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PubMed2001

Preliminary observations of sildenafil treatment for erectile dysfunction in dialysis patients.

Erectile dysfunction is common in dialysis patients. We report our experience with sildenafil citrate in patients undergoing dialysis therapy. Male subjects attending the Outpatient Dialysis Unit at the University of Pennsylvania (Philadelphia, PA) who were prescribed sildenafil by their primary physician or nephrologist were asked to complete the International Index of Erectile Function before their first dose of sildenafil and after at least 4 weeks of therapy. Subjects' mean age was 50.3 +/- 14.63 (SD) years. Ninety-three percent of the subjects were black. Based on a global efficacy question, 66.7% of the subjects believed that treatment had improved their erections. Subjects reported no increase in the sexual desire domain despite experiencing a significant increase in erectile function, orgasmic function, and satisfaction with intercourse. Sildenafil was well tolerated in a selected group of patients who reported improved sexual function with no major adverse effects.

Adult↗
PubMed2001

Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer.

AIMS: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer much attention is given to the oncological aspects. In long-term survivors, urogenital morbidity can have a large effect on the quality of life. This study evaluates the functional outcome after multimodality treatment in these patient groups. PATIENTS AND METHODS: Between 1994 and August 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with multimodality treatment: i.e. high-dose preoperative external beam radiation therapy, followed by extended surgery and intraoperative radiotherapy. The medical records of the 121 patients were reviewed. To assess long-term urogenital morbidity, all patients still alive, with a minimum follow-up of 4 months, were asked to fill out a questionnaire about their voiding and sexual function. Seventy-six of the 79 currently living patients (96%) returned the questionnaire (median FU 14 months, range 4-60). RESULTS: The questionnaire revealed identifiable voiding dysfunction as a new problem in 31% of the male and 58% of the female patients. In 42% of patients after locally advanced primary and 48% after locally recurrent rectal cancer treatment bladder dysfunction occurred. The preoperative ability to have an orgasm had disappeared in 50% of the male and 50% of the female patients, and in 45% of patients after locally advanced primary and in 57% after locally recurrent rectal cancer treatment. CONCLUSION: Multimodality treatment for locally advanced primary and recurrent rectal cancer results in acceptable urogenital dysfunction if weighed by the risk of uncontrolled tumour progression. Long-term voiding and sexual function is decreased in half of the patients. Preoperative counselling of these patients on treatment-related urogenital morbidity is important.

Adult↗
PubMed2000

Endocrine correlates of male breast cancer risk: a case-control study in Athens, Greece.

We studied the relation of certain endocrine-related variables among 23 cases of male breast cancer and 76 apparently healthy male controls. There were significant inverse associations with smoking (P = 0.03), birth order (P = 0.02) and reported frequency of orgasms in later life (P = 0.0004). The study provides strong indirect evidence that endocrine factors are important in the aetiology of male breast cancer.

Adolescent↗
PubMed1991

Cyproterone acetate in the treatment of sexual disorders: pharmacological base and clinical experience.

Cyproterone acetate (CPA) has been discovered more than 25 years ago and it was the first antiandrogen suitable for clinical use. CPA inhibits the action of endogenous and exogenous androgens at all androgen target organs; these include the prostate, seminal vesicles, testes, and the vas deferens. However, this antiandrogen also antagonizes less sex-specific effects of androgens, for example ossification of the epiphyseal cartilage, sebaceous gland function and skin thickness. Indications for CPA: Prostate cancer, androgen induced disorders of the skin (acne, seborrhoea, hirsutism, alopecia), precocious puberty and sexual disorders in men. Concerning sexual deviations clinical trials started in 1966. CPA leads to loss of libido and the ability to achieve erection, followed by the inability to achieve orgasm, after about 14 days of treatment (100-200 mg daily orally or 300 mg weekly i.m.). These effects are reversed in the same order as the onset. About 75 to 80% of patients respond to this therapy. CPA is generally well tolerated. Tiredness, lack of drive, listlessness and depressive moods have been reported as non-specific side-effects. Slight gynecomastia occurs in about 20% of patients. There are no good alternatives in this indication. Pure antiandrogens are unsuitable, because these are unable to inhibit libido sufficiently. Tranquilizers are not very effective, high doses of estrogens are associated with severe (cardiovascular) side effects. Orchidectomy is an irreversible intervention, LHRH analogues are associated with hot flushes and the initial increase in testosterone (flare phenomenon).

