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PubMed2005

Psychosocial effects of hysterectomy: literature review.

OBJECTIVES: With the development of less invasive treatments, the suitability of hysterectomy as a treatment for benign symptoms is being reevaluated. This paper critically and comprehensively reviews the psychosocial outcomes of hysterectomy in areas of sexuality, pain, and psychological functioning. METHODS: Medline, Pub Med, and PsychLit were searched for studies and reviews pertaining to the psychosocial outcomes of hysterectomy. Over 100 studies and reviews, in English, French, and German language, published in the past 30 years were included. Controversial theories and empirical evidence are discussed in the domains of sexuality, pain, and psychological well-being. Special attention is devoted to design, sampling, and measurement issues as well as different surgical approaches with regard to hysterectomy-oophorectomy. RESULTS: While hysterectomy appears to reduce pain, there do not appear strong psychosexual or psychosocial effects. Nonetheless, there may be a subgroup of women (10-20%) who report negative psychosocial outcomes such as reduced sexual interest, arousal, and orgasm, as well as elevated depressive symptoms and impaired body image. CONCLUSIONS: More research is necessary to establish which patients may benefit most and which may not. Directions for future research are discussed.

Adult↗
PubMed2004

Impact of successful liver transplantation on reproductive function and sexuality in women with advanced liver disease.

Abnormalities in the reproductive function and sexuality, which are common among women with advanced liver disease, may reverse after successful liver transplantation (LT). To analyze reproductive function and sexuality in women who underwent successful LT, we interviewed 28 recipients (mean age 44.17 +/- 13.6 years old) at a median posttransplant survival of 36.5 months (range, 6 to 110 months), with good graft function and obeying regular follow-up at our institution. In addition to medical records, all subjects answered a questionnaire on their menstrual pattern, sexual activity, contraceptive practice, pregnancy, and sexuality domain. Nineteen of 22 patients in the child bearing age (86.4%) recovered menstrual function at a median of 1 month after LT (range, 1 to 7 months). Twenty of 28 recipients (71.4%) were sexually active. The most frequent contraceptive practices were barrier methods and tubal ligation. There were four successful pregnancies (one twin) in three patients; five healthy babies were delivered. Overall, 70% of sexually active patients indicated satisfaction with their relationship, 75% had weekly intercourse, and 70% experienced orgasm with intercourse. Eighty percent expressed a desire to receive information concerning sexuality. In conclusion, LT has a positive impact on sexuality and reproductive function in female recipients. It would desirable that LT programs included information regarding these issues for this population.

Adult↗
PubMed2005

Reliability of remembered International Index of Erectile Function domain scores in men with localized prostate cancer.

OBJECTIVES: To test the reliability of recollected International Index of Erectile Function (IIEF) domain scores before and after radical prostatectomy. Recall reliability can be affected by several biases. In men with localized prostate cancer (PCa), conflicting results have been reported. METHODS: Thirty-nine men, aged 44 to 69 years, were invited to participate in a prospectively administered IIEF questionnaire. The survey was administered before and 6 and 12 months after radical prostatectomy. Several months later, a recall IIEF survey targeted the prospectively gathered IIEF data. The independent sample t test, Pearson correlation coefficient, partial correlation, and intraclass correlation coefficient tested the reliability of the recalled IIEF scores versus the prospective ratings. RESULTS: All 39 men completed the prospective and recalled IIEF surveys addressing preoperative erectile function. Surveys targeting function at 6 and 12 months after surgery were completed by 85% and 51% of the participants, respectively. The erectile function domain demonstrated the greatest recall reliability (intraclass correlation coefficient 0.65 to 0.73). Erectile function and sexual desire scale recall reliability was greatest for pretreatment function or function 12 months after surgery. The orgasmic function domain had the lowest recall reliability (intraclass correlation coefficient 0.37 to 0.54). CONCLUSIONS: When restricted to before surgery and 12 months after surgery, most IIEF domains may be reliably used in a retrospective fashion. The erectile function and sexual desire domains appear to be most reliable, possibly because they address more objective areas of men's sexual function.

Adenocarcinoma↗
PubMed2005

Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy.

