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This article provides a selective overview of the physiologic substrates of sexual desire, arousal, and orgasm, and reviews their changes with age. The effect of pharmacologic agents on sexual physiology is discussed, highlighting both the clinical significance and underlying neurophysiologic mechanisms of these agents.
Erectile dysfunction is a common disorder. However, not all dysfunctional men want to pursue evaluation. To delineate the characteristics of men interested in evaluation of erectile dysfunction, we conducted a mailed survey of 1031 randomly selected male veterans aged 30-99 years. We received 427 completed surveys. Using logistic regression, we found loss of sexual pleasure, loss of stiffness and duration of erection, and the ability to have orgasm to be predictors of which men were interested in evaluation of erectile dysfunction. Age, functional status, availability of a partner, marital status, sexual interest, partner's sexual interest, and duration of dysfunction were not significantly different between men interested and not interested in evaluation of erectile dysfunction.
A multicenter long-term study at 13 urologic clinics in Germany and Austria tested the efficacy and safety of a papaverine (15 mg/ml) and phentolamine (0.5 mg/ml) mixture (ANDROSKAT) in achievement of pharmacologically aided erection. The study population of 157 men with chronic erectile dysfunction received a total of 559 injections administered by physicians, to establish the individual minimal dose of the mixture needed by each patient for a rigid erection. Rigidity sufficient for intercourse was achieved by 94% of these men. In the second phase of the study, 92 men administered a total of 4717 self-injections (mean 51.2, SD 7.7), with an average follow-up of 14 months. The mean therapeutic dose was 1.02 ml (SD 0.72). The latency time to full erection averaged 10.3 min (SD 5.5). The average duration of the erection induced was 67.1 min (SD 40.8, min. 11.2, max. 236). Sexual intercourse, orgasm and ejaculation were reported following 90%, 88% and 86%, respectively, of all injections. In the initial diagnostic phase, prolonged erections were seen in 13 patients (3%) and minor bruises at the injection site in 12 men. Side effects of self-injection during home therapy were pain (1.2%), haematoma (2.6%) and prolonged erection (0.9%). We conclude that self-injection with a combination of papaverine and phentolamine is an efficient and safe long-term treatment for erectile dysfunction.
BACKGROUND: The reported incidence of sexual dysfunction associated with antidepressant medication varies from 1.9% to 92%. The majority of studies reporting incidences were not systematically conducted. METHOD: We interviewed 60 patients (22 men and 38 women, with anxiety and mood disorders) who were being treated with various antidepressants. We used a questionnaire focused on sexual side effects and other side effects. RESULTS: The incidence of sexual dysfunction during antidepressant use in our study is 43.3%. The sexual dysfunction was not limited to any particular diagnostic group nor to any particular antidepressant. There was no significant correlation between sexual dysfunction and anticholinergic side effects. The incidence of painful orgasm with antidepressants was 18% among males in our study. CONCLUSION: The relatively high incidence of sexual dysfunction associated with antidepressant treatment in this systematic study emphasizes the importance of a detailed inquiry about sexual side effects as this interferes with treatment compliance.
The deep changes in values, beliefs and behaviour, both individual and group, have been examined, referred to the sexuality, by various methods and prospects. Sexual differentiation, typical of the plast, has been rediscussed and modified. As a result of these changes we can talk about old myths, concerning the conception of sexuality in the past, and new myths that concern the present. In this work we have reviewed the different aspects of male and female roles: masturbation, the obsession abort performance, the orgasm and, not last, the sexuality in old age condition.
An attempt was made to measure the effects of depressive illness and of clomipramine (Anafranil) therapy in doses of 30 mg and 75 mg daily on sexual appetite and performance. A special questionnaire was devised to gather information on sexual habits before illness, during illness and following treatment. It proved difficult to differentiate between the beneficial effects of recovery from depression and the possible adverse drug effects on sexual activity. Two patients dropped out of the study because of supposed sexual side-effects--a male with ejaculatory difficulties and a female with orgasmic impotence. Fifty-four patients completed the sexual questionnaire and a four-week course of clomipramine. There were nineteen males and thirty-five females. Sixty-eight per cent of males and 57% of females had their 'sex life' impaired by depressive illness. Coital rate was decreased and depression interfered with performance and satisfaction. Clomipramine therapy seemed to have advantageous and disadvantageous effects. The advantageous effects were probably associated with improvement in depressive illness. There was evidence that clomipramine had an adverse effect sexually in 26% of males and 14% of females. The effect was dose-related in females.
