated by switching to agents with dissimilar mechanisms to alter the observed adverse effect while maintaining adequate control of the patient's disease state.
Forty-two patients treated for in situ vulvar cancer at two institutions participated in structured assessment interviews and completed questionnaires to examine postoperative sexual, marital, and psychological adjustment. Patient responses were compared with a matched sample of gynecologically healthy women. The results indicated a specific pattern of sexual disruption for the women treated for preinvasive disease. Sexual behavior patterns appeared to be maintained, as was the desire phase of the sexual response cycle. However, there was specific disruption of the phases of excitement and resolution and, to a lesser extent, orgasm. In addition to a two- to threefold increase in the frequency of sexual dysfunction, 30% of the sample was sexually inactive at follow-up. Although replication of these findings is necessary, this investigation suggests that sexual functioning correlates with the magnitude of treatment.