OBJECTIVES: To determine whether propionyl-L-carnitine (PLC) plus acetyl-L-carnitine (ALC) improves the effectiveness of sildenafil in restoring sexual potency after bilateral nerve-sparing radical retropubic prostatectomy. METHODS: We analyzed the data from 96 patients who had undergone bilateral nerve-sparing radical retropubic prostatectomy: 33 were given placebo (group 1), 32 used PLC 2 g/day plus ALC 2 g/day plus sildenafil 100 mg when needed (group 2), and 35 used sildenafil alone (group 3). The studied variables were sexual function (assessed through sexual behavior interviews and the International Index of Erectile Function), peak systolic velocity and end-diastolic velocity of cavernosal arteries (assayed by dynamic echo-color Doppler), the percentage of patients able to achieve a positive intracavernous injection test, and side effects. RESULTS: Placebo proved ineffective and sildenafil and sildenafil plus ALC and PLC proved effective. The International Index of Erectile Function-15 scores of the group 2 patients were significantly greater than those of group 3 in the following domains: erectile function, sexual intercourse satisfaction, orgasm, and general sexual well-being. The drugs did not significantly modify the score in the sexual desire domain or in the peak systolic velocity or end-diastolic velocity of the cavernosal arteries. Sexual behavior interviews revealed that 2 of 29 in group 1, 28 of 32 in group 2, and 20 of 39 in group 3 attained satisfactory sexual intercourse (P <0.01). Only group 2 had a significantly increased percentage of patients with a positive intracavernous injection test after therapy (36.4% versus 63.6%; P <0.01). ALC plus PLC did not significantly improve the side effects of sildenafil. CONCLUSIONS: PLC and ALC proved to be safe and reliable in improving the efficacy of sildenafil in restoring sexual potency after bilateral nerve-sparing radical retropubic prostatectomy.

Acetylcarnitine↗
PubMed2005

Mental health and lifestyle correlates of sexual problems and sexual satisfaction in heterosexual Hong Kong Chinese population.

OBJECTIVES: To examine the lifestyle, mental health, and stress-related factors associated with various types of sexual problems among sexually active, heterosexual Hong Kong residents aged 18 to 59 years. METHODS: An anonymous, cross-sectional, random telephone survey was conducted using a special, validated, computerized telephone interview method. A total of 1281 men and 2130 women completed the interview (response rate 50.6%). Sexual problems were determined according to the Diagnostic and Statistical Manual (of Mental Disorders) IV definitions. RESULTS: Among the men, multivariate analyses indicated that older age, poor spousal relationship, less exercise, high level of family stress, high level of financial-related stress, and past year substance use were significantly associated with sexual problems (odds ratio [OR] 1.41 to 3.83). Among the women, being married or cohabiting with a partner was positively associated with lubrication problems, lack of orgasm, lack of pleasure, lack of interest (OR 1.43 to 1.73) and negatively associated with pain during intercourse (OR 0.66) and anxiety (OR 0.62). A high level of financial stress and neuroses diagnoses were also associated with various female sexual problems (OR 1.40 to 2.66). Sexual satisfaction was associated with being married/cohabitating (OR 1.94) and negatively associated with a poor spousal relationship, low level of exercise, and a high level of work-related stress among men (OR 0.37 to 0.71). Among women, a poor spousal relationship and high levels of family stress and financial stress were associated with not being satisfied sexually (OR 0.24 to 0.71). CONCLUSIONS: Mental health, stress-related factors, and lifestyle factors contribute to sexual problems among Hong Kong Chinese adults. The factors differed between the two sexes.

Adolescent↗
PubMed2006

Evaluation of sexual function in young men with spina bifida and myelomeningocele using the International Index of Erectile Function.

OBJECTIVES: To assess sexual function in young men with spina bifida and myelomeningocele. METHODS: Between November 2003 and February 2004, a cross-sectional study was performed in 55 men older than 18 years of age who had been regularly followed up for myelomeningocele since childhood, between 1961 and 1985, in the Pediatric Internal Surgery Department. The International Index of Erectile Function (IIEF) questionnaire was mailed to each man. RESULTS: The response rate was 72.7%. Of the 40 men who replied, 16 (40%) had had sexual intercourse at least once during the previous month. These were the older men (age 31.9 +/- 5.7 years versus 27.7 +/- 5.5 years, P = 0.027). The IIEF scores for the whole group were erectile function 11.61 +/- 9.44, orgasmic function 3.53 +/- 3.86, sexual desire 6.94 +/- 2.4, intercourse satisfaction 3.7 +/- 4.81, and overall satisfaction 4.7 +/- 3.34. According to the classification of Cappelleri, of the 16 men who had had sexual intercourse during the previous month, 4 had no erectile dysfunction, 3 had mild, 4 mild to moderate, and 5 severe dysfunction. Erectile function was statistically related to the ability to maintain erections (mean IIEF score 4 and 5 for men with no erectile dysfunction versus a mean IIEF score of 4 and 5 for men with erectile dysfunction: 4.75 +/- 0.5 versus 2.00 +/- 1.32, P = 0.011 for IIEF score of 4 and 4.50 +/- 1.5 versus 3 +/- 2, P = 0.040 for IIEF score of 5). CONCLUSIONS: Young adult men with spina bifida and myelomeningocele begin sexual activity late. Moreover, 75% have erectile dysfunction that is related to difficulty in maintaining erections.

