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PubMed2001

Measurement of male and female sexual dysfunction.

Measurement approaches for male and female sexual dysfunction have proliferated in recent years, spurred in large part by the development of new treatments for male and female dysfunction. In the past, physiologic measures of penile tumescence and rigidity in males, and vaginal blood flow in females, played an important role in clinical and research studies. More recently, a variety of brief, self-report measures have been developed for assessing male and female function across a variety of sexual domains (eg, desire, arousal, orgasm, satisfaction). These self-report measures have been shown to have a high degree of reliability and validity, and are sensitive to treatment interventions. Accordingly, they are widely employed in clinical trials. Daily diary or sexual event logs have similarly been developed for this purpose. Self-report measures have been used for clinical screening purposes and for diagnostic assessment of sexual function in a number of studies. Finally, several disease-specific quality of life and treatment satisfaction measures have been developed, which are currently in widespread use in clinical trials of sexual dysfunction.

Female↗
PubMed2001

Sexual dysfunction and depression.

Sexual functioning is generally impaired during depression. Interest in the relationship between sexual dysfunction and depression has risen substantially, prompted primarily by 1) the 1998 Food and Drug Administration approval of sildenafil citrate as the first oral therapy of erectile dysfunction, and 2) the widespread clinical use of selective serotonin reuptake inhibitors, which prominently impair orgasm, and possibly libido and arousal. In this paper, we first review the phenomenology of sexual dysfunction and important contributing factors, such as age and illness, and then focus on the clinical assessment and therapeutic interventions used for sexual dysfunction in depressed individuals.

Age Factors↗
PubMed2000

Prevalence and risk factors of sexual dysfunction in men and women.

Sexual dysfunctions are highly prevalent, affecting about 43% of women and 31% of men. Hypoactive sexual desire disorder has been reported in approximately 30% of women and 15% of men in population-based studies, and is associated with a wide variety of medical and psychologic causes. Sexual arousal disorders, including erectile dysfunction in men and female sexual arousal disorder in women, are found in 10% to 20% of men and women, and is strongly age-related in men. Orgasmic disorder is relatively common in women, affecting about 10% to 15% in community-based studies. In contrast, premature ejaculation is the most common sexual complaint of men, with a reporting rate of approximately 30% in most studies. Finally, sexual pain disorders have been reported in 10% to 15% of women and less than 5% of men. In addition to their widespread prevalence, sexual dysfunctions have been found to impact significantly on interpersonal functioning and overall quality of life in both men and women.

Adult↗
PubMed2000

Sexual side effects of antidepressant drugs.

Sexual functioning often suffers during depression, although depressed people continue to value sex. Many popular antidepressants further impair sexual functioning, with highly serotonergic agents affecting orgasm and libido prominently. This paper addresses clinical assessment of sexual side effects from antidepressant drugs and reviews treatment strategies, including purported antidotes. We pay particular attention to sildenafil, on which there are impressive data and ongoing controlled studies.

Antidepressive Agents↗
PubMed2003

Vardenafil: a new approach to the treatment of erectile dysfunction.

Vardenafil is a phosphodiesterase type-5 (PDE-5) inhibitor developed as an oral therapy for erectile dysfunction (ED). Multiple phase 3 clinical trials have been completed and vardenafil is expected to launch worldwide in 2003. Two pivotal, randomized, double-blind, multicenter studies have evaluated the use of vardenafil in men with ED. Vardenafil improved the rate of achieving and maintaining an erection during sexual intercourse. Improvement also was noted in other aspects of sexual function, including confidence, orgasmic function, and overall satisfaction. Vardenafil produces clinically and statistically significant improvements in erectile function regardless of age, baseline severity, and etiology and is efficacious for the treatment of ED in diabetic and postprostatectomy patients. Vardenafil has a rapid onset of action and completion of successful sexual intercourse is possible for some patients 16 minutes after its administration. Twenty milligrams of vardenafil has sustained long-term efficacy by providing up to 92% of patients with improved erections during more than 2 years of treatment. Vardenafil is well tolerated, with an adverse event profile typical of the class of PDE-5 inhibitors. The most common adverse events were headache, flushing, rhinitis, and dyspepsia, which were mild or moderate and generally decreased with continued treatment. Vardenafil may be associated with transient reductions in blood pressure and commensurate increases in heart rate, with the overall incidence of cardiovascular-related adverse events similar to that of placebo.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1988

Sexual dysfunction in the diabetic patient with hypertension.