UNLABELLED: The authors analyze the incidence of sexual dysfunction (SD) with different SSRIs (Fluoxetine, Fluvoxamine, Paroxetine and Sertraline) and hence the qualitative and quantitative changes in SD throughout time 308 outpatients (169 women, 139 men; mean +/- SD age = 41 +/- 7) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors including questions about the following items decreased libido, delayed orgasm or anorgasmia, delayed ejaculation inability to ejaculation, impotence and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRIs intake, exclusive treatment with SSRIs or associated with benzodiazepines, previous heterosexual or self-orone current sexual practices. We excluded patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recently hormone intake and significant medical illnesses. RESULTS: There is a significant increase in the incidence of SD when the physicians ask the patients direct questions (55.29%) versus spontaneous SD reported (14.2%). There are some significant differences among different SSRIs paroxetine provoked more delay of orgasm/ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (Chi square p < 0.05). Only 22.6% of the patients had a good tolerance about their sexual dysfunction. SD has positive correlation with the dose. The patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women but women's sexual dysfunction was more intense than men. Seven of nine patients (77.7%) experienced total improvement when the treatment was changed to Moclobemide (450 mg/day) and two of four patients (50%) improved when treatment was changed to Amineptine.
Sexual function was studied in 818 patients with benign prostatic hyperplasia (BPH) before and after surgical treatment of this disease. Before surgery, sexual activity was absent in 276 examinees. After surgery 4.3% of them retained erection, 95.7% remained impotent. 542 patients before operations were sexually active. Surgical treatment of BPH (transurethral resection, transvesical adenomectomy) creates grounds for deterioration of sexual function and risk of erection loss. Thus, 77 operated patients had no erection, 176 had weak libido, 159--insufficient erection, 244 retrograde ejaculation, 188 painful orgasm. Transurethral resection led to a complete loss of copulative function in 5.3% of patients, transvesical adenomectomy--in 9.9%. Sexual readaptation after transurethral resection and transvesical adenomectomy has been improved due to a special complex developed by the authors. This complex consists of 14 therapeutic and prophylactic procedures.
Sex reassignment surgery has been performed on thousands of transsexual patients during the past 30 y. Yet, reports of sexual responsivity of post-operative patients are very rare. Reports of physiological measures of sexual arousal are non-existent. Seven reports are received and summarized. Methodological shortcomings and the questionable validity of self-reports render the interpretation of sexual responsivity, notably orgasm, difficult. Laboratory-based research is needed with patients who have undergone the broadening variety of surgical genital reconstruction for the male and female transsexual.
Very few patients complain of the sexual repercussions of surgery for benign prostatic hyperplasia (one or two per year in a very active Parisian Urology department). However, when the patient presents such complaints, they are always dramatic and the patient is particularly critical of the surgeon who operated on him. In order to more clearly understand the importance of these exceptional complaints, associated with marked anxiety, the authors reviewed an IFOP survey concerning sexuality in the elderly: at the age when most prostatectomies are performed, orgasm is no longer considered to be essential. It is essential to always make sure that the patient has clearly understood the explanations given to him, which is particularly difficult in foreign patients. Prostatectomy is obviously an urological indication, but when it does not constitute an emergency, the urologist should defer the operation if his patient still has an active sex life (sexual intercourse once a week, for example).
The effects of hysterectomy on social and psychological behavioural changes were evaluated in 88 patients who were examined psychologically and somatically preoperatively and for a period of 5 to 6 months postoperatively. All patients were aware of the surgical consequences and were investigated in regard to social history and by means of psychological tests (HAWIE, MMPI, Rorschach). The personality profiles of these patients fell within the normal range, although showing a tendency towards psychosomatic alteration, which, however, decreased significantly after the operation. Hysterectomy does not appear to produce any clear-cut changes in the attitude toward sexuality according to the findings of this study. Neither the age at which sexual maturity was reached, nor the intelligence level, number of children, age nor social class appeared to show any significant influence on the capacity to achieve orgasm or the frequency of intercourse. Only three patients showed transient postoperative depression, although this is frequently described in the literature; its aetiology is discussed. The therapeutic approach, especially in the field of surgical gynaecology, must encompass every aspect of medicine and appropriate explanations of the surgical consequences should be given to the patients to prevent postoperative psychological complications.
