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PubMed2006

Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy--results of a randomized prospective study.

AIM: The efficacy of prostaglandin E1 (PGE1)-intracavernous injection (ICI) therapy for erectile dysfunction (ED) after non-nerve-sparing (NNS) radical pelvic surgery depends on patient compliance. The purpose of this study was to verify the utility of sexual counseling in ICI in terms of treatment efficacy, compliance, and dropout rate. METHODS: In this prospective randomized study, 57 patients with ED after NNS radical prostatectomy or cystectomy were divided: 29 patients (group SC+) were treated with sexual counseling and PGE1-ICI therapy; the others 28 (group SC-) were treated with only ICI. At the start of the study all patients were administered the International Index of Erectile Function (IIEF) questionnaire and ICI training test; follow-up (at 3, 6, 9, 12, 18 months) was achieved by home Sildenafil test and ambulatory IIEF test; sexual counseling was provided only to group SC+. RESULTS: The mean IIEF score at the end of study was 26.5 (SC+) vs. 24.3 (SC-) (P < 0.05); eight patients (SC+, 27.5%) became responders to home Sildenafil vs. five (SC-, 17.8%) (P < 0.05); no dropout cases occurred (SC+) vs. eight (SC-, 28.5%) (P < 0.05). Moreover, we recorded best IIEF scores in group SC+ in sexual satisfaction (P < 0.05), sexual desire (P < 0.05), orgasmic function, and general satisfaction. Mean PGE1 doses were better in group SC+ (P < 0.05). ICI-oriented sexual counseling was utilized to motivate couples, to improve sexual intercourses, to correct mistakes in ICI administration. At the end of follow-up 21 patients (SC+) declared themselves satisfied vs. 12 (SC-). CONCLUSIONS: ICI-oriented sexual counseling in ICI increased the efficacy of treatment, the compliance, and Sildenafil responders rate, decreased the dropout rate.

Aged↗
PubMed2006

Sexual problems among a specific population of minority women aged 40-80 years attending a primary care practice.

INTRODUCTION: Clinicians are embarrassed about discussing sex with patients and do not know how to ask about sexual problems in a way that will optimize honest and open responses. Learning about inquiry responses and the prevalence of sexual problems among specific groups of women, including minority women, can help identify appropriate inquiry and management pathways. AIM: To better understand useful inquiry techniques as well as to describe the prevalence of sexual problems among a specific group of minority women aged 40-80 years. MAIN OUTCOME MEASURES: Responses to two styles of sexual problem inquiry, direct vs. ubiquity, were compared among sexually active subjects. Prevalence of sexual problems and interest in discussing problems with personal clinician were determined. METHODS: Minority women aged 40-80 years receiving care at one of two Family Health Centers in Brooklyn, New York who could speak English met inclusion criteria. A cross-sectional survey of 212 subjects, the majority being Afro-Caribbean, identified those who were sexually active and then randomly asked about sexual problems using one of two inquiry types: (i) a direct question, such as "Do you have a problem during sex," or (ii) a ubiquity-style question, such as "Many women with diabetes have sexual problems, how about you?" Sexual problems were characterized by recognized phases of female sexual activity. Interest in discussing sexual problems with a personal clinician was determined. RESULTS: Of the 212 women surveyed, 108 (50.9%) were sexually active with 37 (34.3%) of these women responding "yes" when asked about sexual problems using one of the two inquiry techniques. Stratified analysis by age group showed significantly higher reporting of sexual problems when a ubiquity-style inquiry was used among older women aged 61-80 years (P = 0.028) but not among younger ones. The prevalence of sexual problems was 14.8% reporting pain, 12.0% lack of interest, 9.2% lack of excitation, 5.5% lack of orgasm, and 6.5%"other." Forty-three percent of women with problems said they would like to discuss their problem(s) with their clinician. CONCLUSIONS: In a specific minority group of women aged 40 years and older, especially those over age 60 years, ubiquity-style inquiries may encourage more open and honest responses about sexual problems. The most common sexual problem among this group of women was pain. There is willingness and even interest in talking with clinicians about sexual issues. Recognition of sexual problem prevalences helps clarify the high number of women who could be potentially helped with current and future pharmacologic and psychosocial treatments.

Adult↗
PubMed2006

Etiology of ejaculation and pathophysiology of premature ejaculation.