The prevalence of diabetes mellitus and hypertension in the United States is increasing partly because of the incidence of these diseases in the growing geriatric population. Diabetes and hypertension have been associated with sexual dysfunction in both men and women. Neuropathy, vascular insufficiency and psychological problems have been implicated in impotence, impaired ejaculation and decreased libido in men and in decreased vaginal lubrication, orgasmic dysfunction and decreased libido in women. Several investigations of women with diabetes suggest fewer reports of sexual dysfunction than have been reported by diabetic men. However, there have been few evaluations of sexual dysfunction in women and no standard methods for assessment. Antihypertensive agents, especially diuretics, sympathetic inhibitors and beta-blocking agents have been associated with sexual dysfunction due to autonomic and hormonal effects. An estimated 40 to 80% of diabetic hypertensives have reported sexual dysfunction in several investigations. Clearly, the diabetic hypertensive patient should be evaluated for sexual dysfunction, and appropriate therapy, including changes in medication or referral for sex counseling, should become routine in clinical care.

Aged↗
PubMed1984

Phenoxybenzamine--an effective male contraceptive pill.

Phenoxybenzamine (PBZ), administered in doses up to 20 mg/day, caused aspermia following male orgasm. This led to the development of a male contraceptive pill, PBZ being the active drug. It has been shown that small doses of the drug do not change the hormonal balance of the body, nor do they affect blood pressure. In 2 to 3 days, PBZ blocks ejaculation; this is fully reversed with the cessation of treatment. The drug does not affect semen quality (testicular function), even after a long period of medication. During treatment, the vas deferens, the ampulla and the ejaculatory ducts are probably paralyzed. Cessation of medication brought full recovery of these effects and the reappearance of normal ejaculation. Men complaining of premature ejaculation reported marked improvement in their sexual performance. The recommended regimen for administering PBZ as a male contraceptive is discussed.

Adult↗
PubMed1984

Increased sexual activity during the midcycle portion of the human menstrual cycle.

Daily sexual activity of sexually active lesbian couples was recorded over a 14-week period. Significant peaks in sexual encounters and orgasms were found during the midcycle portion of the menstrual cycle. These results demonstrate a pattern of increased midcycle sexual activity independent of interactions with males, type of contraceptive method, or fear of pregnancy.

Adult↗
PubMed1995

Surgical treatment of intersex disorders.

Despite the progress made in understanding the factors regulating sexual differentiation, infants born with ambiguous genitalia face significant problems. The authors reviewed a group of 84 children with ambiguous genitalia managed surgically between 1986 and 1993. The most frequent condition was male pseudohermaphroditism (PM) (58%); 31% had female pseudohermaphroditism. Fifty-seven percent of patients were raised as males and 43% as females. In each group of patients, feminine and masculine reconstructive operations were performed. In only 31% of PM and 60% of PF cases was the diagnosis made within the first 2 months of life. In 41% of PF and 40% of PM patients, treatment was begun before the second year of life, which we consider an acceptable time. The timing and type of vaginoplasty were determined by the point of entry of the vagina into the urogenital sinus. Of the 29 patients reared as females, 22 required perineal vaginoplasty, had pull-through vaginoplasty, and 2 had colovaginoplasty. Since 1986, we have applied Mollard's clitoroplasty, which preserves the neurovascular bundle and is important for experiencing orgasm. Seventeen percent of patients with feminization procedures experienced complications. The optimal time for masculinization procedures is 2 years of age, after obligatory testosterone treatment. If there is utriculus prostaticus (UP) type II or III, it is removed before urethroplasty. This is not done for UP types 0 and 1. In PM cases, the number of feminization and masculinization operations was 2.1 and 4.05 per patient, respectively. It is easier to make a vagina than a phallus, not taking into consideration dimensions, aesthetics, or capability of erection of the phallus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

The differential impact of diabetes type on female sexuality.

Although diabetes is associated with a high prevalence of erectile impairment in men, its effect on the sexuality of women remains unclear. Since diabetes consists of different disorders, diabetes type may have confounded previous studies by differentially impacting on sexual functioning and marital satisfaction. To evaluate this possibility, 35 Type I diabetic married women were compared with 42 healthy married controls and 23 Type II diabetic women with 23 controls. Assessments were made on all aspects of sexual response, activity, dysfunction and satisfaction; on cognitive and psychological dimensions of sexuality; and on marital adjustment. Results indicated that diabetes type is highly associated with sexual responsiveness and marital satisfaction. Type I diabetes was found to have little or no effect on women, while Type II diabetes had a pervasively negative impact on sexual desire, orgasmic capacity, lubrication, sexual satisfaction, sexual activity, and on the relationship with the sexual partner.