Adult↗
PubMed2006

Neurovascular preservation in orthotopic cystectomy: impact on female sexual function.

OBJECTIVES: The published data regarding female orthotopic cystectomy have focused primarily on urethral recurrence and urinary continence. In a new era of sexuality, evaluating postoperative sexual outcome has become a new surgical endpoint. In this study, we focused on the impact of neurovascular preservation after radical cystectomy and neobladder construction. METHODS: We assessed female sexuality in 13 patients after orthotopic cystectomy using a standardized questionnaire, Female Sexual Function Index (FSFI). Six patients had undergone nerve-sparing cystectomy and seven had undergone contemporary non-nerve-sparing cystectomy. Intraoperatively, the tumor was deemed oncologically safe for neurovascular preservation. All 13 patients were sexually active preoperatively, were younger than 65 years old, had recurrence-free follow-up findings after 1 year, and had undergone no pelvic irradiation. The 19-item FSFI questionnaire analyzed six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) of sexual function. RESULTS: In the nerve-sparing group (mean age 55.9 years), the baseline and 12-month postoperative scores showed a minimal decline in results, with a total mean FSFI score of 24.5 versus 22.3, respectively. In analyzing each of the six domains, no significant decline or difference was observed. Conversely, in the non-nerve-sparing group (mean age 56.7 years), a significant decline or difference was found in the 12-month total mean FSFI scores between the baseline and postoperative FSFI scores (25.0 versus 11.0, respectively). In the non-nerve-sparing group, 6 of 7 patients ultimately discontinued sexual intercourse. CONCLUSIONS: Female sexual function was preserved in patients who received neurovascular preservation. In contrast, all domains of sexual function declined in patients who had undergone non-neurovascular preservation.

Cystectomy↗
PubMed2005

Sexuality in women with epilepsy.

Most women with epilepsy maintain normal reproductive cycles and sexual lives. However, a significant minority, approximately 20-30%, have some degree of sexual dysfunction, including problems with seizure exacerbation, libido, arousal, and orgasm. Fluctuating hormone levels may contribute to an array of reproductive cycling abnormalities. With regard to sexual dysfunction, there is some evidence of reduced genital blood flow in women with temporal lobe epilepsy. Other studies suggest that psychosocial factors, such as depression, feeling stigmatized, and being anxious about having seizures during sex, may contribute to the higher rates of sexual dysfunction in this patient population. Some antiepileptic drugs may adversely affect normal reproductive cycling and sexual function, particularly drugs that increase serotonergic transmission. Conversely, resective epilepsy surgery has been shown to restore sexual function. Treatments for sexual dysfunction include testosterone replacement, although transdermal testosterone replacement is not yet approved by the Food and Drug Administration for women. Given the possibility that women with epilepsy may experience inadequate vasocongestion during arousal, sildenafil may have a useful role, though it has not proved effective for women in general. This review focuses on potential sexual problems that are faced by women with epilepsy, with the suggestion that proper treatment may alleviate these problems.

Anticonvulsants↗
PubMed2004

Menstrual cycle-related changes in plasma oxytocin are relevant to normal sexual function in healthy women.

