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PubMed1999

Sildenafil for women patients with antidepressant-induced sexual dysfunction.

In an open study, sildenafil (Viagra) was prescribed for nine women outpatients who reported sexual dysfunction induced by antidepressant medication, primarily selective serotonin reuptake inhibitors. A 50 mg dose of sildenafil was prescribed, and patients were instructed to take it approximately one hour before sexual activity. They were told to increase the dose to 100 mg on the next occasion if they experienced a partial response or a lack of response to sildenafil. The nine patients, all of whom had experienced either anorgasmia or delayed orgasm with or without associated disturbances, reported significant reversal of sexual dysfunction, usually with the first dose of 50 mg of sildenafil.

Adult↗
PubMedDate not supplied

The physical effects of diabetes on sexuality in women.

Diabetes is a chronic illness that affects all aspects of human sexuality. As an integral part of a woman's day-to-day life, sexuality may be adversely affected by diabetes in ways that are detrimental to her total health, her relationships, and her self-esteem. This descriptive study was conducted to describe the physical effects of diabetes on sexuality in women with insulin-dependent diabetes or non-insulin-dependent diabetes. A sample of 20 women were interviewed and data were analyzed to identify themes. Problems reported by subjects affecting sexuality were fatigue, changes in perimenstrual blood glucose control, vaginitis, decreased sexual desire, decreased vaginal lubrication, and an increased time to reach orgasm. Continued research is recommended to further explore these findings.

Adult↗
PubMed2006

The effect of chronic antipsychotic treatment on sexual behaviour, hormones and organ size in the male rat.

Antipsychotic drug-induced sexual dysfunction is an important and problematic side effect. We have investigated the effect of chronic antipsychotic treatment on sexual behaviour, sex hormones and genital organ size in the male rat. The following sexual functions were significantly impaired in both risperidone (2 mg/kg) and haloperidol (2 mg/kg) groups at 3 weeks: libido (assessed in mounting frequency and intromission), sexual arousability/motivation (in terms of latencies for mounting and intromission) and orgasm (in terms of latency for ejaculation). At 6 weeks, haloperidol also suppressed the 'hit ratio' (intromissions/mounts) as well as the above-mentioned parameters indicating erectile dysfunction. Risperidone had no significant effect on sexual function at 6 weeks. Compared with the control group, haloperidol and risperidone decreased the serum level of testosterone after 6 weeks but not after 3 weeks. The two drugs did not influence the serum level of leutenizing hormone (LH). At 3 weeks, the epididymis was significantly decreased below controls in both risperidone and haloperidol groups. At 6 weeks, the epididymis, seminal vesicle and prostate weights were significantly reduced in the haLoperidol group, but not in the risperidone group. The serum concentration of testosterone significantly correlated with sex organ weight, but not with sexual behaviours. These results suggest that sexual function, testosterone levels and genital tissue size in male rats were affected to different degrees by risperidone and haloperidol. These findings contribute to our understanding of antispsychotic drug-induced male sexual dysfunction.

Animals↗
PubMed1997

A critical review of selective serotonin reuptake inhibitor-related sexual dysfunction; incidence, possible aetiology and implications for management.

There is a high incidence of sexual dysfunction in the general population and sexual dysfunction is often an integral symptom of a depressive disorder. In addition, all antidepressants have effects on sexual functioning, as the result of side-effects of these medications and as a reflection of therapeutic success. The selective serotonin reuptake inhibitors (SSRIs) are clearly associated with delayed ejaculation, inability to ejaculate and absent or delayed orgasm. Furthermore, the incidence of sexual dysfunction obtained by patient self-report does not appear to reflect the true incidence of sexual dysfunction associated with antidepressant therapy and systematic inquiry is needed as sexual dysfunction may be an unrecognized cause of noncompliance. The SSRIs may have advantageous effects on sexual functioning and these may also be underreported due to the same factors resulting in an under-reporting of sexual side-effects in general. In addition, studies have suggested a role for the SSRIs in the management of premature ejaculation. The effects of SSRIs on sexual functioning are clearly dose-related and may vary amongst the group due to their relative effects on the serotonin and dopamine systems and the extent to which plasma levels of these drugs accumulate in the body over time. A variety of strategies have been found useful in the management of SSRI-induced sexual dysfunction including waiting for tolerance to develop, dosage reduction, drug holidays, switching to a different antidepressant and various augmentation strategies with 5-HT2, alpha2 adrenergic receptor antagonists and dopamine receptor agonists.

