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PubMed1989

Asphyxiophilia in Scandinavia.

Asphyxiophilia, the desire for a state of oxygen deficiency in order to enhance sexual excitement and orgasm, is a very precarious form of sexual gratification. Asphyxiophilia has been difficult to document since it is mostly practiced in secrecy and solitude and is usually not discovered until the practitioner has been found dead. Most of the information about asphyxiophilia is found in police reports and medicolegal investigations by doctors of forensic medicine. Our study is based on information from 18 doctors of forensic medicine in Denmark, Norway, and Sweden. Six sources indicate similar frequencies (0.5-1 cases per million inhabitants per year) of observed deaths in Scandinavia. Although the frequency of observed deaths is different from the true mortality rate, this study gives a good illustration of the estimated prevalence. This accuracy is enhanced by the length of the observation periods (10-40 years).

Adolescent↗
PubMed1993

Sexual functioning of male anabolic steroid abusers.

The effects of anabolic steroid use on male sexual behavior were assessed using a structured clinical interview administered to male body builders currently using steroids, and to two comparison groups (body builders with a past but not current history of steroid use, and a group of "natural" body builders who had never used steroids). Current anabolic steroid users had a significantly higher coital and orgasmic frequency than did comparison athletes. They also reported a significantly higher incidence of erectile difficulties during the past month. Beliefs concerning the sexually stimulating effects of steroids did not correlate with the frequencies of specific sexual behaviors. The data support the contention that anabolic steroids, as androgenic compounds, enhance sexual desire.

Adult↗
PubMed1993

The Zurich Study: XXI. Sexual dysfunctions and disturbances in young adults. Data of a longitudinal epidemiological study.

In a cohort of young Swiss adults, sexual disturbances and dysfunctions were assessed by interview four times between ages 20 and 30 years. Over 10 years almost every second female and every third male subject reported disturbances. In females at age 30 years, the prevalence of orgasmic difficulties and of dyspareunia corresponded to non-clinical samples of other studies. Also, in accordance with the literature, impaired interest was much more prevalent in females. In males and females, sexual disturbances were to some extent associated with anxiety and depression; in addition, in women, they were also associated with social phobia and eating disorders. With regard to neuroticism, negative affect and reports of an unsatisfactory childhood, subjects with temporary disturbances resembled more strongly those with chronic problems than controls. Compared with the controls, women's sexual disturbances were more chronic and more strongly associated with minor psychiatric symptoms and personality deviance; this finding was less pronounced in men.

Adult↗
PubMed2001

Neurogenic female sexual dysfunction: a review.

The effect of various spinal lesions on female sexual response has recently been investigated in detail. Studies of women with neurologic disabilities and studies of animal models have provided substantial information regarding the spinal control of sexual responses. In this report, the authors explore findings regarding the neurologic pathways underlying the spinal control of sexual arousal and orgasm. Information available about the effects of multiple sclerosis and various cerebral disorders on female sexual function will also be reviewed, with special attention to areas where further research is needed. Lastly, the current status and techniques available to improve the sexual functioning of women with neurologic disabilities affecting the central nervous system will be reviewed.

Brain Diseases↗
PubMed1996

Female sexuality and historical time: a comparison of sexual biographies of German women born between 1895 and 1936.

Ninety-one German women ages 50 to 91 years (birth cohorts: 1895 to 1936) were interviewed in-depth about their sexual development through the life span. This article presents the results on the historical change in female sexuality during childhood, puberty, and young marriage. The sample was divided into four subgroups, according to the year of birth, which were compared to each other. In contrast to the older groups, a higher percentage of women in the younger cohorts had experience in childhood sexual play, masturbation, "real" and faked orgasm, with historical time only having a slight influence on marital sexuality and fertility experiences. Data indicate that subjects born later were not only more experienced sexually but changed intraindividually more often in sexual matters, whereas the older women mostly "conserved" the sexual morals and habits learned in youth. Subjective sexual experience of the interviewees is illustrated by quotations.

Aged↗
PubMedDate not supplied

Impulse magnetic-field therapy for erectile dysfunction: a double-blind, placebo-controlled study.