Circulating levels of the neuro-hypophysial nonapeptide oxytocin increase during sexual arousal and orgasm in both men and women. A few studies have evaluated the effect of the menstrual cycle on plasma oxytocin in normally cycling, sexually active, healthy fertile women using or not using contraceptive pills. In 20 ovulating women and 10 women taking an oral contraceptive (group 1 and group 2, respectively), sexual function, hormonal profile, and plasma oxytocin (OT) were evaluated throughout the menstrual cycle. In group 1, plasma OT was significantly lower during the luteal phase in comparison with both the follicular and ovulatory phases. Plasma oxytocin was significantly correlated with the lubrication domain of the Female Sexual Function Index (FSFI) during the luteal phase and showed a trend towards statistical significance during the follicular phase. In group 2, plasma OT did not show any significant fluctuation throughout the menstrual cycle, even though a significant correlation was evident with both the arousal and the lubrication domain of the FSFI during the assumption of the contraceptive pill. These findings suggest that plasma OT fluctuates throughout the menstrual cycle in normally cycling healthy fertile women with adequate sexual activity but not taking any oral contraceptive pill. Moreover, plasma OT levels significantly relates to the genital lubrication in both women taking and not taking oral contraceptive pill apparently confirming its role in peripheral activation of sexual function.

Adult↗
PubMed1989

Congenital absence of the vagina. Surgical treatment and perioperative care.

A simple surgical technique is described for the correction of an absent vagina. It combines the positive features of the traditional approach of using a split-thickness skin graft from the thigh or buttock applied on a plastic mold with the intermittent-pressure method of vaginal development. Since 1975, the new isograft technique has been performed on 15 patients at the Royal Women's Hospital, Melbourne, with excellent results and no complications. With one exception, satisfactory coitus productive of orgasm has occurred following the procedure.

Adult↗
PubMed1999

Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease.

Erectile dysfunction is a common condition in men with cardiovascular disease, probably as a result of shared factors that impair hemodynamic mechanisms in the penile and ischemic vasculature. Sildenafil citrate, an orally active, selective inhibitor of phosphodiesterase type 5 (PDE5), has demonstrated excellent efficacy and safety profiles in men with erectile dysfunction of various etiologies. Sildenafil administration is contraindicated in patients who are taking nitrates or nitric oxide donors. This retrospective subanalysis of data from double-blind, placebo-controlled studies assessed the efficacy (9 studies) and safety (11 studies) of sildenafil in patients with erectile dysfunction and ischemic heart disease who were not taking nitrates. Of 3,672 patients randomized to receive sildenafil (5-200 mg) or placebo for 4-24 weeks in 11 double-blind, placebo-controlled studies, 357 (10%) reported a history (past or present) of ischemic heart disease and were not taking nitrates. Efficacy was assessed using end-of-treatment responses to Question 3 (ability to achieve an erection) and Question 4 (ability to maintain an erection) of the International Index of Erectile Function (IIEF), scores for the 5 domains of male sexual function assessed by the IIEF (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), and responses to a global efficacy question ("Did the treatment improve your erections?"). The responses to the 2 IIEF questions were graded on a scale of 1 (almost never or never) to 5 (almost always or always), with a score of 0 indicating no attempt at sexual intercourse. At the end of treatment, the mean scores for Question 3 and Question 4 of the IIEF for patients with erectile dysfunction and ischemic heart disease were significantly higher for the sildenafil group than for the placebo group (p <0.0001). Mean end-of-treatment scores for the IIEF domains also demonstrated significant increases for sildenafil-treated patients compared with those receiving placebo (p <0.05). At the end of treatment, improved erections were reported by 70% of patients who received sildenafil and by 20% of those in the placebo group p <0.0001). For the sildenafil group, the incidences of the most common adverse events (headache 25%, flushing 14%, and dyspepsia 12%) for patients with ischemic heart disease were similar to those in patients without this concomitant illness (21%, 15%, and 10%, respectively). Moreover, the overall incidence of cardiovascular adverse events other than flushing was comparable in patients with and without ischemic heart disease for both treatment groups. Since there is a degree of cardiac risk associated with sexual activity, clinicians should consider the patient's cardiovascular status before initiating any treatment for erectile dysfunction. Physicians should be aware that patients with underlying cardiovascular disease could be adversely affected by the vasodilator effects of sildenafil, especially in combination with sexual activity. The results of the present subanalysis indicate that oral sildenafil significantly improves erectile function and is well tolerated in patients with erectile dysfunction and ischemic heart disease who are not taking nitrate therapy.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2003

McIndoe procedure for vaginal agenesis: long-term outcome and effect on quality of life.