INTRODUCTION: Ejaculation is comprised of three stages of the male sexual response cycle, namely emission, ejection, and orgasm; however, in comparison with erection, which is a well-understood component of male sexual response, the pathophysiology of ejaculation has yet to be fully delineated. Premature ejaculation (PE), the most common sexual disorder in men, while believed to have a multifactorial etiology, is even less well understood. AIM: This article reviews the physiology of ejaculation, and the multifactorial pathophysiology of PE. METHODS: The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. MAIN OUTCOME MEASURE: Data were obtained by extensive examination of published peer-reviewed literature. RESULTS: Evidence supports that biologic mechanisms associated with neurotransmitters such as norepinephrine, serotonin, oxytocin, Gamma-amino-butyric acid, and nitric oxide (NO) as well as the hormone estrogen play central roles in ejaculation, and subsequently may mediate PE. There is also emerging evidence to show that hyperthyroidism may be a causal factor in PE. Recent data also suggest that psychogenic factors include high level of any experience by some men with PE. CONCLUSIONS: The pathophysiology of both lifelong and acquired PE appears to be both neurobiogenic and psychogenic. While psychogenic factors appear to be contributory to PE, pharmacologic intervention of PE can modify intravaginal ejaculatory latency time (IELT), which suggests that IELT is a biological variable, and is likely biologically dependent upon neurotransmitters and hormones.

Adult↗
PubMed2006

Sexual function in women with urinary incontinence treated by pelvic floor transvaginal electrical stimulation.

INTRODUCTION: Women's sexual dysfunctions (WSD) have been commonly associated with urinary incontinence (UI). Women with UI and who scored low on the Female Sexual Function Index (FSFI) showed an improvement in urinary leakage and also in their sexual life following treatment by transvaginal electrical stimulation (TES). AIMS: To determine the effects of TES in 37 women complaining of UI, of whom 23 also had WSD, and to compare the FSFI scores of women with UI and 43 women not affected by UI who underwent routine urologic evaluation. METHODS: Thirty-seven women complaining of UI were evaluated by voiding diary and with FSFI before and after 3 months of TES. All had a urogynecologic evaluation and urodynamic study. MAIN OUTCOME MEASURES: In the voiding diary the women reported the types of liquid they ingested, urinary frequency, and episodes of urgency and urine leakage. The domain scores of the FSFI, including desire, arousal, lubrication, orgasm, satisfaction, and pain, were calculated. TES was conducted for 15-30 minutes, twice a week for 3 months, using biphasic intermittent current with a frequency of 50 Hz for stress UI (SUI) and 20 Hz for urge UI (UUI), and the most tolerable intensity of stimulation. RESULTS: After TES, only two of the 10 women with UUI experienced a few leakage incidents; patients with SUI were completely dry during TES; and only three reported a few episodes of UI during intense activities. The five patients with mixed UI improved mainly as regards urgency. The FSFI scores of patients complaining of UI showed significantly lower desire and sexual satisfaction, and higher sexual pain than controls. After 3 months, the 23 women affected by WSD, of the 37 participants with UI, reported a remarkable improvement in their sexual life. CONCLUSIONS: TES was found to be a safe and effective therapy for selected patients affected by mild to moderate UI. Because women with UI also complain of WSD compared with the general female population, an investigation of female sexuality is suggested for these patients.

Arousal↗
PubMed2006

A prospective study examining the anatomic distribution of nerve density in the human vagina.

INTRODUCTION: Women possess sufficient vaginal innervation such that tactile stimulation of the vagina can lead to orgasm. However, there are few anatomic studies that have characterized the distribution of nerves throughout the human vagina. AIM: The aim of this prospective study was to better characterize the anatomic distribution of nerves in the adult human vagina. A secondary aim was to assess whether vaginal innervation correlates with the subject's demographic information and sexual function. METHODS: Full-thickness biopsies of anterior and posterior vagina (proximal and distal), cuff, and cervix were taken during surgery in a standardized manner. Specimens were prepared with hematoxylin and eosin, and S100 protein immunoperoxidase. The total number of nerves in each specimen was quantified. Enrolled patients completed a validated sexual function questionnaire (Female Sexual Function Index, FSFI) preoperatively. MAIN OUTCOME MEASURES: A description of vaginal innervation by location and an assessment of vaginal innervation in association with the subject's demographic information and sexual function. RESULTS: Twenty-one patients completed this study, yielding 110 biopsy specimens. Vaginal innervation was somewhat regular, with no site consistently demonstrating the highest nerve density. Nerves were located throughout the vagina, including apex and cervix. No significant differences were noted in vaginal innervation based on various demographic factors, including age, vaginal maturation index, stage of prolapse, number of vaginal deliveries, or previous hysterectomy. There were no correlations between vaginal nerve quantity and FSFI domain and overall scores. Fifty-seven percent of the subjects had female sexual dysfunction; when compared to those without dysfunction, there were no significant differences in total or site-specific nerves. CONCLUSIONS: In a prospective study, vaginal nerves were located regularly throughout the anterior and posterior vagina, proximally and distally, including apex and cervix. There was no vaginal location with increased nerve density. Vaginal innervation was not associated with demographic information or sexual function.