This double-blind, placebo-controlled study assessed the efficacy of 3 weeks of impulse magnetic-field therapy for erectile dysfunction (ED). Twenty volunteers who suffered from ED or orgasmic disturbances were randomly assigned to either active treatment or placebo (n = 10 each). Efficacy was assessed in terms of intensity and duration of erection, general well-being, sexual activity, and warm sensation in the genital area. In the active-treatment group, all efficacy endpoints were significantly improved at study end (P < or = .01), with 80% reporting increases in intensity and duration of erection, frequency of genital warmth, and general well-being. The remaining 20%, who experienced minor improvements, were found to have an influenza-like infection after the study that may have influenced their results. Only 30% of the placebo group noted some improvement in their sexual activity; 70% had no change. No side effects were reported.

Adult↗
PubMed2001

[Sexuality in patients with coronary disease and heart failure].

INTRODUCTION: When a cardiologist is speaking about sexual disorder with a patient with coronary artery disease (CAD) or heart failure (HF) mostly the male sexual disorder is the point. Questions about sexual physical stress and the use of Viagra or MUSE are dominant in the first step. But usually sexual disorders of men and women are a challenge for the cardiologist: is there not another problem behind? Is sexual disorder only a "common symptom"? Is there a need for psychotherapy? There are patients with a "well functioning" of all sexual functions but however feeling unhappy and not satisfied because lacking in sexual fulfilling [32]. The most common questions in my opinion deal with male patients after CABG or valve replacement surgery or after myocardial infarction (MI) or percutaneous transluminal coronary angioplasty (PTCA). Those patients often are concerned about future sexual activity or about a diminished libido. Some fear of failing during intercourse. HOPEFUL PREMISE: The risk of having severe complications during sexual activity is far less than many of the patients and their partners or we the cardiologists would have expected. In only about 0.9% of patients with MI sexual activity was a likely contributor to the onset of MI [27]. Regular exercise reduces the risk of MI by sexual activity. Even in high risk CAD-patients the risk for MI or death are low with 20 chances per million per hour with known CAD [14]. THE PREVALENCE OF ERECTILE DYSFUNCTION (ED) IN POPULATION BASED STUDIES: One of the largest and longest during newer studies is the Massachusetts Male Aging Study (MMAS) asking men with an age of 40-69 years. There was a prevalence of ED (3 levels: mild, moderate, complete) of 39% in the 40 years old and of maximal 67% in men with 69 years of age [16]. Common risks for ED are lower education, diabetes, heart disease, hypertension, cigarette smoking, obesity [22]. As early as possible we should reinforce patients (or even "non-yet-patients") to adopt healthy lifestyles with more physical activity to modify risk for sexual malfunction and for heart disease as well [15]. THE FEMALE SEXUAL DYSFUNCTION (FSD): The prevalence seems to be the same as in men. The most common complaints depending upon their age include decreased libido, vaginal dryness, pain with intercourse, decreased genital sensation and difficulty or inability to achieve orgasm [5]. One of the most important problems for older women are the availability of a sexually active partner and the presence of concurrent illnesses. We should ask for sexual history in older women because the need of love and sexual intimacy does not diminish with age [25]. The risks for FSD are age related as well as para-aging: level of education, history of sexual abuse or sexually transmitted disease, the "integrity" of physical health as well as the overall state general happiness [19]. DEPRESSION AS A RISC FACTOR FOR CAD AND IMPAIRMENT OF SEXUALITY: As cardiologists know sexual dysfunction may be a risk indicator for arteriosclerosis and for heart disease or even a consequence of heart disease. Depression is meanwhile recognized as a independent risk factor for MI. But the connexion of depression and sexual dysfunction is a common problem for psychiatrists', gynaecologists', urologists' and cardiologists' consulting-hours [2, 3, 18, 20, 21, 23]. HEART FAILURE AND SEXUALITY: There is very little data available on this topic. Data are dealing with the need of information for patients and partners on the physical stress during sexual activity [33]. RISK STRATIFICATION FOR SEXUAL ACTIVITY DEPENDING ON THE CLINICAL STATUS OF HEART DISEASE: The examples for clinical status are given in a simple scheme of the Princeton Consensus Panel. Patients with low risk (the large majority of patients) can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. In group 2 patients with an intermediate risk should undergo cardiologic evaluation before restratification into low- or high-risk category. In the high-risk patients there is a precondition before resuming sexual activity: stabilisation by specific treatment [13]. CONCLUSIONS: Think on the sexual dysfunction when treating female and male cardiologic patients. Work together with other disciplines (gynaecology, psychiatry, sexual medicine, urology) when evaluating a treatment plan. As early as possible try to reinforce lifestyle change for risk factor modification. The absolute risk for death or MI during sexual activity is very low even in patients with known CAD.

