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PubMed2005

Cognitive and partner-related factors in rapid ejaculation: differences between dysfunctional and functional men.

Despite the high prevalence of rapid ejaculation in community samples, there is still a paucity of data on cognitive and other relevant aspects of the subjective experience of premature ejaculation (PE) patients and their functional counterparts. Therefore, the main aim of this study was to expand our understanding of the complex nature of rapid ejaculation disorders by providing a detailed characterization of ejaculatory patterns, behavioral aspects, cognitive, and partner-related factors in a sample of unselected PE patients compared to a group of functional men. To explore the areas that might differentiate PE men from their sexually functional counterparts, a multidimensional self-administered questionnaire, the PEQuest, was created. This 36-item instrument addresses a number of domains relevant to ejaculatory function and dysfunction such as ejaculatory latencies and ejaculatory control, cognitions and feelings during sexual intercourse, factors interfering with ejaculatory control, techniques to delay ejaculation, and partnership factors. A total of 45 PE patients (mean age: 41.8 years) and 72 non-patients (mean age: 37.1 years) were included. The results show significant group differences in the majority of PEQuest domains. In the functional group, an average intravaginal latency time of 12.8 min (median: 10 min) was reported compared to 3.7 min (median: 2 min) in the patient group with 87% of PE patients ejaculating within 2 min and 100% within 5 min after penetration. In their subjective experience in sexual situations, PE patients were totally preoccupied with thoughts about controlling their orgasm, with the anxious anticipation of a possible failure, and thoughts about keeping their erection while the inner experience of functional men is focused on sexual arousal and sexual satisfaction. The factors that maximally impede the control of ejaculation are similar for both groups, but functional men normally succeed in adapting their sexual behavior to these factors whereas PE men fail in their efforts. Regarding partner-related factors, PE patients felt less secure and experienced with respect to female sexuality than their functional counterparts, and more often reported a discrepancy between their own limited experience and the more extensive sexual experience of their partner. In conclusion, a number of salient differences in ejaculatory behavior, cognitive-affective patterns, and partner-related factors between PE patients and functional men could be delineated in this study, indicating that chronic rapid ejaculation is a serious disorder with a profound impact on the man's life and his partnership.

Adult↗
PubMed2005

In vitro functional responses of isolated human vaginal tissue to selective phosphodiesterase inhibitors.

Only little is known as to the significance of the cyclic nucleotide-mediated signal transduction in the control of the function of human vaginal smooth musculature. Recently, the presence of the phosphodiesterase (PDE) isoenzymes 4 (cAMP-PDE) and 5 (cGMP-PDE) in the human vagina was reported. Thus, it was the aim of the study to elucidate the effects of some PDE inhibitors on the tension induced by endothelin 1 (ET-1), as well as on levels of cGMP and cAMP in isolated human vaginal wall tissue. Using the organ bath technique, the ability of norepinephrine (NE), carbachol, serotonin (5-HT), oxytocin and ET-1 to contract isolated vaginal wall muscle strips was evaluated. In another set-up, the effects of the PDE4 inhibitor rolipram and PDE5 inhibitors sildenafil and vardenafil (1 nM-10 microM) on the tension induced by 0.1 microM ET-1 of human vaginal wall tissue strips were investigated. In order to measure drug effects on tissue levels of cGMP and cAMP, vaginal tissue was exposed to different concentrations (0.1, 1 and 10 microM) of the compounds and the accumulation of cyclic nucleotides was determined. The adenylyl cyclase stimulating agents forskolin and nitric oxide donor sodium nitroprusside (SNP) (0.01, 0.1 and 1 microM) were used as reference compounds. While NE, carbachol and oxytocin failed to contract the vaginal tissue, ET-1 and, to a certain degree, 5-HT elicited contractile responses of the isolated strip preparations. The tension induced by 0.1 microM ET-1 was dose-dependently reversed by the drugs. The rank order of efficacy was sildenafil > forskolin > rolipram >or= vardenafil > SNP. Rmax values ranged from 24% (SNP) to 50% (sildenafil). With sildenafil being the only exception, none of the compounds reached an EC50 value. The relaxing effects of the drugs were paralleled by a fourfold to tenfold increase in tissue levels of cGMP and/or cAMP. Our results demonstrate that PDE inhibitors can relax human vaginal tissue and increase levels of cyclic nucleoside monophosphates. The findings with regard to the PDE5 inhibitors may indicate that the NO-cGMP pathway is, to a certain degree, involved in the control of vaginal smooth muscle tone. This might be of significance with regard to the pharmacological treatment of disorders connected with female sexual arousal and the ability to achieve orgasm.