Androgen Antagonists↗
PubMed1991

Sexual dysfunction in patients with hypothalamo-pituitary disorders.

Four different studies of sexual problems and sexual dysfunction in patients with hypothalamo-pituitary disorders have been undertaken and data about the sex life of the patients have been correlated with diagnosis, tumour extension and pathology, endocrine insufficiency and pituitary hormone hypersecretion. In the first study 48 out of 53 (76.2%) adult males with pituitary tumours reported decreased or absent sexual desire. The corresponding figure in the second study was 29 out of 37 (78.4%) among adult males with pituitary tumours and hyperprolactinaemia. Twenty (31.7%) and 18 (48.6%) patients, respectively, reported decreased sexual desire as the first symptom of their tumour. A highly significant correlation between a decrease in serum testosterone and a decrease in sexual desire was found. Some males with normal serum testosterone but hyperprolactinaemia also reported decreased sexual desire. In the third study, 109 females (aged 20-60) with morphologically verified hypothalamo-pituitary disorders, 68 (62.4%) had noticed a decrease in sexual desire. This problem was registered for 53 (84.1%) out of the 63 women in this group who had hyperprolactinaemia but only in 15 (32.6%) out of the 46 women with normal serum prolactin (p less than 0.001). In the last study 48 women with well-defined hypothalamo-pituitary disorders underwent a comprehensive interview about sexual function and sexual appreciation. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasms were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Preservation of normal menstrual pattern, age, and intrasellar tumour growth was correlated to normal sexual desire and function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

[Female sexuality and its disorders from the psychological viewpoint].

Female sexuality is determined to a far greater extent by the woman's emotional receptiveness to sexual feelings than by her physiological reactions. Concerning sexual symptoms, female patients suffer much more from a lack of sexual desire and from a deficit in sexually stimulating feelings and sexual pleasure than from insufficient genital functions. The following sexual symptoms are presented: sexual arousal disorders, orgasm disorders, vaginismus, dyspareunia, sexual desire disorders, sexual aversion/sexual phobia. Sex consultation and sex therapy are recommended as preferential treatment options.

Diagnosis, Differential↗
PubMed2000

[Social transformation of sexuality in the past decades. An overview].

The societies of the Western world have witnessed a tremendous cultural and social transformation of sexuality during the eighties and nineties, a process Sigusch refers to as "the neosexual revolution". Up to now, this transformation and reassessment of sexuality has proceeded rather slowly and quietly. Yet both its real and its symbolic effects may indeed be more consequential that those brought about in the course of the rapid, noisy sexual revolution of the sixties and seventies. The neosexual revolution is dismantling the old patterns of sexuality and reassembling them anew. In the process, dimensions, intimate relationships, preferences and sexual fragments emerge, many of which had submerged, were unnamed or simply did not exist before. In general, sexuality has lost much of its symbolic meaning as a cultural phenomenon. Sexuality is no longer the great metaphor for pleasure and happiness, nor is it so greatly overestimated as it was during the sexual revolution. It is now widely taken for granted, much like egotism or motility. Whereas sex was once mystified in a positive sense--as ecstasy and transgression, it has now taken on a negative mystification characterized by abuse, violence and deadly infection. While the old sexuality was based primarily upon sexual instinct, orgasm and the heterosexual couple, neosexualities revolve predominantly around gender difference, thrills, self-gratification and prosthetic substitution. From the vast number of interrelated processes from which neosexualities emerge, three phenomena have been selected for discussion here: the dissociation of the sexual sphere, the dispersion of sexual fragments and the diversification of sexual relationships. The outcome of the neosexual revolution could be described as self-disciplined and self-optimized "self-sex".

Humans↗
PubMed2002

Paroxetine-induced vaginal anaesthesia.