Adult↗
PubMed2003

[Sex, erectile dysfunction, and the heart: a growing problem].

BACKGROUND: Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. ED may also be an early sign of cardiovascular disease. The main risk factors for coronary heart disease (high LDL, smoking, hypertension, diabetes) and ED are the same. ED after the diagnosis of coronary artery disease or myocardial infarction is also common. CARDIOVASCULAR EFFECTS AND RISK OF SEXUAL ACTIVITY: Cardiac and metabolic expenditures during sexual intercourse will vary depending on the type of sexual activity. When oxygen uptake was measured in men, an average metabolic expenditure during stimulation and orgasm of 2.5 metabolic equivalents (METs) was found for woman-on-top coitus, and of 3.3 METs for man-on-top coitus (range 2.0-5.4 METs). However, coital death is rare, encompassing only 0.6% of all sudden death cases. A retrospective case-crossover study has shown that although sexual activity can trigger the onset of myocardial infarction, the relative risk in the 2 h after sexual activity was low (2.5; 95% confidence interval [CI] 1.7-3.7). Sexual activity was a likely contributor to the onset of myocardial infarction only 0.9% of the time. Regular exercise appears to prevent triggering. It has to be cautioned that these reassuring data should not be extrapolated to patients taking sildenafil, if they perform at higher cardiac and metabolic expenditures during coitus. The hemodynamic changes associated with sexual activity may be far greater with an unfamiliar partner, in unfamiliar settings, and after excessive eating and drinking. The Princeton Consensus Table for estimation of cardiovascular risk during sexual intercourse gives a first orientation regarding the question which patients can perform sex safely and which subgroup needs further diagnosis and treatment. PHOSPHODIESTERASE-5 INHIBITORS FOR ED TREATMENT: The introduction of sildenafil has been a valuable contribution to the treatment of ED. Sildenafil acts as a selective inhibitor of cyclic guanosine monophosphate-(cGMP-)specific phosphodiesterase type 5 (PDE 5), resulting in smooth muscle relaxation, vasodilation, and enhanced penile erection. Reported cardiovascular side effects in healthy males are headache, flushing, and < 10% decreases in systolic and diastolic blood pressures. Significant hypotension can be found in patients who are concurrently taking nitrates. On the basis of the pharmacokinetic profile of sildenafil, the co-administration of a nitrate within the first 24 h is likely to produce a severe, potentially lifethreatening hypotensive response and is therefore contraindicated. The risk of precipitating a cardiotoxic, hypotensive, or hemorrhagic event secondary to combining sildenafil (a PDE 5 inhibitor) with specific PDE 3 inhibitors such as milrinone and enoximone or with nonspecific PDE inhibitors such as theophylline and pentoxifylline is unlikely. Sildenafil is predominantly metabolized by both the P450 2C9 pathway and the P450 3A4 pathway. Thus, potent inhibitors of the P450 3A4 pathway may increase the plasma concentrations of sildenafil, like cimetidine, erythromycin, digitoxin, and CSE inhibitors (simvastatin, atorvastatin, etc.). A creatinine clearance < 30 ml/min also increases plasma levels of sildenafil. SAFETY PROFILE OF SILDENAFIL: Sildenafil is safe in healthy subjects. In a postmarketing study on 6,527 males, no increase of cardiovascular events was found. However, in older males with coronary heart disease, the risk of sildenafil and the risk of physical exercise during sexual intercourse contribute both to fatal outcomes. Of 69 cases reported to the FDA, 46 patients might have had a cardiovascular event, and in twelve a possible interaction with nitrate use has been reported. Sildenafil is absolutely contraindicated in patients taking long-acting nitrates, those with severe aortic stenosis, and patients with hypertrophic obstructive cardiomyopathy (HOCM). No nitrates should be used within 24 h of sildenafil use. Caution is necessary in patients with a combination of antihypertensive medications, and in patients with cardiac insufficiency. A "pre-Viagra" treadmill test to assess for the presence of stress-induced ischemia can be helpful for both the patient and the physician. If the patient can achieve > or = 5 METs without demonstrating ischemia, the risk of ischemia during coitus is low. MANAGEMENT OF SEVERE ADVERSE EVENTS: If severe hypotension occurs, aggressive fluid resuscitation is the first step, followed by administration of vasoactive drugs and, if necessary, by intraaortic balloon counterpulsation. If unstable angina or myocardial infarctions occurs after the use of sildenafil, the patient is treated according to the guidelines, but without nitrates. CONCLUSION: Sexual activity is a cornerstone of quality of life. However, giving the incidence of "occult" cardiovascular disease in patients with ED and the indications and contraindications of PDE 5 inhibitors in patients with cardiovascular diseases, all patients with ED must be evaluated by a cardiovascular specialist.

