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PubMedDate not supplied

Sexual dysfunction in male posttraumatic stress disorder patients.

BACKGROUND: Previous studies have suggested that sexual dysfunction may be associated with posttraumatic stress disorder (PTSD). Yet such studies have not examined a full range of sexual functioning and have not accounted for the possibility that medication used to treat PTSD may contribute to sexual dysfunction. OBJECTIVE: The current study compares the various components of sexual functioning among three groups of males: (1) untreated PTSD patients (n = 15), (2) PTSD patients currently treated with selective serotonin reuptake inhibitor (SSRI) agents (n = 27) and (3) a group of normal controls (n = 49). METHODS: All participants completed an 18-item questionnaire for assessment of sexual functioning. Those with PTSD also completed the Impact of Events Scale and the Symptom Check List-90 (SCL-90). RESULTS: Untreated and treated PTSD patients had significantly poorer sexual functioning in all domains (desire, arousal, orgasm, activity and satisfaction) as compared to normal controls. Those treated with SSRI had greater impairment in desire, arousal and frequency of sexual activity with a partner. There was a high correlation between sexual dysfunction among the PTSD group and the anger-hostility subscale of the SCL-90. CONCLUSIONS: PTSD appears to be associated with pervasive sexual dysfunction that is exacerbated by treatment with SSRIs. PTSD may represent a heterogeneous syndrome. Patients with PTSD have a high rate of comorbid panic disorder, major depression and anxiety, and it could thus be argued that these comorbid disorders, rather than PTSD, accounted for the observed result. Future research aimed at understanding comorbidity and heterogeneity should help to illuminate the psychobiology of PTSD and eventually guide both medication and psychosocial treatments.

Adult↗
PubMed2000

Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options.

Female sexual dysfunction is a significant age-related, progressive and highly prevalent problem that affects a substantial number of women in the United States. The female sexual response cycle is initiated by neurotransmitter-mediated vascular and nonvascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. These mechanisms are mediated by a combination of neuromuscular and vasocongestive events. Physiological impairments that interfere with the normal female sexual response bring about complaints associated with diminished sexual arousal, libido, vaginal lubrication, genital sensation, and ability to achieve orgasm. Therapy aimed at restoring hormone levels as well as genital blood flow will be discussed.

Female↗
PubMed1999

Effects of losartan on the sexual behavior of male rats.

Many commonly used antihypertensive drugs such as diuretics and beta-blockers can interfere with sexual function in both sexes, causing loss of libido, impairment of erectile function and ejaculation in men, and delay or prevent orgasm in women. Newly developed antihypertensive drugs should ideally not interfere with the patients' quality of life including sexual function. This study examined the effects of losartan, a nonpeptide, specific antagonist for type I angiotensin II receptors, on the male sexual behavior of rats. Spontaneously hypertensive rats (SHRs) and normotensive Wistar-Kyoto (WKY) rats were treated with losartan 30 mg/ kg/day or saline control for 7, 30 and 90 days. Dark-cycle video recording was used to analyze the male sexual activities of the rats. No significant alteration in male sexual performance was observed after 7 and 30 days of treatment with losartan. In contrast, SHRs treated with propranolol 5 mg/kg/day showed increases in intromission latency, ejaculation latency and postejaculatory period indicating decreased libido and erectile and ejaculatory function. Upon completion of 90 days of losartan administration, the mount latency of the SHR was significantly increased, suggesting a decrease in libido although other parameters were unchanged and there was no effect in WKY rats. It is therefore concluded that losartan may have an advantage in preservation of sexual function when used clinically for the treatment of hypertensive disorders.

Animals↗
PubMed2001

Congenital micropenis: long-term medical, surgical and psychosexual follow-up of individuals raised male or female.

OBJECTIVES: To document long-term medical, surgical and psychosexual outcome of individuals with congenital micropenis (13 males, 5 females). METHODS: Physical measurements from childhood were collected retrospectively from medical records and at adulthood by physical examination. An adult psychosexual assessment was conducted with a written questionnaire and oral discussion. RESULTS: Adult penile length was below the normal mean in all men. Three women had vaginoplasty resulting in normal length. All men reported good or fair erections but 50% were dissatisfied with their genitalia. Dissatisfaction with body image resulted from having a small penis (66%), inadequate body hair (50%), gynecomastia (33%) and youthful appearance (33%). Ten men were heterosexual, 1 homosexual and 2 bisexual. Among women, 4 (80%) were dissatisfied with their genitalia. Three women reported average libido with orgasm and were also heterosexual. Two women had no sexual interest or experience. Finally, males were masculine and females feminine in their gender-role identity, and both groups were satisfied with their sex of rearing. CONCLUSIONS: Regarding choice of gender, male sex of rearing can result in satisfactory genito-sexual function. Female gender can also result in success, however it requires extensive feminizing surgery.