Female↗
PubMed2005

Sexual activity, sexual dysfunction and associated help-seeking behaviours in middle-aged and older adults in Spain: a population survey.

To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviours among mature adults in Spain, a telephone survey was conducted in Spain in 2001-2002. This was completed by 750 men and 750 women aged 40-80 years. Eighty-eight percent of men and 66% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (31%) and lack of sexual interest (17%) were the most common male sexual problems. A lack of sexual interest (36%) and an inability to reach orgasm (28%) were the most common female sexual problems. Approximately 80% of men and women with a sexual problem had not sought help from a health professional. Many men and women in Spain report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.

Adult↗
PubMed2006

Sexual behaviour, sexual dysfunctions and related help seeking patterns in middle-aged and elderly Europeans: the global study of sexual attitudes and behaviors.

To study the sexual activity and the prevalence of sexual dysfunctions and related help seeking behaviour, among people in Europe aged 40-80 years. A telephone survey was carried out in 2001-2002 in Sweden, the UK, Belgium, Germany, Austria, France, Spain and Italy, of 4,977 men and 5,023 women, using a structured, standardized questionnaire Eighty-three percent of men and 66% of women had sexual intercourse during the year preceding the interview. The sexual dysfunctions most frequently reported were early ejaculation (11%) and erectile dysfunction (8%) in men; and a lack of sexual interest (18%), an inability to reach orgasm (13%) and lubrication difficulties (11%) in women. Of the 23% of men and 32% of women who reported sexual dysfunction, 26% had consulted a physician, with considerable between-country differences. Sexual activity is widespread among adult middle-aged and elderly people, but many experience sexual dysfunctions and few seek medical care.

Adult↗
PubMed2006

Female sexual dysfunction, voiding symptoms and depression: common findings in partners of men with erectile dysfunction.

The aim of this study was to investigate the prevalence of female sexual dysfunction (FSD), urinary symptoms, and depressive symptoms in female partners of men presenting with erectile dysfunction (ED). A multi-component questionnaire was administered to female partners of men with erectile dysfunction presenting to a urology center. It contained a standardized sexual function component (the Brief Index of Sexual Function for Women), a depression scale (Centers for Epidemiologic Studies-Depression, CES-D), a demographics questionnaire and a general medical questionnaire. A total of 73 consecutive female partners of male patients presenting with ED, were surveyed using the questionnaire at their counterpart's visit. Fifty-two women responded, of whom 50 filled out the questionnaire adequately for proper evaluation. This indicated a response rate of 68% (50/73). The mean age was 44.8 years (range 20.0-83.0). Thirty-eight of the 50 women (76%) reported being sexually active. A variety of sexual behaviors were reported including 40% (20/50) of women engaging in vaginal intercourse. Sexual dysfunction symptoms included: anxiety/inhibition (26%), hypoactive desire (20%), arousal/lubrication difficulty (30%), orgasmic difficulty (24%), dyspareunia (18%), incontinence during intercourse (8%), and sexual dissatisfaction (34%). Eight women (16%) reported difficulty communicating sexual issues with their partners. Forty-one women (82%) rated sexual activity as an important part of their lives. Urinary symptoms of frequency and urgency were reported by 18/50 (36%). Depressive symptoms were present in 22/50 (44%). FSD disorders, urinary symptoms and depressive symptoms are common in partners of men with erectile dysfunction.