Coronary Disease↗
PubMed1997

[Skin disease and sexuality. An empirical study of sex behavior or patients with psoriasis vulgaris and neurodermatitis in comparison with skin-healthy probands].

Fifty-three patients with psoriasis, 24 patients with atopic eczema and 52 controls with healthy skin were compared with regard to their sexual behavior. For the test, questionnaires developed by Arentewicz as well as our own questionnaire on sexuality and partnership were used. Patients with skin diseases had a significantly impaired sex life, compared to those with healthy skin. There was a highly significant reduction in the exchange of tenderness in patients of both sexes, and in the capacity for orgasm in female patients. On the other hand, no significant difference was found concerning the frequency of intercourse. Patients with psoriasis felt more impaired than those with atopic eczema. Ninety-three percent of psoriatics and 96% of patients with atopic eczema had not been asked about their sexual life by their attending doctor. We discuss to what extent skin diseases are possibly involved in the regulation of nearness and distance among partners. The dermatologist should a be knowledgeable and understanding source for patients which skin diseases who have questions about their disease and its effect on their sex life.

Adult↗
PubMed2003

The effect of pelvic floor training on sexual function of treated patients.

The aim of this study was to determine the effects of improvements in urinary incontinence resulting from pelvic floor rehabilitation on the sexual function of patients. The study involved 42 clinic patients who received pelvic floor rehabilitation treatment. Their sexual histories were obtained through face-to-face interviews. Pelvic muscle strength was measured with a perineometer. Improvement in incontinence was measured with the pad test. Seventeen women reported decreased sexual desire before the treatment; 5 of these indicated improvement after treatment. Nine of 17 women who experienced dyspareunia prior to treatment reported an improvement afterwards, and four women reported complete relief from pain. Five of 15 women who complained of difficulty in reaching climax before the treatment experienced improvement in this area. In conclusion, an improvement in sexual desire, performance during coitus and achievement of orgasm were observed in women who received pelvic floor muscle rehabilitation. No change was seen in the arousal and resolution stages of sexual activity.

Aged↗
PubMed2005

Impact of tension-free vaginal tape on sexual function: results of a prospective study.

The purpose of this study was to prospectively assess the impact of a TVT insertion for the treatment of stress urinary incontinence (SUI) on coital incontinence and overall sexual life. Sexually active women with pure SUI and without concomitant pelvic organ prolapse scheduled for TVT procedure completed a sexual function questionnaire at baseline and 6 months after surgery. Fifty-three patients were enrolled. Preoperatively 23 (43.4%) women experienced urine leakage during intercourse, 21 (91%) during penetration and 2 (9%) on orgasm. The objective cure rate for SUI was 98%. Coital incontinence was cured in 20 of 23 patients (87%). Thirty-three (62.2%) women reported no change in sexual function after surgery and 18 (34%) reported an improvement. Of the latter, 17 (94%) were of those cured from coital incontinence. No significant difference in the incidence of dyspareunia was found postoperatively. Two patients (3.8%) reported intercourse to be worse following surgery, one because of a vaginal erosion and one cited de novo anorgasmia as the main reason.

Adult↗
PubMed2006

Sexual function in patients presenting to a urogynecology practice.