Adult↗
PubMed2006

Vardenafil improves sexual function and treatment satisfaction in couples affected by erectile dysfunction (ED): a randomized, double-blind, placebo-controlled trial in PDE5 inhibitor-naïve men with ED and their partners.

INTRODUCTION: Erectile dysfunction (ED) is a common condition with diverse sequelae affecting men and their women partners. AIM: The FINDER study aimed to evaluate the efficacy and tolerability of the phosphodiesterase type-5 (PDE5) inhibitor, vardenafil, in a broad population of PDE5-naïve men with ED of different etiologies and severity and included their partners' assessments of treatment with vardenafil. METHODS: Men with ED (N = 260) were randomized to receive either vardenafil or placebo in a multicenter, flexible-dose study. MAIN OUTCOME MEASURES: Primary efficacy variables were patients' responses to the Global Assessment Question (GAQ), and Sexual Encounter Profile questions 2 and 3 (SEP2 and SEP3). RESULTS: Compared with placebo, vardenafil significantly improved rates of successful "Yes" responses to SEP3 ("Did your erection last long enough for you to have successful intercourse?") (49% placebo vs. 78% vardenafil at last period carried forward [LPCF]; P < 0.0001), SEP2 ("Were you able to insert your penis into your partner's vagina?") (65% placebo vs. 85% vardenafil at LPCF; P < 0.0001), and GAQ (36% placebo vs. 83% vardenafil at last observation carried forward; P < 0.0001). In addition, patients' and their partners' Treatment Satisfaction Scale (TSS) scores were statistically significantly improved across each of the TSS domains (satisfaction with orgasm, ease with erection, confidence, pleasure, erectile function satisfaction, and satisfaction with medication) in the vardenafil group compared with the placebo group. CONCLUSIONS: Vardenafil improved sexual function to the extent that both patients and their partners expressed a considerable and agreed level of satisfaction with treatment.

Adult↗
PubMed1986

The relationship between the sexual attitudes of parents and their college daughters' or sons' sexual attitudes and sexual behavior.

This study determined if three selected sexual attitudes of parents were related to similar sexual attitudes of their college daughters or sons and to five sexual behaviors. Only never married, college freshmen (N = 83) with both parents participating were utilized. A self-report questionnaire was administered to students at a large midwestern university and distributed to and returned from parents by mail. The Pearson product-moment correlation and the stepwise and multiple regressions were used to test four hypotheses. Mothers' sexual attitudes had a stronger relationship than fathers' attitudes with offspring sexual attitudes and behaviors, particularly for daughters. Generally, mothers with the most positive attitudes toward sexual-self had daughters who were more responsive relative to personal sexual expression (masturbation frequency and orgasmic experience), but who were not any more involved heterosexually (frequency of coitus and number of coital partners). Fathers' sexual attitudes had little relationship to offspring sexual attitudes and behavior. None of the male students' sexual behaviors were related strongly to parent sexual attitudes. Implications for school and parent sexuality education programs are briefly discussed.

Adolescent↗
PubMed1991

Significance of substance P- and enkephalin-peptide systems in the male genital tract.