Adult↗
PubMed1999

Quality-of-life studies in patients with ambiguous genitalia.

No published study to date has adequately addressed the quality of life (QOL) of intersexuals, although three studies reviewed some of these aspects. A tool specifically for studies in intersexuality is being developed. A pilot survey tested by this author using questions from a population-specific, standardized QOL survey tool was evaluated by use on a small sampling of an intersexual patient test population. The group comprised ten adult intersexuals with an average age of 34.2 years (range: 22-47 years). Survey results disclosed that all considered themselves healthy and physically active. Family relationships were described as generally good, though in discussion most showed some family problems that centered on gender issues. Six had many friends, three had some, and one had few. Eight of the ten had experienced orgasm. Only two felt they trusted doctors. All but one were partially or completely satisfied with their overall physical appearance. Those who had surgery were distressed by the appearance of their genitals, some expressing complete dissatisfaction. With development of sensitive survey tools reflecting the attitudes and concerns of this special population, important issues relating to intersexuality can be addressed.

Adult↗
PubMed2004

Does laparoscopic colorectal resection for diverticular disease impair male urinary and sexual function?

BACKGROUND: Laparoscopic colorectal resection may induce bladder and sexual dysfunction secondary to injury to the autonomic nervous system. The aim of this study was to evaluate urinary and sexual function in male patients after laparoscopic colorectal resection for diverticular disease. METHODS: From January 1997 to March 2002, we performed a retrospective analysis of urinary and sexual function in 56 consecutive male patients who had undergone laparoscopic colorectal resection for diverticular disease. Preoperative and 6-month postoperative assessment was carried out using data collected via standardized postal questionnaires. RESULTS: Three patients were excluded (one had a prior prostatectomy, one had Peyronie's disease, and one was treated with neuroleptics). Fifty-three patients with a mean age of 54 A+/- 2 years were included in the study. There were no conversions. The morbidity rate was 9.4%. Mean follow-up was 27 A+/- 2 months. There was no significant difference in preoperative and postoperative urinary function. Fifty-one patients (96%) were sexually active preoperatively and were still sexually active postoperatively. Compared with the preoperative period, postoperative impairment of libido, erection, ejaculation, and orgasm were not significant. Every patient was able to achieve ejaculation after the intervention, and no retrograde ejaculations were reported. One patient was unable to have an erection after the intervention. CONCLUSION: Laparoscopic colorectal resection for diverticular disease does not significantly impair urinary and sexual function.

Diverticulosis, Colonic↗
PubMed2003

Quality of life aspects in kidney cancer patients: data from a national registry.

GOALS: We investigated quality of life aspects, including health-related quality of life, psychological functioning, relationship issues and sexual functioning in kidney cancer patients. PATIENTS AND METHODS: We conducted an anonymous, cross-sectional survey of a random sample of patients with kidney cancer from a national database. A questionnaire was mailed to 301 members of the Kidney Cancer Association. The questionnaire included demographics, medical history, the Watts Sexual Function Questionnaire (WSFQ), the SF-12 Health Survey, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Revised Dyadic Adjustment Scale (RDAS). RESULTS: Of the 266 eligible participants, 84 (33%) returned the questionnaire. The mean ages of the respondents were 57.5 and 57.9 years for men and women, respectively. Overall, the total WSFQ scores as well as the four domain scores (desire, arousal, orgasm and satisfaction) were similar in men and women, and lower than in female breast cancer and male hypertensive populations reported in the literature, indicating relatively worse sexual function. While subjects reported health-related quality of life and relationship scores similar to the general population, 51% of men and 57% of women reported depressive symptoms (CES-D >/=16). CONCLUSIONS: This is the first study in which sexual function in patients with renal cancer has been addressed. While most patients remain sexually active in non-distressed relationships, many reported depressive symptoms, and sexual functioning may be worse than in comparable chronically ill populations. Quality of life and sexual function issues should be addressed when counseling urological cancer patients.