OBJECTIVE: To examine changes in women's physical health during the first postpartum year. DESIGN: Participants completed surveys at 1, 3, 6, 9, and 12 months post partum. PARTICIPANTS AND SETTING: Four hundred thirty-six first-time mothers who gave birth at one of two St Paul, Minn, hospitals during a 12-month period and who met the criteria for the study. MAIN OUTCOME MEASURES: Physical symptoms and number of illness days experienced within the previous 2 weeks. RESULTS: Physical problems seen at a higher prevalence at 1 month post partum included breast symptoms, vaginal discomfort, fatigue, hemorrhoids, poor appetite, constipation, increased sweating, acne, hand numbness or tingling, dizziness, hot flashes, and illness days. Several of these disorders--hemorrhoids, dizziness, fatigue, and constipation--persisted beyond 1 month and were joined by other "late" problems, including respiratory symptoms, sexual concerns, and hair loss. Women who returned to the work force noted more symptoms of respiratory infections, and women with vaginal deliveries had a higher prevalence of hemorrhoids, vaginal discomfort, pain with intercourse, difficulty reaching orgasm, sinus problems, and acne. CONCLUSIONS: Recovery from childbirth often requires more than the 6 weeks traditionally allotted, and postpartum health appears to be affected by delivery type and work status.
OBJECTIVE: To determine the frequency and nature of sexual dysfunction, as well as its response to medications, in a sample of patients with multiple sclerosis (MS). DESIGN: Retrospective and prospective survey of 65 female and 36 male patients with MS. RESULTS: Sixty-three percent of patients reported that they had less sexual activity, and 35% said that they had less interest in lovemaking than before their diagnosis of MS. Fifty-seven patients reported that they had problems with sexual dysfunction. Sexual dysfunction preceded the diagnosis of MS in only 10 of these patients. A higher percentage of men (78%) than women (45%) reported that they experienced sexual dysfunction (P = .002). Men had prominent erectile dysfunction, women had problems with vaginal lubrication, and both sexes had problems with decreased sensation and achieving orgasm. The presence of sexual dysfunction was associated with the presence of urinary problems (P = .02) and with a history of treatment of (P = .04) or a current report of (P = .02) depression. No association could be found between sexual dysfunction and duration of disease, type of disease, disability score, or presence of fatigue. Twenty of 57 patients with sexual dysfunction reported that they had associated marital problems. Forty-three of 60 patients who discussed sexual problems with their spouses and four of six who tried formal counseling found it helpful. Surprisingly, corticosteroid treatments that were started for problems other than sexual dysfunction resulted in improved sexual functioning in many patients. CONCLUSIONS: Sexual dysfunction is common in patients with MS. Determining the frequency and nature of problems allows issues of sexual dysfunction to be addressed as part of comprehensive care of patients with MS and suggests treatments that could improve their quality of life.
BACKGROUND: A priori hypothesis: vaginal and/or cervical self-stimulation will not produce perceptual responses in women with "complete" spinal cord injury (SCI) at or above the highest level of entry of the hypogastric nerves (T10-12) but will produce perceptual responses if SCI is below T-10. DESIGN: Women with complete SCI were assigned to a group with "upper" (T-10 and/or above) (n = 6) or "lower" (below T-10) (n = 10) SCI; uninjured women (n = 5) constituted a control group. Perceptual response to vaginal and/or cervical self-stimulation was quantified as magnitude of analgesia to calibrated finger compressive force. SETTING: Rutgers, The State University of New Jersey, Human Physiology Laboratory, College of Nursing, Newark. PARTICIPANTS: Consecutive samples of first 16 of 34 women with SCI who responded to nationwide advertisements, met inclusion criteria, and volunteered; control group was the first 5 respondents. INTERVENTION: Vaginal or cervical (cervix uteri) self-stimulation applied for 12 minutes, interspersed with non-stimulation periods, while measuring analgesia. MAIN OUTCOME MEASURE: Quantify analgesia magnitude to vaginal or cervical self-stimulation. RESULTS: Significant analgesia was produced in the uninjured group and the group with lower SCI, supporting the hypothesis. Unexpectedly, significant analgesia was also produced in the group with upper SCI. Women in the group with upper SCI also experienced menstrual discomfort, awareness of vaginal and/or cervical stimulation per se, and orgasms. CONCLUSIONS: (1) Genitospinal visceral afferent pathways function in the women in the group with upper SCI, although unrecognized by the American Spinal Injury Association criteria, and/or (2) there exists a functional genital afferent pathway that bypasses the spinal cord and projects directly to the brain, which we propose to be via the vagus nerves.