The plexi of the male reproductive tract have components of both the autonomic and sensory nervous systems. Rat epididymis was found to be a rich source of substance P. Substance P levels in the epididymis were higher by about 2.8 and 19.3 times than those in the prostate and seminal vesicles, respectively. Seminal vesicles were found to be a rich source of enkephalins. They had about 2.9 and 2.6 times higher leucine enkephalin levels than epididymis and prostate, respectively. Human seminal plasma contained about 47 times higher levels of leucine enkephalin than substance P. Using the split ejaculate technique, it has been demonstrated that early fractions of the human ejaculate contain fluids from prostate (and possibly epididymis), whereas later fractions represent seminal vesicle secretions. A low exogenous concentration of substance P (400 nM) increased sperm motility, whereas leucine enkephalin (100 microM) depressed it. Substance P (1-10 micrograms/mL) and muscarinic agonists enhanced the adrenergic transmission of the rat vas deferens to electrical stimulation. Leucine enkephalin (1-10 micrograms/mL) depressed adrenergic transmission and antagonized the effects of substance P and muscarinic agonists. These studies suggest that substance P-like tachykinins may play a role in sperm maturation, in expulsion of fluid from the epididymis, and in initiation of motility, whereas leucine enkephalin-like peptides may contribute to the orgasmic experience and detumescence.

Animals↗
PubMed1990

The orifice revisited: women in gynaecological texts.

A content analysis was carried out on obstetric and gynaecological textbooks recommended for medical students at four Australian universities. The texts were read for a hidden curriculum of sexist ideology. This study is a partial replication of a study carried out by Scully and Bart in the United States eighteen years ago. The findings of Scully and Bart demonstrated that obstetric and gynaecological texts contained outdated and erroneous views about women's sexuality and portrayed women in stereotyped roles. It was anticipated that institutionalized changes may have occurred since the time that Scully and Bart carried out their research and the texts would reflect this accordingly; particularly with the effect of the women's health movement which has been expressing dissatisfaction with the health care system. The findings of this research show that sexist ideology still pervades the obstetric and gynaecological texts, though to a lesser extent than eighteen years ago. There are some differences from what Scully and Bart discovered, but major similarities were found. The main difference between the results of this study and the findings of Scully and Bart, is that the majority of texts analysed here did not contain outdated and incorrect information about women's sexual response. For example, none of the texts refer to vaginal orgasm as the 'mature' response for women. The main similarity is that women's sexuality is still depicted with a heterosexual perspective, with marriage and mothering the 'natural' aspirations of all women.

Books↗
PubMed1989

Prevalence and patterns of same-gender sexual contact among men.

The prevalence and patterns of same-gender sexual contact among men are key components of models of the spread of HIV infection and AIDS in the U.S. population. Previous estimates by Kinsey et al. from data collected between 1938 and 1948 have been widely criticized for inadequacies of sample design. New lower-bound estimates of prevalence developed from data from a national sample survey conducted in 1970 indicate that minimums of 20.3 percent of adult men in the United States in 1970 had sexual contact to orgasm with another man at some time in life; 6.7 percent had such contact after age 19; and between 1.6 and 2.0 percent had such contact within the previous year. Although these estimates incorporate adjustments for missing data, the likelihood of underreporting suggests that these estimates might be lower bounds on the prevalence of same-gender sex among men. Two sets of alternative estimates are derived to assess the sensitivity of these estimates to the assumptions made in imputing values to missing data. Detailed estimates are presented by frequency of contact, age, education, and marital status; and supporting estimates are derived from a 1988 national survey. Data from both the 1970 and 1988 surveys indicate that never-married men are more likely than other men to have had same-gender sexual contacts within the last year. The 1970 survey also indicates, however, that approximately half the men estimated to have such contacts are found among the more numerous population of currently or previously married men.

Adult↗
PubMed1970

Androgen function in "psychogenic" and "constitutional" types of impotence.

Androgen function was studied in twenty-five physically healthy "primarily" impotent males classified on clinical criteria into "psychogenic" or "constitutional" groups. The mean urinary testosterone level in the former was significantly higher than in the latter group (P<0.005). Important variables associated significantly with higher urinary testosterone levels (P<0.05) were (a) "late onset" impotence, (b) shorter duration than two years, (c) stronger "sex drive," and (d) an alternative sexual outlet to orgasm and ejaculation in the three months preceding referral; the last-mentioned appeared to be the single most important discriminatory feature.It is suggested that testosterone excretion patterns-namely, high, average, and low-may be one method of classifying impotence.

Adolescent↗
PubMed2003

Problems with sexual function in people attending London general practitioners: cross sectional study.