Dose-Response Relationship, Drug↗
PubMed1989

Development of sexuality in female children and adolescents.

Female sexuality (meaning sexual desire, excitement and orgasm) has been of considerable interest in psychiatry. Women's efforts to define and legitimize their own experience of their sexuality have increased in the past 25 years. However, the integration of these new views into the body of psychiatric (especially psychoanalytic) theory has not occurred very actively or successfully. Very little is known about the development of sexuality in childhood and adolescence. This paper looks at various behaviours, interests and events in women's lives that might reveal something about the development of their sexuality. The literature on female masturbation is reviewed and some sex differences high-lighted. The literature on interest in babies, the wish to have babies, and menarche is explored for possible associations with sexuality. Rather than sexuality being a central organizer of experience, it seems quite possible that experience is an organizer of sexuality. Therefore, to better understand female sexuality we need to consider the impact of experiences during childhood and adolescence.

Adolescent↗
PubMed1995

Clomipramine treatment of paraphilias in elderly demented patients.

Sexually inappropriate conduct often accompanies the disinhibition associated with dementia and neuropsychologic deficits. Management of these behaviors is problematic and time consuming. We report two cases in which paraphilias responded to treatment with clomipramine. This effect was not due to the sexual side effects of the drug (e.g., decreased ability to sustain an erection or orgasm). Careful monitoring of the elderly patient is required during treatment with clomipramine, particularly with regard to orthostasis, the increased risk of falls, and worsened confusion secondary to the potential risks of anticholinergic delirium and toxicity.

Age of Onset↗
PubMedDate not supplied

Fluvoxamine-associated sexual dysfunction.

OBJECTIVE: To report two cases of sexual dysfunction induced by fluvoxamine, a selective serotonin reuptake inhibitor (SSRI). SETTING: University teaching hospital. PATIENTS: Two depressed patients who developed ejaculation and orgasmic difficulties after initiation of fluvoxamine therapy. DISCUSSION: The literature concerning sexual dysfunction with serotonergic antidepressants is reviewed, and speculated mechanisms for this untoward effect are discussed. CONCLUSIONS: Sexual dysfunction associated with antidepressant drugs, including SSRIs, may be underreported. This troublesome adverse effect may significantly affect patient comfort and compliance. Careful evaluation of sexual function is warranted, prior to and during drug treatment, especially as more serotonergic antidepressant agents become available.

Adult↗
PubMed2006

Sexual function after surgery for prostate or bladder cancer.

BACKGROUND: Compromised sexual function is often a side effect for patients following radical surgical procedures for bladder or prostate cancer. METHODS: The authors review the classification and physiology of sexual function and dysfunction. Moreover, they explain the possible pathophysiology directly resulting from surgery, and they discuss several approaches available to address these problems. RESULTS: Options for male sexual dysfunction, primarily erectile dysfunction resulting from radical prostatectomy or surgery for bladder cancer, range from patient education to penile prosthesis implantation. Female sexual dysfunction caused by surgical intervention for bladder cancer includes problems with libido, arousal, orgasm, and dyspareunia. Treatment options for women can include sex therapy, hormonal therapy, and preventive strategies. However, no consensus has been established on the most effective agents and time points to treat male or female sexual dysfunction following radical cystectomies or prostatectomies. The chronic intermittent treatment of erectile dysfunction following radical prostatectomy has been commonly referred to as penile rehabilitation. CONCLUSIONS: Additional research is needed to obtain further data concerning sexual dysfunction in both men and women following radical pelvic surgeries. Modification of surgical techniques, the use of various treatment modalities for sexual dysfunction, and the development of new agents will help to successfully minimize or prevent damage and restore normal sexual function after local surgical therapy for prostate or bladder cancer in the future.