Adult↗
PubMed1993

Mechanisms of urine loss during sexual activity.

The objective of the study was to establish the prevalence of urine loss during sexual activity and to identify the major mechanisms which cause this complaint. The study was carried out in two gynecological out-patient clinics in Rotterdam, The Netherlands. This exploratory study was conducted by using a detailed questionnaire filled in by all incontinent sexually active female patients. The results show that 66 (34%) of 196 incontinent and sexually active women experienced the complaint. The results are based on 57 women (response rate, 86%). The mean age was 47 years. Deep penetration and abdominal pressure were considered to be responsible in 77%. Also, 74% of the women experienced leakage during orgasm and in 50% it was noticed during clitoral stimulation. It is concluded that urine loss during sexual activity is a frequently encountered problem in female incontinent patients. A multifactorial pathophysiology with mechanical and non-mechanical factors is suggested.

Coitus↗
PubMed1985

Sexual behavior frequency and biphasic ovulatory type menstrual cycles.

College students whose menarche had occurred 7 years previously, prospectively recorded menstrual and sexual behavior history for 14 weeks as well as basal body temperatures. Regular weekly coital activity associates with the highest incidence of fertile type cycles in this sample of young women as follows: (1) Regular weekly heterosexual behavior was associated with 29.5 +/- 3 day menstrual cycle length. Less frequent sexual activity (sporadic) and celibacy were associated with an increased frequency of aberrantly short and long cycle lengths. (2) Either of two heterosexual behaviors (coitus and/or genital stimulation by a man) were behaviors which were adequate as associates of 29.5 +/- 3 day cycles. (3) Self-stimulation (masturbation to orgasm) was inadequate as an associate of the above-described pattern of menstrual cyclicity. (4) Women with regular weekly coital activity had the highest incidence (90%) of fertile type basal body temperature (BBT) rhythms. Sporadically active women had the next highest incidence (55%) of fertile type BBT rhythms. Celibate women had the lowest incidence (44%) of fertile type BBT's.

Adolescent↗
PubMed1986

Pregnancy and sexual function in women with bladder exstrophy.

As a result of improved surgical and medical treatment, an increasing number of women with bladder exstrophy are reaching childbearing age. Unfortunately, little data exist regarding their sexual capacity, fertility, and potential complications of pregnancy. To assess these parameters, the medical records of 40 women ranging in age from nineteen to thirty-six years who had been treated in infancy for bladder exstrophy were reviewed. The 14 pregnancies in 11 women (25%) resulted in 9 successful deliveries, 3 spontaneous abortions, and 2 elective abortions. Nine women in this group had previous urinary diversion. Twelve of the 40 women agreed to participate in a survey of sexual capacity. Eight of this group reported that they engaged in regular sexual activity. Six reported regular orgasms, 4 dyspareunia, and 5 dysmenorrhea. Five of these women had achieved 7 pregnancies, and only 1 woman in this group who desired pregnancy had been unable to conceive. Complications during pregnancy included: uterine prolapse in 7, acute pyelonephritis in 1, prolapsed ileal conduit in 1, and transient urinary incontinence in 1.

Adult↗
PubMed1992

Twelve-month comparison of two treatments for erectile dysfunction: self-injection versus external vacuum devices.

This study directly compared two nonsurgical treatments for erectile dysfunction, self-injection of papaverine/phentolamine and external vacuum devices, in terms of usage rates, effectiveness, side effects, dropout rates, and impact on patient sexual and psychologic functioning. Both alternatives were regularly, successfully, and safely used by patients, though dropout rates were higher for self-injection. Both produced erections of improved quality, and effected sustained improvements in frequency of intercourse, orgasm, and sexual satisfaction. Spontaneous erections also improved with both treatments. General psychiatric symptomatology was decreased, and anxiety was improved. There were no differences between the two treatments in sexual or psychologic impact. Relative contraindications and esthetic considerations are presented.

Coitus↗
PubMed1989

Prostate cancer: a model of cancer in the elderly.