Sexual excitement depends on a scenario the person to be aroused has been writing since childhood. The story is an adventure, an autobiography disguised as fiction, in which the hero/heroine hides crucial intrapsychic conflicts, mysteries, screen memories of actual traumatic events and the resolution of these elements into a happy ending, best celebrated by orgasm. The function of the fantasy is to take these painful experiences and convert them to pleasure-triumph. In order to sharpen excitement-the vibration between the fear of original traumas repeating and the hope of a pleasurable conclusion this time-one introduces into the story elements of risk (approximations of the trauma) meant to prevent boredom and safety factors (sub-limnal signals to the storyteller that the risk are not truly dangerous). Sexual fantasy can be studied by means of a person's daydreams (including those chosen in magazines, books, plays, television, movies, and outright pornography), masturbatory behavior, object choice, foreplay, techniques of intercourse, or postcoital behavior.
In a multiaxial system for classifying the sexual dysfunctions, the axes specify sexual problems associated with the desire, arousal, and orgasm phases of the sexual response cycle, as well as types of coital pain, dissatisfaction with the frequency of sex, and certain other information relevant to sexual functioning. In contrast to DSM-III and other existing diagnostic systems for sexual dysfunctions, this new multiaxial system is based on highly specific empirical descriptions of sexual behavior. There are no inferences made about the cause of the dysfunctions.
This article provides a review of the past and current literature on the neurobiology of sexual function. The influence of endocrine, neurotransmitter, and central nervous system influences on male and female sexual function are discussed for sexual desire, arousal, and orgasm or ejaculation stages of sexual responding. Endocrine factors reviewed include the following: androgens, estrogens, progesterone, prolactin, oxytocin, cortisol, and pheromones. Neurotransmitters and neuropeptides discussed include nitric oxide, serotonin, dopamine, epinephrine, norepinephrine, opioids, acetylcholine, histamine, and gamma-aminobutyric acid. Central nervous system influences on sexual function are discussed briefly with reference to brainstem regions, the hypothalamus, and the forebrain.
CONTEXT: Sexual dysfunction is a common adverse effect of antidepressants that frequently results in treatment noncompliance. OBJECTIVE: To assess the efficacy of sildenafil citrate in men with sexual dysfunction associated with the use of selective and nonselective serotonin reuptake inhibitor (SRI) antidepressants. DESIGN, SETTING, AND PATIENTS: Prospective, parallel-group, randomized, double-blind, placebo-controlled trial conducted between November 1, 2000, and January 1, 2001, at 3 US university medical centers among 90 male outpatients (mean [SD] age, 45 [8] years) with major depression in remission and sexual dysfunction associated with SRI antidepressant treatment. INTERVENTION: Patients were randomly assigned to take sildenafil (n = 45) or placebo (n = 45) at a flexible dose starting at 50 mg and adjustable to 100 mg before sexual activity for 6 weeks. MAIN OUTCOME MEASURES: The primary outcome measure was score on the Clinical Global Impression-Sexual Function (CGI-SF); secondary measures were scores on the International Index of Erectile Function, Arizona Sexual Experience Scale, Massachusetts General Hospital-Sexual Functioning Questionnaire, and Hamilton Rating Scale for Depression (HAM-D). RESULTS: Among the 90 randomized patients, 93% (83/89) of patients treated per protocol took at least 1 dose of study drug and 85% (76/89) completed week 6 end-point assessments with last observation carried forward analyses. At a CGI-SF score of 2 or lower, 54.5% (24/44) of sildenafil compared with 4.4% (2/45) of placebo patients were much or very much improved (P<.001). Erectile function, arousal, ejaculation, orgasm, and overall satisfaction domain measures improved significantly in sildenafil compared with placebo patients. Mean depression scores remained consistent with remission (HAM-D score < or =10) in both groups for the study duration. CONCLUSION: In our study, sildenafil effectively improved erectile function and other aspects of sexual function in men with sexual dysfunction associated with the use of SRI antidepressants. These improvements may allow patients to maintain adherence with effective antidepressant treatment.