Erectile Dysfunction↗
PubMed2006

Sex, the heart, and heart failure.

In the modern era of pharmacologic treatment of erectile dysfunction, men with heart disease increasingly approach their physicians regarding the possibility of restoring sexual activity. At the same time, patients are also frequently aware of public figures that have reportedly died during coitus, often in the arms of their mistresses or prostitutes. Added to this is the perception of patients, and oftentimes their physicians, that coitus and orgasm are associated with a near maximal or even "supermaximal" cardiac workload and therefore may be hazardous for a diseased heart. Accordingly, knowledge of the cardiovascular effects of sexual activity, the risks of triggering a cardiovascular event, and the potential risks inherent in the use of drug therapy of male impotence is important to properly advise patients and their spouses regarding this sensitive issue.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2002

Supracervical hysterectomy versus total abdominal hysterectomy: perceived effects on sexual function.

BACKGROUND: Our investigation sought to compare changes in sexual function following supracervical hysterectomy (SCH) and total abdominal hysterectomy (TAH). METHODS: A retrospective chart review was performed to identify all patients who underwent supracervical hysterectomy or total abdominal hysterectomy at a tertiary care center. Patients who met criteria for participation were sent a one page confidential, anonymous questionnaire to assess sexual function experienced both pre- and postoperatively. A total of 69 patients in each group were eligible for participation. A multiple logistic regression model was used to analyze measured variables. RESULTS: Forty-eight percent (n = 33) of women undergoing a SCH returned the questionnaire, while 39% (n = 27) of those undergoing a TAH chose to participate. There were no significant demographic differences between the two groups. Patients who underwent TAH reported worse postoperative sexual outcome than SCH patients with respect to intercourse frequency, orgasm frequency and overall sexual satisfaction (P = 0.01, 0.03, and 0.03, respectively). Irrespective of type of hysterectomy, 35% of patients who underwent bilateral salpingoophorectomy (BSO) with hysterectomy experienced worse overall sexual satisfaction compared to 3% of patients who underwent hysterectomy alone (P = 0.02). CONCLUSIONS: Our data suggest that TAH patients experienced worse postoperative sexual function than SCH patients with respect to intercourse frequency and overall sexual satisfaction. Irrespective of type of hysterectomy, patients who underwent bilateral salpingoophorectomy experienced worse overall sexual satisfaction.

Journal Article↗
PubMed1978

Two clinically discrete syndromes of transsexualism.

Transsexuals are defined as subjects who have a sustained feminine gender identity combined with a wish to alter their bodily appearance towards the feminine. The results of this study indicate that they can be differentiated into two clinically discrete groups. In an investigation of 29 transsexuals who sought a change of sex operation it was found that those who had experienced fetishistic arousal were significantly more likely to be older, to have experienced heterosexual intercourse, to be married and to show penile responses to pictures of men and women indicative of a more heterosexual orientation. They had less experience of homosexual contact to orgasm as compared transsexuals who had not experiennced fetishistic arousal , but this difference was not statistically significant. Frequency of cross-dressing, strenght of feminine gender identity and intensity of desire for a sex change operation did not discriminate the two groups. The fact that desire for a sex change operation may be associated with experience of fetishistic arousal could be one reason for the higher incidence transsexualism in men than in women.

Adult↗
PubMed1983

Abnormal dexamethasone suppression test in normal females.