The purpose of this study was to evaluate sexual function in women referred to a urogynecology practice. All new patients were mailed an optional female sexual function index (FSFI) in conjunction with their history forms; other sexual function information was obtained during the physician interview. Over 6 months, four hundred fifty new patients were enrolled. Of these, 243 (54%) were not sexually active. Reasons listed for sexual inactivity included partner problems/no partner (32%), low desire (14%), prolapse (10%), and pain (10%). There were several differences between sexually active and non-sexually active participants; however, after a multivariate analysis, only age, marital status, and stage/grade 1-2 of prolapse remained significant. One hundred nine sexually active patients completed the FSFI; the majority was sexually active two to four times per month. Female sexual dysfunction was noted in 70 (64%) patients. Lowest scores were noted for the domain of desire, followed by arousal, orgasm, lubrication, satisfaction, and pain. Reduced frequency of intercourse was the only factor significantly associated with dysfunction. Ninety-four percent were not embarrassed by the survey. Overall, sexual inactivity is common in patients presenting for urogynecologic care. Those that are sexually active report low rates of sexual activity and high rates of sexual dysfunction. Most sexually active patients will accept a sexual function questionnaire as part of their routine assessment.

Adult↗
PubMed2006

Effects of sacral neuromodulation on female sexual function.

The aim of this prospective study was to determine if sacral neuromodulation has an effect on the patient's subsequent sexual function. Sexually active patients that underwent an Interstim Sacroneuromodulator implantation (Medtronic, Minneapolis, MN) for control of bladder symptoms were enrolled. A Female Sexual Function Index (FSFI) was completed before surgery and at a mean of 5.7 months postoperatively. Eleven subjects proceeded to permanent implantation, seven of these were sexually active before and after placement. Three subjects (43%) felt the device impacted on their sexual function in a positive way (1) by decreasing urgency and (2) by increasing desire. Overall sexual frequency increased significantly after the surgery (p=0.047). There were also significant increases in the FSFI total (p=0.002), and domain scores for desire (p=0.004), lubrication (p=0.005), orgasm (p=0.043), satisfaction (p=0.007), and pain (p=0.015). There was no correlation between patient report of urinary symptom improvement and FSFI scores. In conclusion, sacral neuromodulation may improve sexual frequency and sexual function scores in subjects with urgency frequency and urge incontinence.

Adult↗
PubMed1999

Sexual function in women attending a urogynecology clinic.

The study prospectively evaluated the relationship between sexual dysfunction and urodynamic diagnoses in 100 consecutive female patients referred for urogynecologic evaluation. Sexual function was evaluated by a detailed questionnaire that addressed four phases of the sexual cycle: desire, arousal, orgasm and satisfaction. Each phase of the sexual cycle was assessed separately using a score of 1-4. Total sexual function (TSF) score was calculated by combining the scores of the four examined parameters (range 4-16). Analysis revealed statistically significant (P < 0.05) lower TSF scores in patients with detrusor instability (DI) than in those with genuine stress incontinence, sensory urge or mixed urodynamic diagnoses (8.65 +/- 4 versus 12.22 + 3.6, 10.25 +/- 4.1 and 11.47 +/- 4.1, respectively). Three per cent of the elderly women (>60 years) compared to 29% of the younger women (< or = 60 years) reported urinary incontinence during sexual activity. Sexual function should therefore be routinely evaluated in women presenting with urinary symptoms.

Adult↗
PubMed2002

The selective serotonin re-uptake inhibitors fluvoxamine and paroxetine differ in sexual inhibitory effects after chronic treatment.