Prostate cancer is the most common malignancy in men over 70. Chronic course of the disease and multiple therapeutic options allow a customized management of the patient's individual problems. Prognostic factors are stage, size of primary tumors, serum acid phosphatase levels, number of metastases, ureteral obstruction and patient's age. In localized disease, surgery and radiation therapy are equally effective for patients with a life expectancy less than or equal to 10 years. Surgery may be superior to radiation if longer survival is expected. In locally advanced disease radiation therapy is preferred to surgery, due to a lower rate of complications. Management of metastatic disease requires offsetting androgen effects by castration or by antiandrogens. Orchiectomy, the safest way to produce castration, is unacceptable to 50% of patients. LHRH analogs are safer than estrogens, but more expensive; the risk of tumor flare up controindicates these compounds in life-threatening situations. The use of ketoconazole is limited by long-term toxicity, but may be life-saving in life-threatening situations, due to a rapid onset of action. Antiandrogens are as effective as castration, but are not commercially available in the USA. Alternative treatments include Estracyt, intermittent estrogentherapy, progesterone derivative and aminogluthetimide. Radical prostatectomy and radiation therapy to the prostate cause erectile impotence with persistence of orgasmic sensations. These patients are ideal candidates for erection-restoring interventions, such as intrapenile injections or penile implants.

Aged↗
PubMed1985

Elevation of pain threshold by vaginal stimulation in women.

In 2 studies with 10 women each, vaginal self-stimulation significantly increased the threshold to detect and tolerate painful finger compression, but did not significantly affect the threshold to detect innocuous tactile stimulation. The vaginal self-stimulation was applied with a specially designed pressure transducer assembly to produce a report of pressure or pleasure. In the first study, 6 of the women perceived the vaginal stimulation as producing pleasure. During that condition, the pain tolerance threshold increased significantly by 36.8% and the pain detection threshold increased significantly by 53%. A second study utilized other types of stimuli. Vaginal self-stimulation perceived as pressure significantly increased the pain tolerance threshold by 40.3% and the pain detection threshold by 47.4%. In the second study, when the vaginal stimulation was self-applied in a manner that produced orgasm, the pain tolerance threshold and pain detection threshold increased significantly by 74.6% and 106.7% respectively, while the tactile threshold remained unaffected. A variety of control conditions, including various types of distraction, did not significantly elevate pain or tactile thresholds. We conclude that in women, vaginal self-stimulation decreases pain sensitivity, but does not affect tactile sensitivity. This effect is apparently not due to painful or non-painful distraction.

Adult↗
PubMed1990

Pre and posttreatment evaluation of sexual function in patients with adenocarcinoma of the prostate.

Twenty-seven patients with adenocarcinoma of the prostate, and available partners, were interviewed to qualitatively and quantitatively assess their level of sexual function prior to and 12 months after radiotherapy. Assessments were made using the Derogatis Interview for Sexual Functioning (DISF). Five domains of sexual functioning are measured: sexual fantasy, arousal, experience, orgasm, and drive. Prior to therapy 17 of 27 patients (62.9%) were considered impotent. There were eight patients with a DISF score of less than 20 who were impotent. Six patients had a DISF score of greater than 47 and were considered potent. Of the patients with DISF scores between 20-47 four were potent, and nine were impotent. Post radiation therapy three of the patients considered potent (with a score greater than 47) maintained their potent status. Four patients considered impotent prior to therapy became potent after therapy. All patients with a score less than 20 prior to radiation therapy remained impotent after therapy. Results indicate that an objective evaluation of sexual function pre treatment is necessary to determine the effect of radiotherapy. Our method of qualitative assessment of sexual function was easy to implement, was reproducible and could be used to evaluate long-term effects of radiotherapy on sexual function. Of the patients presenting for radiotherapy, 62.9% were impotent. Twelve months after radiation therapy 19 of 27 (70.3%) were impotent.

Adenocarcinoma↗
PubMed1982

Coitus and chorioamnionitis: a prospective study.

Amniotic fluid infections have been strongly associated with coitus during pregnancy. If the relationship is causal it may be possible to identify a time sequence between coitus, penetration of bacteria through the mucous plug in the cervix, the development of infection in the extraplacental membranes near the cervical os, spread of the infection to the amniotic fluid and complications of the infection. The present study looked for such a sequence in an analysis of 541 pregnancies. A peak frequency of chorioamnionitis limited to the extraplacental membranes was present when labor and delivery took place within two days of the last coitus. In the next two days the infection spread to the amniotic fluid as evidenced by a peak frequency of maternal neutrophils migrating through the placental plate toward the amniotic cavity. Premature delivery was 4 times more frequent when there had been recent coitus and an amniotic fluid infection was present than when either factor was absent (P less than 0.01). Spontaneous rupture of the fetal membranes before the onset of and the membranes were inflamed than when these factors were absent (P less than 0.01). This raises the possibility that orgasm further weakened or ruptured membranes that had already been weakened by infection.

Amnion↗