Eighty women taking part in a population study were subjected to a dexamethasone suppression test (DST) intended as a diagnostic aid for melancholia. The women were selected systematically from two age strata, 38 and 50 years. Fifteen subjects (19 per cent) were found to be non-suppressors. High post-dexamethasone serum cortisol concentrations were not the result of elevated concentrations of the main cortisol binder, transcortin. There were no differences between suppressors and non-suppressors as regards depressive symptoms, strain experience, body mass, gynaecological history, drug use, smoking, erythrocyte sedimentation rate, number of leucocytes, activity of serum aminotransferases and gamma-glutamyltransferase, serum iron, bilirubin, ferritin content, serum growth hormone or serum prolactin. However, the nonsuppressors reported a significantly lower (P less than 0.01) orgasmic capacity in a questionnaire inquiry about two weeks before the DST. The outcome of the study indicates that DST as the presently recommended procedure for out-patients has a lower specificity for melancholia than has been reported previously.

Adult↗
PubMed2003

Nithsdale Schizophrenia Surveys 24: sexual dysfunction. Case-control study.

BACKGROUND: That sexual dysfunction occurs in schizophrenia is not in doubt. Previous studies have had weaknesses such as the use of selected populations or the absence of a control group. AIMS: To measure rates of sexual dysfunction in people with schizophrenia compared with the general population. METHOD: Sexual dysfunction was assessed by a self-completed gender-specific questionnaire. Ninety-eight (73%) of 135 persons with schizophrenia and 81 (71%) of 114 persons recruited as controls returned the questionnaire. RESULTS: At least one sexual dysfunction was reported by 82% of men and 96% of women with schizophrenia. Male patients reported less desire for sex, were less likely to achieve and maintain an erection, were more likely to ejaculate more quickly and were less satisfied with the intensity of their orgasms. Female patients reported less enjoyment than the control group. Sexual dysfunction in female patients was associated with negative schizophrenic symptoms and general psychopathology. There was no association between sexual dysfunction and type of antipsychotic medication. CONCLUSIONS: People with schizophrenia report much higher rates of sexual dysfunction than do the general population. Men and women with schizophrenia have a different pattern of sexual dysfunction.

Adult↗
PubMed1997

Sexual dysfunction in nonseminoma testicular cancer patients is related to chemotherapy-induced angiopathy.

PURPOSE: To establish the prevalence of sexual dysfunctions after different treatment modalities for nonseminomatous testicular germ cell tumor (NSTGCT) and to investigate whether treatment-induced angiopathy and neuropathy is related to sexual dysfunction. PATIENTS AND METHODS: A questionnaire assessing sexual dysfunction was sent to 255 NSTGCT survivors. Polychemotherapy (PCT) regimens (cisplatin, vinblastine, and bleomycin [PVB], vinblastine substituted by etoposide [BEP], or cisplatin substituted by carboplatin [CEB], etoposide combined with cisplatin [EP], or with ifosfamide and cisplatin [VIP] were compared regarding treatment-induced angiopathy and neuropathy. Sexual dysfunctions were related to Raynaud's phenomenon and acral paresthesia. RESULTS: Among the 215 responders, 56 (26%) had been treated by orchidectomy and surveillance, 42 (19.6%) by PCT, and 117 (54.4%) by PCT and resection of residual retroperitoneal tumor mass (RRRTM). Overall, loss of libido was reported by 19.1%, decreased arousal by 11.2%, erectile dysfunction by 12.1%, decreased intensity of orgasm by 20%, and ejaculatory problems by 28%. Patients treated with PVB suffered more often from Raynaud's phenomenon compared with those treated with other regimens (40.4% v 29%; P < .05) and from paresthesia (31.6% v 14.7%; P < .05). Patients with Raynaud's phenomenon had more often erectile dysfunction (28.8%) compared with those without (8.4%) (P < .05). CONCLUSION: Compared with orchidectomy alone, PCT, with or without RRRTM, induced more often posttreatment sexual dysfunction. Compared with other chemotherapeutic regimens, signs of angiopathy and neuropathy were most prevalent in those treated with PVB. Erectile dysfunction was related to the chemotherapy-induced Raynaud's phenomenon but not to acral paresthesia.