RATIONALE: The selective serotonin re-uptake inhibitors (SSRIs) delay orgasm and ejaculation in men. In men with rapid ejaculation it was shown that, of the SSRIs, paroxetine exerted the strongest delay in ejaculation and fluvoxamine the weakest. OBJECTIVES: In the present study, we compared the acute and chronic effects of fluvoxamine and paroxetine on sexual behavior in the male rat in order to compare their differential inhibitory effects on sexual behavior. METHODS: During a 4-week period, 48 male Wistar rats, selected on the basis of their sexual performance, were repeatedly tested for sexual behavior. All male rats received vehicle (saline, n=12), fluvoxamine (30 mg/kg, n=12), or paroxetine (10 mg/kg, n=12) daily for 2 weeks. Sexual behavioral tests were performed on days 1 (acute), 7, and 14. RESULTS: After acute oral administration, fluvoxamine and paroxetine did not inhibit sexual behavior. After 7 days and 14 days treatment, fluvoxamine mildly inhibited certain parameters of sexual behavior but ejaculation was never delayed. In contrast, paroxetine, after 7 days and particularly after 14 days treatment, strongly inhibited sexual behavior, including ejaculation. CONCLUSIONS: These results strongly concur with clinical data, suggesting that paroxetine, but not fluvoxamine, delays ejaculation. Because fluvoxamine does not delay ejaculation it may serve as an optimal treatment for depressive illness when sexual side effects, such as a delayed ejaculation, are undesired. The mechanisms whereby paroxetine and fluvoxamine, both being selective serotonin uptake inhibitors, differentially inhibit sexual behavior are unclear.

Animals↗
PubMed1998

Clomipramine enhances the cortisol response to 5-HTP: implications for the therapeutic role of 5-HT2 receptors.

We measured the cortisol response to the 5-HT precursor, 5-hydroxytryptophan, (5-HTP) in seven patients with major depression before and after 8 weeks treatment with the tricyclic antidepressant, clomipramine. The cortisol response to 5-HTP was significantly increased following clomipramine treatment, suggesting that clomipramine, like selective serotonin re-uptake inhibitors (SSRIs), enhances this 5-HT2 receptor mediated response. Because other tricyclic antidepressants do not increase 5-HTP-mediated cortisol release, it seems unlikely that enhancement of 5-HT2 receptor function is a critical mechanism for antidepressant action. However, facilitation of neurotransmission at 5-HT2 receptors could account for the efficacy of clomipramine and SSRIs in the treatment of obsessive compulsive disorder and also for their liability to cause orgasmic dysfunction.

5-Hydroxytryptophan↗
PubMed1999

Chronic fluoxetine inhibits sexual behavior in the male rat: reversal with oxytocin.

RATIONALE: Selective serotonin reuptake inhibitors, used widely in the treatment of depression, progressively inhibit sexual orgasm in many patients and induce a transient inhibition of sexual desire. OBJECTIVES: We attempted to model the effects of these drugs in sexually experienced male rats during tests of copulation in bilevel chambers. These chambers allow the study of both appetitive and consummatory sexual responses of male rats. METHODS: Males were treated daily with fluoxetine hydrochloride (0, 1, 5, or 10 mg/kg) and tested for sexual behavior with receptive females at 4-day intervals. Rats were treated with oxytocin (200 ng/kg) or saline after ejaculations had decreased. RESULTS: Fluoxetine decreased ejaculatory responses of male rats in a dose- and time-dependent fashion, but left the copulatory efficiency of the males intact. In contrast, conditioned level changing, a measure of appetitive sexual excitement, was inhibited following acute and chronic treatment with 10 mg/kg, although tolerance may have developed to the effect of 5 mg/kg. Subsequent administration of oxytocin restored the ejaculatory response but not the measure of sexual excitement to baseline levels. CONCLUSIONS: The reversal by oxytocin of the fluoxetine-induced deficit in ejaculations is consistent with the hypothesis that serotonin suppresses ejaculatory mechanisms by interrupting the action of oxytocin, which normally accompanies sexual behavior. Co-administration of oxytocin may help to alleviate the predominant sexual side effect of serotonin reuptake blockers.

Animals↗
PubMed2005

Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping.

Ejaculatory disorders (disorders of emission, ejaculation and orgasm) are the most frequent sexual complaint. Conventional algorithms on ejaculatory disorders are based on an organic or psychogenic dichotomy, with the latter being traditionally considered the main etiological cause. The scope of this review is to propose a new classification of ejaculatory disorders, with special emphasis on epidemiology and subtyping of the most frequent: premature ejaculation (PE). There is growing agreement on definition, diagnosis, and treatment options. In many cases, ejaculatory disorders can be classified by psycho-neuro-uro-endocrine symptoms. Epidemiological data, new classifications and subtyping, together with new diagnostic procedures and the availability of pharmacological aids, place this topic in the mainframe of sexual medicine. This will soon demolish the barriers to seeking help perceived by patients suffering ejaculatory disorders.

Ejaculation↗