OBJECTIVE: The purpose of this study was to evaluate quality of life, sexual function, and long-term outcome in women after undergoing the McIndoe procedure for vaginal agenesis. STUDY DESIGN: This was a retrospective descriptive study of patients who were treated with the McIndoe procedure for vaginal agenesis. Participants answered a structured questionnaire to describe self-reported outcomes in quality of life, sexual function and satisfaction, and body image after the McIndoe procedure. Patient characteristics along with short- and long-term findings were abstracted from the medical record. RESULTS: Eighty-six patients responded to the questionnaire. Average age (+/-SD) at surgery was 21+/-6 years (range, 12-49 years). The mean number of years (+/-SD) since surgery was 23+/-12 (range, 2-50 years). Seventy-nine percent of the respondents stated that the McIndoe procedure improved their quality of life. Ninety-one percent of the respondents were sexually active, with 75% able to achieve orgasm. Reported self-image was improved in 55% of the women. CONCLUSION: The McIndoe procedure improves quality of life and sexual satisfaction and provides a functional vagina with minimal complications.

Adolescent↗
PubMed1980

Coital activity and premature delivery.

The coital activities of 111 patients who delivered after spontaneous premature labor were compared to a matched group of patients who subsequently delivered at term. The percentage of patients who were sexually active, the mean coital frequency, and the incidence of orgasm with coital activity were not significantly different between the two groups. Coital activity in the group delivering prematurely was significantly greater (p less than 0.05) than that in the group delivering at term only when no apparent reason for premature labor (18 or 111 cases) was evident. This relationship was especially true after the thirty-second week of gestation. Normal coital activity does not result in premature delivery and should not be discouraged during pregnancy in the absence of complications.

Coitus↗
PubMed1996

Neocolpopoiesis with split-thickness skin graft as a surgical treatment of vaginal agenesis: retrospective review of 201 cases.

OBJECTIVES: Our goals were to present a modified Abbe-Mcindoe technique of vaginoplasty with split-thickness skin graft and to analyze 51 years of experience in performing this procedure. STUDY DESIGN: Two hundred one women with vaginal agenesis were diagnosed and operated on by the same surgeon in 51 years (1943 through 1994). The patients' ages ranged from 14 to 41 years with an average of 20.5 years (SD 3.9 years). In most of the cases surgical intervention was performed when the patient desired to begin her sexual experience. The graft was taken from the thigh or gluteal region, followed by dissection of the urethrovesicorectal space. The access in this space was performed through two mutually perpendicular incisions (a modification of the Abbe-Mcindoe technique). A multiholed, rigid plastic mold was inserted during surgery and was replaced after 8 to 10 days with a semirigid silicone mold, which remained in place at least 6 months after operation or until the patient became sexually active. RESULTS: We retrospectively reviewed 201 cases of Mayer-Rokitansky-Küster-Hauser syndrome in which vaginoplasty was performed. The data were obtained from the personal records of Dan Alessandrescu, MD, PhD, for the 76 cases operated on between 1943 and 1967 and from the medical records in the Polizu Hospital Archive, Bucharest, Romania, for 125 cases operated on between 1968 and 1994. Overall surgical mortality was null. Intraoperative and postoperative complications consisted of two rectal perforations (1%), eight graft infections (4.0%), and 11 infections of graft-site origin (5.5%). Additional information was obtained during follow-up. Sexual satisfaction was investigated with objective (depth of constructed vagina) and subjective (ability to have sexual intercourse, presence or absence of dyspareunia, vaginal lubrication, orgasm) criteria and was analyzed on a qualitative scale. In 12 patients we performed biopsies of the neovaginal wall for histologic evaluation. CONCLUSION: Because of the simplicity, low morbidity, and high success rate, our modified Abbe-Mcindoe technique is a procedure of choice for vaginoplasty.

Adolescent↗
PubMed1999

The anatomic and functional outcomes of defect-specific rectocele repairs.