Adult↗
PubMed2003

Oxytocin receptor is expressed in the penis and mediates an estrogen-dependent smooth muscle contractility.

Oxytocin (OT) is released by the posterior pituitary during male orgasm and is supposed to participate in the ejaculatory process. We now report evidence demonstrating the presence of an OT receptor gene (real-time RT-PCR and Northern blot) and protein (immunohistochemistry, Western blot, and binding studies) expression in the rabbit and human corpus cavernosum (CC) and its possible involvement in postorgasmic penile detumescence. OT receptor is expressed in the penis at a concentration similar to that present in other portions of the male genital tract and mediates CC contractility. OT-induced CC contractility is clearly regulated by the changing sex steroid milieu. In fact, we found that in a rabbit model of hypogonadotropic hypogonadism (induced by a single administration of the long-acting GnRH agonist triptorelin pamoate, 2.9 mg/kg), OT responsiveness was strongly reduced and was completely restored by estradiol valerate (3.3 mg/kg weekly), but not by testosterone enanthate (30 mg/kg weekly). As we found that CC expresses both subtypes of estrogen receptors and P450 aromatase, we hypothesized a physiological role for endogenous estrogens in regulating OT responsiveness. We therefore treated adult rabbits with an aromatase inhibitor (letrozole, 2.5 mg/kg) or an antiestrogen (tamoxifen, 0.25 mg/kg) for 3 wk. Both treatments significantly reduced CC responsiveness to OT stimulation. In conclusion, these findings indicate that OT might participate in inducing postorgasmic penile flaccidity and suggest a new role for estrogens in the male: regulation of CC responsiveness to OT.

Animals↗
PubMed1983

The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men.

Sexual function and the effects thereon of testosterone enanthate were studied in six hypogonadal men with the objective of delineating the specific components of male sexuality affected by androgen. To obtain a detailed picture of these components, prospective self-report data (from daily logs) of sexual activity and feelings, recordings of all night penile tumescence, and laboratory psychophysiological data were assessed. Double blind placebo experiments with cross-over design were used to compare the effects of placebo and 200- and 400-mg doses of testosterone enanthate. Erectile responses to erotic film and fantasy were not lower in the hypogonadal patients than in normal men and, in fact, were higher on some parameters, especially prolongation of detumescence time after exposure to film or fantasy. Three subjects who kept consistent daily logs had increased frequencies of sexual acts and feelings, orgasms, and spontaneous erections after testosterone administration. Nocturnal penile tumescence and spontaneous daytime erections were reduced in untreated hypogonadal men and were significantly increased after testosterone treatment, but the laboratory-tested erectile responses to film and fantasy were not affected by testosterone. These data and previous findings lead to the conclusion that the major androgen action on male sexuality involves libido factors (i.e. sexual motivation/interest). Though stimulus-bound erections elicited in the laboratory were not reduced in hypogonadal men, spontaneous (sleep or waking) erections were clearly testosterone dependent.

Adult↗
PubMed1990

Sexual function in married men with Parkinson's disease compared to married men with arthritis.

We evaluated the sexual function of 41 married men with Parkinson's disease (PD) and its relation to age, severity of PD, and depression. We used a group of 29 married men with arthritis for comparison. Total sexual functioning and categories of desire, arousal, orgasm, and satisfaction did not differ significantly between patients with PD and arthritis. For both PD and arthritis, increased age, severity of illness, and depression were associated with reduced sexual function. These results suggest that sexual dysfunction is common in married men with PD, but no more so than in men with another chronic illness that does not involve the nervous system.

Adult↗
PubMed2006

Retarded ejaculation - a review.

Retarded ejaculation, now termed the male orgasmic disorder is not only difficult to manage, but also the scientific evidence for aetiology, treatment and outcome is poor. This is compounded by incomplete consensus regarding definition from the scientific community. In this review, we intend to collate the available information on this sexual problem including definitions, possible aetiological factors and treatment options.

Ejaculation↗