Adult↗
PubMed2005

Sexual function in men and women after anterior surgery for chronic low back pain.

Sexual dysfunction after anterior lumbar fusion has mainly been focused on male biological function (retrograde ejaculation). The aim of the present study is to assess the effect of fusion surgery for chronic low back pain on the sex-related quality of life. Apart from routine prospective questionnaires, additional gender-specific mailed questionnaires produced retrospective data on sexual enjoyment and function after 2 years of follow-up. Patients randomised to non-surgical treatment and anterior or posterior fusion were compared. We found that surgically treated patients had a significantly better sex life than those non-surgically treated. The improved sex life was significantly associated with the reduced back pain. The improvement after anterior fusion, however, was counteracted by a trend towards disturbed orgasm and genital sensation in women, and a significant disturbance of ejaculation and genital sensation in men. In view of the increased frequency of anterior lumbar surgery with the strong promotion of disc replacement, the findings in the present small retrospective pilot study should be tested in larger prospective trials.

Adult↗
PubMed2005

Sexuality in multiple sclerosis.

Sexuality and partnership have an important influence on the quality of life of every person and also on people with chronic disorders such as multiple sclerosis. The findings in literature show high evidence that people with multiple sclerosis experience high levels of sexual dysfunction, most of them with hypoactive sexual behaviour often associated with dissatisfaction in relationship, and also the partners seem to show lower sexual and partnership satisfaction. The most common problems in women are lack of sexual interest and decreased libido, often with problems in orgasmic capacity, while men report erectile dysfunction and also lack of sexual interest. The impact of the level of disability and duration of the illness remains unclear. Positive familial support can often help the patient in coping with the illness, nonetheless problems with changing roles and multiple-sclerosis-minimizing can improve the need of contacts to outstanding persons.

Humans↗
PubMed2004

Sexual function and quality of life in women after elective aortic surgery.

The incidence of sexual dysfunction in women after open aortic reconstruction is unknown. Additionally, previous studies of quality of life (QOL) following aortic surgery include small numbers of women compared to those of men. The purpose of this study was to determine the effects of elective aortic surgery on sexual function (SF) and QOL in women. Two validated questionnaires, the Female Sexual Function Index (FSFI) and Short Form 36 (SF-36), were mailed to all women who underwent elective aortic reconstruction between 1995 and 2000. Comparisons were made between preoperative (baseline) SF, 1-year postoperative SF, and SF within the 4 weeks preceding receipt of the questionnaire. The SF-36 responses were compared to national norms. Of the 182 women who underwent elective aortic reconstruction, only 122 patients (67%) were alive and able to complete the questionnaires. Of 56 patients (46%) who had sexual partners, 21 (38%) returned both questionnaires and 22 patients returned only the SF-36 portion. There were no differences in desire, arousal, lubrication, orgasm, satisfaction, or pain scores. There was a trend toward poorer baseline sexual function in claudicants in all domains, with the pain domain reaching significance (p = 0.03). Previous hysterectomy did not affect sexual function (p > 0.05). Following aortic surgery, patients had a significant decrease in the role-physical (p = 0.03), social functioning (p = 0.01), role-emotional (p < 0.001), and mental health domains (p < 0.001) compared to national norms. There were no differences in QOL scores between claudicants and aneurysm patients or married and nonmarried patients. Sexual function is maintained in women undergoing open reconstructive aortic surgery. Patients with occlusive disease tend to have poorer preoperative sexual function than aneurysm patients. Compared to national norms, QOL is worse in women after aortic surgery.

Aged↗
PubMed2006

Sexual functioning of people with rheumatoid arthritis: a multicenter study.