Antidepressant drugs cause a variety of sexual side effects such as decreased libido, impaired erection and delayed or absent ejaculation and orgasm. They cause distress, strain relationships, impair quality of life and reduce compliance to treatment. However, antidepressant-induced changes in sexual sensations are rare. Here, we report on a case of paroxetine-induced loss of sensation in the vagina.

Adult↗
PubMed2003

Evaluation and treatment of autonomic disorders of the urogenital system.

Autonomic pathways are important in the regulation of both lower urinary tract and sexual function, and their interruption in neurological pathologies predictably results in variable urogenital dysfunction, depending mainly on the level of the lesion. A normal neurological examination of a patient with urogenital complaints should exclude an underlying neurological pathology, and the neurologist should become involved in the management of symptoms. Electromyography can be of value in the diagnosis and management of cauda equina lesions and multiple system atrophy, but neurophysiological investigations are of no importance in the diagnosis of neurogenic sexual dysfunction. Urodynamic studies have proven helpful in determining the type and management of lower urinary tract dysfunction. Oral anticholinergics usually combined with clean intermittent catheterizations are the first-line treatment options for neurogenic lower urinary tract dysfunction, with intravesical treatments emerging as the main alternative in intractable incontinence. The availability of effective oral phosphodiesterase inhibitors has revolutionized the management of erectile dysfunction, but treatment of ejaculatory and orgasmic disorders as well as of female sexual dysfunction still remains problematic.

Animals↗
PubMed1994

[Modification of sexual functions by antidepressants].

Sexual dysfunctions appear to be frequently occurring adverse events in treatment with antidepressants. Due to methodological reasons, a reliable estimation of the frequency of such events is currently not yet possible. There is evidence, that antidepressants could be differentiated with respect to their potency and specificity for disturbances of certain sexual subfunctions according to their pharmacological profile. With SSRIs in particular impaired functions of orgasm and ejaculation can be observed. No deteriorations are reported for buproprion and an improvement of sexual dysfunctions within the course of treatment for moclobemide. Viloxazine and trazodone appear to possess marked stimulating effects on libido and erectile functions. Generally the incidence of sexual adverse events is underestimated, although there is a pronounced impact on patient compliance. Taking into account this well documented side effect, sexual impairments should be monitored carefully within antidepressive treatment.

Antidepressive Agents↗
PubMed1986

[Sex behavior following primary radiotherapy of cervix cancer].

57 women with invasive cervical carcinoma treated by primary irradiation were asked by means of a questionnaire about their partnership, especially about their sexual life. 9 women (15.7%) had no more sexual intercourse. 50% of those 48 patients who were sexually active also after the treatment had marked discomfort during coitus due to lack of lubrication. They reported pain caused by a short or narrow vagina less often (20.8%). Only 33.3% had their first intercourse 3 months after the irradiation, frequency of cohabitation was reduced in 68.4% of the patients. The reason for this was fear of recurrence of the cancer, fear of pain and lack of libido: 57.9% of the women mentioned reduced libido. Before irradiation 14% had no orgasm during the coitus, but 52% had none after treatment. The sexual life was not disturbed in those women who had been well informed about the consequences of the irradiation and who had their first intercourse soon after the therapy.

Adult↗
PubMed1981

[Notes on sexual development and sexual behaviour of sterile marriage partners (author's transl)].

Criteria which are essential for sexual development were examined on the basis of interviews conducted with 57 married couples who had remained without children without wanting to be childless, the reasons for their sterility being different in each case. It appears that both the experience of the first cohabitation and of the first orgasm, as well as the number of sexual partners before marriage are in some way connected with subsequent infertility. We also attempted to examine marital sexual relations in a kind of stock-taking operation. The cumulative occurrence of disturbances of intimate life was confirmed by this study, especially the reduced sexual satisfaction which depends on the cause of sterility. It also appears that changes in libido and feeling are influence by fertility; however, relative increases in such changes seem to indicate psychosexual disturbances of maturity in some of the partners, from which it would be possible to derive causal connections with infertility and therapeutic approaches.

Age Factors↗
PubMed1978

Frequency of sexual dysfunction in "normal" couples.