OBJECTIVES: To assess sexual behaviour, prevalence of ICD-10 diagnosed sexual dysfunction, associations between sexual and psychological problems, and help seeking for sexual problems in people attending general practice; to assess predictors of ICD-10 diagnosis of sexual dysfunction. DESIGN: Cross sectional study. SETTING: 13 general practices in London. PARTICIPANTS: 1065 women and 447 men attending general practices. MAIN OUTCOME MEASURE: Prevalence and predictors of ICD-10 diagnoses of sexual dysfunction. RESULTS: 97 (22%, 95% confidence interval 18% to 25%) men and 422 (40%, 37% to 43%) women received at least one ICD-10 diagnosis, but only 3-4% had an entry relating to sexual problems in their general practice notes. The most common problems were erectile failure and lack or loss of sexual desire in men and lack or loss of sexual desire and failure of orgasmic response in women. Increasing age and being unemployed predicted sexual problems in women, and bisexual orientation, being non-white, and being unemployed were demographic predictors in men. No practice note factors predicted sexual problems in women, but high consulting rate predicted problems in men. The main clinical predictors were poor physical function and dissatisfaction with current sex life in both sexes and higher psychological morbidity in women. When all factors were considered, increasing age (odds ratio 1.01, 1.00 to 1.02), physical subscale score on the SF-12 (0.98, 0.97 to 0.99), sexual dissatisfaction (1.9, 1.5 to 2.4), and scoring over a 3/4 threshold score on the general health questionnaire (1.5, 1.1 to 1.9) independently predicted an ICD-10 sexual dysfunction diagnosis in women. Being bisexual (4.1, 1.3 to 12.8) was the only independent predictor of an ICD-10 diagnosis in men. CONCLUSIONS: Sexual difficulties are common in people attending general practitioners, and many people are prepared to talk about them with their doctors.

Adolescent↗
PubMed1999

Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey.

STUDY OBJECTIVE: To investigate the association of sexual problems with social, physical, and psychological problems. DESIGN: An anonymous postal questionnaire survey. SETTING: Four general practices in England. PARTICIPANTS: 789 men and 979 women responding to a questionnaire sent to a stratified random sample of the adult general population (n = 4000). MAIN RESULTS: Strong physical, social, and psychological associations were found with sexual problems. In men, erectile problems and premature ejaculation were associated with increasing age. Erectile problems were most strongly associated with prostate trouble, with an age adjusted odds ratio of 2.6 (95% confidence intervals 1.4, 4.7), but hypertension and diabetes were also associated. Premature ejaculation was predominantly associated with anxiety (age adjusted odds ratio 3.1 (95% confidence intervals 1.7, 5.6)). In women, the predominant association with arousal, orgasmic, and enjoyment problems was martial difficulties, all with odds ratios greater than five. All female sexual problems were associated with anxiety and depression. Vaginal dryness was found to increase with age, whereas dyspareunia decreased with age. CONCLUSIONS: This study indicates that sexual problems cluster with self reported physical problems in men, and with psychological and social problems in women. This has potentially important consequences for the planning of treatment for sexual problems, and implies that effective therapy could have a broad impact on health in the adult population.

Adolescent↗
PubMed2002

Sexual function in men with cauda equina lesions: a clinical and electromyographic study.

OBJECTIVE: To investigate the effects of cauda equina lesions on sexual function in men. METHODS: Sexual function was investigated in 46 men with long standing cauda equina/conus medullaris lesions. All had clinical and radiological findings supporting the diagnosis. The validated Slovene translation of the international index of erectile function (IIEF) was used. The responses were scored and sexual dysfunction categorised as absent, mild, moderate, or severe. The number of patients receiving help for sexual dysfunction was noted. Neurological examination of the trunk and lower limbs, electromyographic (EMG) evaluation of the sacral reflex, and quantitative EMG of the external anal sphincter muscles were done. RESULTS: Severe sexual dysfunction was reported by 35% of patients, moderate dysfunction by 24%, and slight dysfunction by 26%; normal sexual function was reported by 15%. Orgasmic function was slightly more impaired than erectile function, and sexual desire slightly less. The patients' age, but no findings on clinical neurological or EMG examination, correlated with sexual function. Only five men had received medical attention for sexual dysfunction. CONCLUSIONS: There is significant sexual impairment in men with lesions of the cauda equina or conus medullaris. This is poorly correlated with neurological and EMG findings and has received insufficient medical attention.

Adult↗
PubMed1997

Psychological and psychosexual aspects of vulvar vestibulitis.