The objective of this study is to compare men and women with rheumatoid arthritis (RA) to controls regarding sexual motivation, activity, satisfaction, and specific sexual problems, and to determine the correlation of physical aspects of the disease with sexual functioning. Questionnaire for screening sexual dysfunctions (QSD), self-constructed questionnaire on experienced distress with joints during sexual activities, arthritis impact measurements scales 2 (AIMS2), and the modified disease activity score 28 (DAS 28) were the methods used. RA patients were recruited from a registration base in three Dutch hospitals. Controls were age and sex matched healthy volunteers. A completed questionnaire was sent back by 271 patients (response 23%). Forty-seven men and 93 women were clinically examined to obtain the DAS 28. Male patients felt less sexual desire, and female patients masturbated and fantasized less than controls. Differences in satisfaction were not found. Male and female patients did not experience more sexual problems than controls. Among the women, correlations were predominantly found between age and sexual motivation and activities, among the men between physical health and sexual problems. Up to 41% of the men (4-41 depending on the joints), and up to 51% of the women (10-51 depending on the joints) have troubles with several joints during sexual activities. Medications influencing ejaculation in men correlated with distress with orgasm. Conclusions are that patients are less sexually active than controls and a considerable number of both male and female patients have trouble with their joints during sexual activities. However, patients do not differ from controls regarding sexual satisfaction. Physiological changes due to RA are apparently independent from those on psychological level. It is argued that sexual satisfaction also depends on personal and social factors. In men, physical health and disease activity are more related with sexual problems than in women.

Arthritis, Rheumatoid↗
PubMed2006

Sex, touch, and HIV risk among ecstasy users.

We examined HIV risk among heavy and nonheavy ecstasy users, focusing specifically on touch and sexual behavior as part of the ecstasy experience. Structured interviews were conducted with 268 young adult (age 18-25) ecstasy users in Atlanta, Georgia. Heavy ecstasy users were more likely to have been tested for HIV than nonheavy users (79 vs. 68%). However, they also were more likely to perceive no chance of contracting HIV (36 vs. 26%). Touch, both sensual and sexual, was a significant part of the ecstasy experience. In addition, ecstasy use seemed to increase the sexual desire, however, not the ability to achieve an orgasm. Heavy users reported more sexual risk-taking than their nonheavy using counterparts. Results suggest that the setting of ecstasy use also may influence involvement in risk behaviors. Future longitudinal studies are needed on the relationship between ecstasy use, touch, sexual arousal and ability, and risk behavior.

Adolescent↗
PubMed2005

Validation of the McCoy Female Sexuality Questionnaire in an Italian sample.

This article presents the result of a study that translated into Italian and validated the McCoy Female Sexuality Questionnaire (MFSQ) on an Italian sample. The questionnaire was first administered to a sample of 240 Italian women (age range, 18-65 years) recruited from a gynecology clinic. A principal component analysis identified 2 factors: sexuality (9 items) and partnership (5 items). Both factors showed an adequate inter-item reliability (Cronbach's alpha of .88 and .75, respectively). The validity of the Italian MFSQ was then tested by administering the questionnaire to a sample of 16 women with sexual dysfunction and 46 control women. Sexual dysfunction diagnoses were assessed through a semi-standardized interview based on the DSM-IV-TR diagnoses for Female Sexual Arousal Disorder, Female Orgasmic Disorder, Dyspareunia, and Hypoactive Sexual Desire Disorder. A discriminant validity test showed significant differences between women with and without female sexual dysfunction. These results indicate that the translated version of the MFSQ is a reliable and valid measure of sexual dysfunction among Italian women. The results also indicated a difference in factor structure between the Italian and the original version of the MFSQ, which warrants further investigation.

Adult↗
PubMed2006

Effects of depressive symptoms and experimentally adopted schemas on sexual arousal and affect in sexually healthy women.