OBJECTIVE: This study was undertaken to evaluate the anatomic, functional, and quality-of-life effects of site-specific posterior colporrhaphy in the surgical management of rectocele. STUDY DESIGN: In a retrospective observational study 125 patients were studied who had undergone site-specific posterior colporrhaphy between 1995 and 1996, either alone or in conjunction with other pelvic procedures. Physical examination was performed >/=6 months after the operation to assess the anatomic success of the repair. Standardized questionnaires were used to assess quality of life, sexual function, and bowel function. RESULTS: Surgical correction was found at follow-up examination to have been achieved in 82% of eligible patients (73/89). All daily aspects of living improved significantly (P <.05), including ability to do housework (56% improvement or cure), travel (58% improvement or cure), and social activities (60% improvement or cure). Emotional well-being also significantly improved after the operation, as measured by thoughts of embarrassment (57% improvement or cure) or frustration (71% improvement or cure). Sexual function was not affected; however, reports of dyspareunia significantly (P <.04) improved or were cured after the operation in 73% of patients (19/26), worsened in 19% of patients (5/26), and arose de novo in 3 patients. Results showed no other significant differences in vaginal dryness, orgasm ability, sexual desire, sexual frequency, or sexual satisfaction. Bowel symptoms were assessed subjectively and were noted to have significantly improved (P <.008) after the operation. The following improvement or cure rates were obtained: stooling difficulties, 55%; pelvic pain or pressure, 73%; vaginal mass, 74%; and splinting, 65%. CONCLUSION: This study indicates that defect-specific posterior colporrhaphy is equal to or superior to traditional posterior colporrhaphy. This type of repair provides durable anatomic support and is successful in restoring bowel function. It does not detrimentally affect sexual function, may aid in the resumption of sexual activity, and significantly improves quality of life and social aspects of daily living.

Adult↗
PubMed1999

Functional outcomes and satisfaction after abdominal hysterectomy.

OBJECTIVES: Our aim was to compare urinary, lower gastrointestinal, and sexual function and to describe patients' expectations and satisfaction before and after hysterectomy. STUDY DESIGN: Forty-three women completed questionnaires before and about 1 year after abdominal hysterectomy for benign gynecologic conditions. Symptoms related to urinary, lower gastrointestinal, and sexual function and satisfaction with treatment were assessed. To account for multiple comparisons, only P </=.002 was considered statistically significant. RESULTS: There were no statistically significant changes in urinary or bowel symptoms before and after hysterectomy, with preoperative symptoms resolving in some women after surgery and developing in others. Sexual function including orgasmic ability did not change in the 34 sexually active women. The level of satisfaction with treatment was very high. CONCLUSIONS: Women experience high degrees of satisfaction and no consistent changes in urinary, lower gastrointestinal, or sexual function after abdominal hysterectomy for benign gynecologic conditions.

Adult↗
PubMed1999

Psychosexual effects of menopause: role of androgens.

Ovarian hormones-estrogens, androgens, and progesterone-produce a myriad of effects in the nervous system. The effects of androgens in the brain are mediated through androgen-specific receptors and by the aromatization of testosterone to estradiol. Alterations in the circulating levels of androgens play an important role in psychologic and sexual changes that occur after menopause. The effects of short-term estrogen therapy in improving psychologic symptoms, maintaining vaginal lubrication, decreasing vaginal atrophy, and increasing pelvic blood flow in postmenopausal women are well documented. However, some patients require more than estrogen alone to improve psychologic dysfunction, decreased sexual desire, or other sexual problems associated with menopause. Results from clinical studies show that hormone replacement therapy with estrogen plus androgens provides greater improvement in psychologic (eg, lack of concentration, depression, and fatigue) and sexual (eg, decreased libido and inability to have an orgasm) symptoms than does estrogen alone in naturally and surgically menopausal women.

Affect↗
PubMed2004

[Sexual dysfunction among 78 Moroccan male hemodialysis patients: clinical and endocrine study].

PURPOSE: To investigate the correlation between biochemical and endocrine variables with sexual disorders in 78 male patients on chronic hemodialysis at the Ibn Rochd University Hospital (Casablanca-Morocco). METHODS: Seventy-eight male hemodialysis patients with chronic renal failure were evaluated with regard to their sexual function. All patients answered a personal questionnaire on their sexual activity. Hormone (FSH, LH, prolactin, testosterone, and parathyroid hormone) and zinc and ferritin assays were also performed. RESULTS: The men reported erection (44.9%), libido (44.9%), ejaculation (26.8%), and orgasm (21.8%) disorders. Gynecomastia was observed in 17.9% of the patients. There was no correlation with weight nor the nature of the causal nephropathy nor with duration of dialysis. Levels of gonadotropins (FSH, LH), prolactin, and parathyroid hormone were elevated. Testosterone levels were low. Ferritinemia was elevated but there was no significant variation in zincemia. There was a negative curvilinear relationship between serum testosterone and sexual disorders, and between gynecomastia and ferritinemia. LH and prolactin levels were positively correlated with gynecomastia. CONCLUSION: Abnormal hormonal and iron overload could be important factors involved in the complex pathogenesis of sexual dysfunction in chronic renal failure patients undergoning hemodialysis.

Adult↗