In analyzing the responses of 100 predominantly white, well educated and happily married couples to a self-report questionnaire, this study examined the frequency of sexual problems experienced and the relations of those problems to sexual satisfaction. Although over 80 per cent of the couples reported that their marital and sexual relations were happy and satisfying, 40 per cent of the men reported erectile or ejaculatory dysfunction, and 63 per cent of the women reported arousal or orgasmic dysfunction. In addition, 50 per cent of the men and 77 per cent of the women reported difficulty that was not dysfunctional in nature (e.g., lack of interest or inability to relax). The number of "difficulties" reported was more strongly and consistently related to overall sexual dissatisfaction than the number of "dysfunctions."

Adult↗
PubMed2000

Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.

BACKGROUND: The ovaries provide approximately half the circulating testosterone in premenopausal women. After bilateral oophorectomy, many women report impaired sexual functioning despite estrogen replacement. We evaluated the effects of transdermal testosterone in women who had impaired sexual function after surgically induced menopause. METHODS: Seventy-five women, 31 to 56 years old, who had undergone oophorectomy and hysterectomy received conjugated equine estrogens (at least 0.625 mg per day orally) and, in random order, placebo, 150 microg of testosterone, and 300 microg of testosterone per day transdermally for 12 weeks each. Outcome measures included scores on the Brief Index of Sexual Functioning for Women, the Psychological General Well-Being Index, and a sexual-function diary completed over the telephone. RESULTS: The mean (+/-SD) serum free testosterone concentration increased from 1.2+/-0.8 pg per milliliter (4.2+/-2.8 pmol per liter) during placebo treatment to 3.9+/-2.4 pg per milliliter (13.5+/-8.3 pmol per liter) and 5.9+/-4.8 pg per milliliter (20.5+/-16.6 pmol per liter) during treatment with 150 and 300 microg of testosterone per day, respectively (normal range, 1.3 to 6.8 pg per milliliter [4.5 to 23.6 pmol per liter]). Despite an appreciable placebo response, the higher testosterone dose resulted in further increases in scores for frequency of sexual activity and pleasure-orgasm in the Brief index of Sexual Functioning for Women (P=0.03 for both comparisons with placebo). At the higher dose the percentages of women who had sexual fantasies, masturbated, or engaged in sexual intercourse at least once a week increased two to three times from base line. The positive-well-being, depressed-mood, and composite scores of the Psychological General Well-Being Index also improved at the higher dose (P=0.04, P=0.03, and P=0.04, respectively, for the comparison with placebo), but the scores on the telephone-based diary did not increase significantly. CONCLUSIONS: In women who have undergone oophorectomy and hysterectomy, transdermal testosterone improves sexual function and psychological well-being.

Administration, Cutaneous↗
PubMed2002

Outcomes after total versus subtotal abdominal hysterectomy.

BACKGROUND: It is uncertain whether subtotal abdominal hysterectomy results in better bladder, bowel, or sexual function than total abdominal hysterectomy. METHODS: We conducted a randomized, double-blind trial comparing total and subtotal abdominal hysterectomy in 279 women referred for hysterectomy because of benign disease; most of the women were premenopausal. The main outcomes were measures of bladder, bowel, and sexual function at 12 months. We also evaluated postoperative complications. RESULTS: The rates of urinary frequency (urination more than seven times during the day) were 33 percent in the subtotal-hysterectomy group and 31 percent in the total-hysterectomy group before surgery, and they fell to 24 percent and 20 percent, respectively, at 12 months (P=0.03 for the change over time within each group; P=0.84 for the interaction between the treatment assignment and time). The reduction in nocturia and stress incontinence and the improvement in bladder capacity were similar in the two groups. The frequency of bowel symptoms (as indicated by reported constipation and use of laxatives) and measures of sexual function (including the frequency of intercourse and orgasm and the rating of the sexual relationship with a partner) did not change significantly in either group after surgery. The women in the subtotal-hysterectomy group had a shorter hospital stay (5.2 days, vs. 6.0 in the total-hysterectomy group; P=0.04) and a lower rate of fever (6 percent vs. 19 percent, P<0.001). After subtotal abdominal hysterectomy, 7 percent of women had cyclical bleeding and 2 percent had cervical prolapse. CONCLUSIONS: Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.