The present study examined the effects of depressive mood symptoms and experimentally adopted sexual schemas on women's sexual arousal and affect. Women's vaginal response, subjective sexual arousal, and affect were measured in response to sexually explicit visual material in a laboratory setting. At baseline on a self-report measure, women with depressive mood symptoms (n = 28) reported significantly lower sexual desire than women with normal mood (n=28), but no significant differences in arousal, orgasm, satisfaction, or pain. Participants were asked to adopt both a positive and negative sexual self-schema prior to viewing erotic stimuli. Women in both mood groups demonstrated significantly greater subjective sexual arousal, vaginal response, and positive affect in the positive schema condition than in the negative schema condition when controlling for anxiety. There were no main effects for mood symptoms. These findings support an information processing conceptualization of sexual arousal and suggest that an acute dose of cognitive sexual schemas can significantly impact subsequent sexual and affective responses. Implications of findings for the assessment and treatment of sexual dysfunction are noted.

Adult↗
PubMed2007

Sexual practices and sexual satisfaction: a population based study of Chinese urban adults.

This study examined sexual satisfaction and its social and behavioral correlates among urbanites aged 20-64 in China, using data from a nationally representative sample of 1,194 women and 1,217 men with a spouse or other long-term sexual partner with whom they had sex during the last year. The results from structural equation models suggest a multiplex set of determinants of sexual satisfaction, including relationship characteristics, sexual knowledge and personal values, physical vitality, and environmental impediments. A large proportion of the effect of these background characteristics was mediated by frequent orgasms, varied sexual practices, and perceived partner affection. In particular, much of the effect of knowledge and beliefs was mediated through variety in sexual practices. While many of the observed patterns were shared among women and men, much of the effect of relationship characteristics was mediated through perceived partner affection for women. Men, in contrast, paid greater attention to his partner's physical attractiveness and to her extramarital sex. A sexual transition is well underway in urban China, even if more rapidly for men than for women. While knowledge and values are arguably more important in this transitional period, many antecedents of sexual well-being drawn from the literature on sexual behavior in developed Western countries are also applicable to urban China.

Adult↗
PubMed2006

Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery.

This study examined preoperative preparations, complications, and physical and functional outcomes of male-to-female sex reassignment surgery (SRS), based on reports by 232 patients, all of whom underwent penile-inversion vaginoplasty and sensate clitoroplasty, performed by one surgeon using a consistent technique. Nearly all patients discontinued hormone therapy before SRS and most reported that doing so created no difficulties. Preoperative electrolysis to remove genital hair, undergone by most patients, was not associated with less serious vaginal hair problems. No patients reported rectal-vaginal fistula or deep-vein thrombosis and reports of other significant surgical complications were uncommon. One third of patients, however, reported urinary stream problems. No single complication was significantly associated with regretting SRS. Satisfaction with most physical and functional outcomes of SRS was high; participants were least satisfied with vaginal lubrication, vaginal touch sensation, and vaginal erotic sensation. Frequency of achieving orgasm after SRS was not significantly associated with most general measures of satisfaction. Later years of surgery, reflecting greater surgeon experience, were not associated with lower prevalence rates for most complications or with better ratings for most physical and functional outcomes of SRS.

Adult↗
PubMed2001

Symptoms and therapies: exertional and sexual headaches.

This article discusses the headache disorders associated with physical and sexual activity, highlighting their differences and similarities. The place of exertional and sexual headaches in the classification of the International Headache Society and in the proposed classification of Indomethacin-Responsive Headache Disorders is addressed here. The Valsalva's maneuver as a shared pathophysiologic mechanism is mentioned as well. Exertional headaches are divided into two subtypes, according to the pattern of physical exercises. Sexual headaches are divided into three subtypes, based on the onset time, related to orgasm. The clinical characteristics of each type are presented, and their etiologies pointed out. The diagnostic approach is discussed, as well as the nonpharmacologic and pharmacologic treatment options.

Coitus↗