AIMS: To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis. METHODS: 30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the patient before review. These questionnaires were the STAI and a modified psychosexual questionnaire introduced by Campion. RESULTS: Patients experienced considerable psychological dysfunction compared with controls. All aspects of psychosexual dysfunction were affected. CONCLUSIONS: When managing patients, psychosexual and psychological issues must be considered in addition to other conventional types of therapy. Vulvar vestibulitis may be a risk factor for developing psychosexual complications including vaginismus, low libido, and orgasmic dysfunction. Consideration of these factors must be an integral part of the management of patients with all chronic vulval conditions.

Adolescent↗
PubMed2004

Alternative therapies for male and female sexual dysfunction.

Sexual dysfunction is prevalent in both men and women. Although new pharmaceutical agents have been identified for male erectile problems, sexual desire and orgasm disorders, individuals with sexual dysfunction often seek alternative therapies, including traditional Chinese medicine. This article reviews currently used alternative therapies, such as herbal medications, L-arginine, acupuncture, biofeedback and others. Potential herb-drug interactions are also presented.

Acupuncture Therapy↗
PubMed2006

[Female sexual function and related factors].

OBJECTIVES: To appraise female sexual function and to describe the factors that most commonly accompany dysfunction. DESIGN: Transversal, descriptive study. SETTING: Primary care. PARTICIPANTS: Two-hundred and twenty-three women from 18 to 76 seen at an urban health centre between November 2004 and February 2005 and who wanted to take part in the study. MAIN MEASUREMENTS: These were collected in an anonymous questionnaire structured in 5 sections with 53 items. The questionnaire comprised social and economic, cultural and life-style variables; female sexual function (FSF); and perception of own state of health (SF-12). A binary logistical regression analysis was run. RESULTS: Female sexuality reaches its maximum expression at 30-35 years (FSF=30.0, 95% CI, 28.3-31.6). Risk factors for sexual dysfunction were: age over 44 and religion (OR, 6.5; 95% CI, 2.8-15); physical component on the SF-12 below 37 (OR, 3; 95% CI, 1.3-7.2); mental component on the SF-12 below 31 (OR, 3.1; 95% CI, 1.2-7.8). Not having a stable partner was a risk factor for arousal (OR, 9.6; 95% CI, 2.8-24.0); for lubrication (OR, 9.3; 95% CI, 4.0-21.5); for orgasm (OR, 8.8; 95% CI, 3.1-24.8); and for dyspareunia (OR, 8.9; 95% CI, 3.9-20.5). It was not a risk factor for desire or satisfaction with sexual life. CONCLUSIONS: The profile of sexual dysfunction consisted of a woman aged over 44 without a stable partner, who practised religion, was unemployed and had perception of low quality of life.

Adolescent↗
PubMed1998

An open trial of oral sildenafilin antidepressant-induced sexual dysfunction.

BACKGROUND: Sildenafil is a selective inhibitor of cyclic GMP-specific phosphodiesterase type 5 that has been associated with greater improvement of erectile function compared to placebo among men with erectile dysfunction. The goal of our study was to evaluate its efficacy in a small sample of outpatients with antidepressant-induced sexual dysfunction. METHODS: We studied the first 14 depressed outpatients (9 men and 5 women; mean age: 46.4 +/- 8.4) who were consecutively treated with oral sildenafil. Twelve of the 14 patients were treated with an SSRI and 2 with mirtazapine. All patients were prescribed oral sildenafil tablets at the initial dose of 50 mg q.d. p.r.n., with the possibility of increasing the dose to 100 mg q.d. p.r.n., if clinically indicated. We administered a sexual functioning questionnaire derived from the Guided Interview Questionnaire for females and males and from the Arizona Sexual Experience Scale to all patients before and after at least 4 weeks of treatment with oral sildenafil. The mean sildenafil dose in our 14 patients was 57 +/- 18 mg/day. RESULTS: All 14 subjects completed the follow-up assessments and no subjects discontinued the drug prematurely. We observed statistically significant improvements in all domains of sexual functioning, including libido, arousal, orgasm, sexual satisfaction, and (in males only) erectile function, with a 69% rate of patients reporting themselves as much or very much improved. Oral sildenafil treatment appeared to be very well tolerated, with only 1 out of 14 (7%) patients reporting an adverse event (hot flashes). CONCLUSIONS: Our findings of statistically significant improvements in all domains of sexual functioning in a sample of 14 men and women with antidepressant-induced sexual dysfunction suggest that this agent may represent an efficacious approach to this population.

Administration, Oral↗