Adult↗
PubMed2002

A prospective study of sexual and urinary function before and after total mesorectal excision with autonomic nerve preservation for rectal cancer.

BACKGROUND: Oncologic resection of rectal cancer has been reported to be associated with a significant (10%-60%) rate of sexual and urinary dysfunction. We hypothesize that curative total mesorectal excision (TME) with autonomic nerve preservation (ANP) can be done with high rates of preservation of such function. STUDY DESIGN: We studied prospectively preoperative and postoperative urinary and sexual function in patients who had sphincter-preserving operations for rectal carcinoma without preoperative irradiation. Standardized questionnaires were used preoperatively and postoperatively, including the International Prostatic Symptom Score and a score of quality of urinary function satisfaction. Urodynamic evaluation was performed preoperatively and 3 months after the operation. The sexual results were evaluated after 1 year. RESULTS: Twenty patients, 13 men and 7 women, had TME, with ANP technique. Fourteen patients had coloanal anastomosis, 4 had a stapled colorectal anastomosis, and 2 had an ileoanal anastomosis. In all patients, hypogastric and sacral splanchnic nerves were identified and preserved. There was no mortality. Tumors are graded by Astler-Coller classification: A1 in 3 cases, A2 in 3, B1 in 7, B2 in 2, C2 in 1, and D in 1. There was no difference in preoperative and postoperative urinary function, International Prostatic Symptom Score, or urodynamic results, nor in the results of the quality of urinary function questionnaire. Four of the 7 women (69%) were sexually active before undergoing the surgical procedure. Sexual activity and ability to achieve orgasm was unchanged in these women. No dyspareunia was reported. Nine of the 13 men (69%) were sexually potent in the preoperative period. Sexual activity and potency were unchanged in these men. Retrograde ejaculation was reported in 1 man who previously had had normal antegrade ejaculation. After 3 months, 4 patients reported a reduced rigidity of erection, returning to normal by 1 year. CONCLUSIONS: The authors conclude that TME and ANP for cancer limited to the mesorectum do not impair urinary and sexual function.

Adult↗
PubMed2002

Sexual diversity in urban Norwegians.

The purpose of this study is to describe homosexual and heterosexual experiences in terms of sexual fantasies, sexual attraction, sexual conduct, and falling in love in an urban Norwegian population. In 1997, a random sample of 5,000 persons (18-49 years) was drawn from the population register in Oslo to participate in a sexual behavior survey. Data collection was carried out by means of postal questionnaires and 45% responded. The results indicated that exclusive homosexuality was rare in the population. One exception was the prevalence of homosexual fantasies in women. Compared to respondents who had had exclusively heterosexual contact, respondents reporting bisexual contacts had a significantly higher number of lifetime sex partners, higher frequency of anal and oral sex and masturbation, and lower age at orgasm and masturbation debut. What significantly separated the groups of exclusive heterosexuals, bisexuals, and exclusive homosexuals were attitudes towards various expressions of sexuality and number of lifetime sex partners.

Adult↗
PubMed2003

Recalling sexual behavior: a methodological analysis of memory recall bias via interview using the diary as the gold standard.

This study examined the effect of time lag on the validity of retrospective self-reports of sexual behavior. Seventy-five heterosexual students (44 women, 31 men) made daily recordings of sexual behavior, condom use, and alcohol or substance use for 1 month. Ability of respondents to recall sexual behavior recorded during this period was assessed at 1, 2, and 3 months after diary completion using recall interviews (25 interviewed at each interval). For vaginal intercourse, total recall error was significantly greater at 3 months than at 1 month post-diary. For all other variables assessed, the 2- and 3-month time intervals did not produce significant increase in total recall error. Higher frequency of vaginal intercourse, orgasm, and alcohol use prior to sexual activity were associated with total recall error for some but not all behaviors and outcomes. The results provide a partial validation of the diary-interview recall model as a method for studying recall error.

Adult↗