Adolescent↗
PubMed2002

Termination of pregnancy and women's sexuality.

OBJECTIVE: To determine the influence of termination of pregnancy (TOP) on women's sexuality. DESIGN: Prospective qualitative and quantitative study. SUBJECTS: 103 women undergoing induced abortion by vacuum aspiration, interviewed 1-3 weeks before surgery and 6 months later. RESULTS: After TOP, patients described symptoms of fatigue (39%), feelings of guilt (35%), sadness (34%) and anxiety (29%). Thirty-one percent of women presented at least one sexual dysfunction, 18% a decrease in sexual desire, 17% orgasmic disorders, 12% vaginal dryness and 11% dyspareunia. These sexual dysfunctions were correlated with anxiety and symptoms of depression following TOP. Six months after TOP, 57% of the women reported no change in their sexual satisfaction, 17% were 'more satisfied' and 7% 'less satisfied'. Lessening of sexual satisfaction after TOP was correlated with diminished partner satisfaction (p < 0.00001), fatigue (p < 0.0009), feelings of guilt (p < 0.01), low frequency of sexual relations (p < 0.01) and anxiety over sexual relations (p < 0.02). CONCLUSIONS: Six months after TOP some women presented persisting sexual dysfunction. This sexual dysfunction may be explained essentially by the appearance of symptoms of anxiety and depression following TOP. When the quality of the relationship was satisfying, women could cope more easily with the appearance of a sexual dysfunction.

Abortion, Induced↗
PubMedDate not supplied

Sildenafil citrate for the sexual dysfunction in antidepressant-treated male patients with posttraumatic stress disorder. A preliminary pilot open-label study.

BACKGROUND: Previous studies have suggested that posttraumatic stress disorder (PTSD) may be associated with pervasive sexual dysfunction. Sildenafil citrate was established as a highly effective and well-tolerated oral agent for the treatment of sexual dysfunction of various etiologies. There are no studies that have examined the efficacy of oral sildenafil in PTSD patients with sexual dysfunction. OBJECTIVE: The current study evaluated the impact of sildenafil added to an ongoing antidepressive treatment in male PTSD patients. METHODS: Ten consecutive male PTSD patients who complained of sexual dysfunction were enrolled in an open-label 4-week fixed-dose study of sildenafil citrate 50 mg/day p.r.n. Patients were evaluated at baseline and after treatment with the Clinician-Administered PTSD Scale (CAPS); sexual function assessments were performed using the International Index of Erectile Function. RESULTS: All patients completed the study and statistically significant improvement was observed in all evaluated domains of sexual functioning: erectile function (53.5%), orgasmic function (40.3%), sexual desire (53%), intercourse satisfaction (82%) and overall satisfaction (57.4%). Oral sildenafil treatment appeared to be well tolerated and no single patient stopped the treatment. Improvements in various CAPS subscales were also obtained; however, there was no significant correlation between improvement in sexual functioning and the changes in CAPS subscale scores. CONCLUSION: Sildenafil seems to be an efficacious, safe and well-tolerated treatment of sexual dysfunction in antidepressant-treated male PTSD patients.

Adult↗
PubMed2002

Comparison of total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy.

We compare the surgical results of 60 women undergoing laparoscopically assisted vaginal hysterectomy (LAVH) and 41 having total laparoscopic hysterectomy (TLH) under the indications of uterine fibroids or adenomyosis. With similar specimen weight, TLH required longer surgery duration (140.4 vs. 115.1 min; p < 0.05) than LAVH. Among women with uteri weighing 0.05) although the TLH group had a significantly higher rate of previous abdominal surgery (57.7 vs. 20%; p < 0.05). There were no significant differences between the two groups with respect to the mean cost, length of hospital stay and rate of various complications (p > 0.05). As for sexual symptoms, dyspareunia decreased significantly post-operatively in the LAVH group (p < 0.05), but not in the TLH group. A significant reduction in the frequency of orgasms after surgery was detected in both groups (p < 0.05). In conclusion, LAVH has advantages over TLH with reduced operating time. Although it is a technical challenge, TLH can be effectively performed within reasonable time limits in selected cases. The effects on sexual function, following either LAVH or TLH, are found to be similar.

Adult↗
PubMed2002

Sexual functioning in Chinese stroke patients with mild or no disability.

This study was conducted to assess the effects of stroke on sexual functioning of patients with mild or no disability and to explore the associations of clinical and psychosocial factors with post-stroke changes in sexual functions. Consecutive stable Chinese patients were invited to complete a self-administered questionnaire concerning their pre- and post-stroke sexual functions and habits. Results from this cohort of 63 men and 43 women revealed a post-stroke decrease in libido, coital frequency, sexual arousal, orgasm and sexual satisfaction in 54.3%, 43.8%, 25.0% (women) to 51.6% (men), 20.0% (women) to 45.9% (men) and 28.6% of patients, respectively. Logistic regression indicated unwillingness for sex and a belief in an adverse effect of stroke on sexuality as explanatory factors for decreased sexual satisfaction. Thus, sexual dysfunctions are common in Chinese stroke patients with mild or no disability.

Adult↗
PubMed1999

Penile implants in erectile impotence. The importance of clinical experience on outcome.

PURPOSE: We assessed maximum patient and partner acceptance and satisfaction by informed preoperative prosthesis selection. MATERIALS AND METHODS: Six months to 5 years after penile prosthesis implantation, 71 men and partners were interviewed personally. Evaluation was focused on delineating not only the etiologic factors but also factors most likely to affect prosthesis recommendation and contribute to prognosis. RESULTS: Overall, 94% of the patients and 95% of the partners were satisfied, and 90% of these believed that they had equal erections to previously without the implant, and 81% reported an improvement in nonsexual relations with their partners after the device was implanted. 83 and 17% of the patients said they had increased or had no change in sexual desire, respectively. No one had a decrease in sexual desire. 86% of all the patients believed that their orgasm was improved. 89% of the patients were completely satisfied with the fit of their clothes after prosthesis implantation. 93% of the patients reported good to excellent emotional adjustment to the prosthesis and the prosthesis produced a positive change in self-esteem in 94% of all the patients. CONCLUSIONS: A detailed assessment of patient-partner expectations is essential in order to be able to predict more accurately which patients will be best suited to the implant and which may need either concurrent counseling or preimplant education. A team was formed in which urologists and psychologists worked together, provided comprehensive information on several personality variables of interest in treatment planning and postoperative satisfaction. Our results clearly demonstrate that not only patient preference but also clinical data are important factors in enhancing patient and partner satisfaction.

Adult↗
PubMed2006

Progress in female sexual dysfunction.

INTRODUCTION: Female sexual dysfunction (FSD) is a significant age-related, progressive and highly prevalent problem that affects a substantial number of women that causes personal distress and has negative effects on quality of life and interpersonal relationships. DEFINITIONS: The female sexual response cycle consists of three phases: desire, arousal, and orgasm, and is initiated by non-adrenergic/non-cholinergic, e.g. vasoactive intestinal polypeptide and nitric oxide, neurotransmitters that maintain vascular and non-vascular smooth muscle relaxation resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. Furthermore, hormonal status may influence female sexual function. For the diagnosis of FSD, a detailed history should be taken initially, followed by a physical examination and laboratory studies. CONCLUSION: Due to the fact that there has been little research and attention on FSD, our knowledge in this field is quite limited and there is still no approved therapy. Future advances in evaluation and treatment of female sexual problems are forthcoming.

Female↗
PubMed1983

Testicular feminization syndrome. An experimental model for the study of hormone action on sexual behavior.

Truly feminine consciousness of gender identity, normal extragenital erotogenic sensitivity, suppressed or very reduced clitoris sensitivity and reaction, normal reaction of the labia minora and the vagina which deepens with the renewal of intercourse, realization of pleasure climax without clonicotonic orgasm and followed by resolution, and a normal maternal attitude seem to characterize sexual behavior in a complete or almost complete testicular feminization syndrome. These features allow one to clearly distinguish, without ignoring multiple psychologic mechanisms, the factors related to androgens and to estrogens in normal feminine sexual behavior.

Adult↗
PubMed1985

Hyperprolactinemia and sexual function in men.

Male hyperprolactinemia (HPRL) is known to induce different types of sexual dysfunctions. In order to determine the incidence of HPRL among patients referred for sexual dysfunction, serum prolactin (PRL) was assayed in 1053 clinically idiopathic cases. Among 850 cases complaining of erectile impotence, 10 with marked HPRL (1.1%, PRL above 35 ng/ml) were found, of whom 6 cases were associated with a pituitary adenoma. 17 mild HPRL (2%, PRL 20-35 ng/ml) were also found. Among 124 cases with premature ejaculation, 13 (10%) mild HPRL were found. Serum PRL was normal in 51 cases complaining of an ejaculation without orgasm, and 27 patients exclusively complaining of reduced sexual desire. Our results lay stress on the fact that serum PRL must be assayed in every case of clinically idiopathic erectile impotence. Indeed, 5 of the 10 marked HPRL patients would have been misdiagnosed if we had only assayed this hormone when plasma testosterone was below the normal range. Moreover, in order to shed some light on the mechanisms by which HPRL disturbs male sexual function, the sexual behaviour of 17 markedly HPRL males was compared to their serum levels of PRL and testosterone, first before treatment, then at regular intervals during treatment. Our main conclusion is that impotence cannot be totally explained by a decrease in plasma testosterone, because this steroid hormone was within the normal range 7 of the 16 impotent patients. Moreover, when serum PRL was lowered by bromocriptine, 6 patients recovered their potency before plasma testosterone clearly increased, and in 3 of those patients before it reached the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1995

Oxytocin and female sexuality.

A search of the literature has been prepared to determine how oxytocin may affect sexual and reproductive in women. Many animal studies suggest that oxytocin induces a variety of reproductive behaviors, including grooming, sexual arousal, orgasm, gamete transport, nesting, birthing, and specific maternal behaviors such as breast-feeding and bonding between mother and infant. These actions are apparently facilitated by the 'priming' effect on certain cells by sex and steroid hormones - as the brief case report would also suggest. However, no adequate double-blind trial has confirmed the observations from this report in women. Only animal studies have been performed, albeit over a wide range of species. A variety of other causes and effects of sexual interest and arousal relating to oxytocin are considered, including some of those in males. More research is needed to clarify the role of oxytocin in human reproductive behaviors, including its potential 'aphrodisiac' or prosexual effect in women in the presence of the sex-steroid hormones.

Female↗
PubMed1987

Changes in the sexual behavior of couples after prostatectomy. A prospective study.

Sexual behavior after prostatectomy was observed in 90 couples, with a follow-up of 3-6 years. Retropubic prostatectomy was performed on 53 patients (58.7%), transvesical prostatectomy on 12 patients (13.7%), and transurethral prostatectomy on 25 patients (27.7%). In order to have a reliable figure of the sexual behavior after surgery, all the couples underwent personal interviews separately before and 3-6 years after surgery. The interview included 4 main subjects: erection allowing sexual intercourse; antegrade ejaculation; orgasm, and libido. The separate identical double interviews were performed in order to achieve a high reliability in answer to sexual performance, this being the main unsolved question in previous studies. The results of the interviews were assessed by a computer-processing program and statistically analyzed. Our results imply that prostatectomy has an unfavorable influence on sexual activity: 33% of the potent preoperative patients became impotent after surgery.

Aged↗
PubMed1979

The use of Midodrin in the treatment of ejaculation disorders following retroperitoneal lymphadenectomy.

The long-term treatment of retrograde ejaculation disorders following retroperitoneal lymphadenectomy with the alpha-sympathomimetic, Midodrin, administered orally, led to improvements in the intensity of orgasm and the degree of erection. Normal ejaculation was induced in 7 out of 12 patients and emission of spermatozoa into the posterior urethra was restored in 3 out of 12 patients by a single intravenous injection of 25--30 mg Midodrin.

Adult↗
PubMed1982

Partial ejaculatory incompetence: the therapeutic effect of midodrine, an orally active selective alpha-adrenoceptor agonist.

The syndrome of partial ejaculatory incompetence has been reviewed. 6 patients, diagnosed as suffering from partial ejaculatory incompetence, were studied. For each subject, large numbers of spermatozoa were present in the post-masturbation urine sample providing evidence of disturbed ejaculatory function. The effect of a potent alpha-adrenoceptor agonist (Midodrine) was evaluated in these patients by means of a double-blind crossover study. Active treatment resulted in a significant increase in intensity of orgasmic sensation, and in a statistically significant improvement in ejaculatory function.

Adult↗
PubMed1980

Opiate use and sexual function.

Although opiate addicts often equate the drug experience with sexual orgasm, diminished libido and impaired sexual performance are common sequelae of chronic use. Early clinical studies suggested that opiates may interfere with sex hormone secretion. The authors carried out three sequential studies which demonstrated that heroin use in man results in acute suppression of luteinizing hormone (LH) release from the pituitary followed by a secondary drop in plasma testosterone levels. The time course of these neuroendocrine events correlates well with the tension-reducing effects of heroin and suggests that drive reduction is an important component of opiate reinforcement.

Erectile Dysfunction↗
PubMed1990

Sexual side effects of antipsychotic medication: evaluation and interventions.

Sexual side effects of antipsychotic medications, which include disturbances of erection and ejaculation, changes in libido, and priapism in men and decreased libido, orgasmic dysfunction, and menstrual irregularities in women, are estimated to occur in 30 to 60 percent of persons taking the drugs. The authors review side effects associated with specific drugs and present guidelines for assessing whether sexual dysfunction is related to medication. Pharmacological interventions that may reduce antipsychotic-induced sexual dysfunction include gradually reducing the dose or changing the type of medication and administering other medications such as bethanechol, neostigmine, cyproheptadine, and bromocriptine that are known to improve sexual dysfunction.

Adult↗