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Priapism is defined as a prolonged penile erection that fails to subside despite orgasm. It is a medical emergency which should be diagnosed and treated early to preserve erectile function and avoid corporal fibrosis resulting from anoxia of the corporal tissue. Decompression is usually successful with no permanent damage if treatment is provided within 12 hours of onset.
In Sweden and other Western societies, the number of women above the age of 40 is increasing and health and well-being of middle-aged women is an increasing matter of concern. This study examines menstrual histories, gynecological operations, urinary incontinence, and reproductive functions in a representative sample of middle-aged women, as well as the frequency of climacteric symptoms and how to predict the women at risk for acquiring these symptoms. The sexuality of the mature woman as also explored. Women aged 37 to 66 years were randomly selected from the Census Register in Goteborg, Sweden. The bulk of information was obtained by means of questionnaires. Among the findings are that the median age for natural menopause was 50.9 years. Forty percent of the postmenopausal women reported frequent vasomotor symptoms. The occurrence of climacteric complaints is strongly connected to psychosocial variables. Every tenth woman reported frequent urinary leakage. Fifty-three percent of the women had undergone a D&C and 9% were hysterectomized. The woman around 40 reported few sexual partners (median 3) and her first intercourse occurred at age 18. Extramarital sex was uncommon. The masturbation rate was low and the frequency of homosexuality was extremely low. The majority of women had experienced orgasm.
Sexual abuse, particularly childhood sexual abuse, has been linked to chronic pelvic pain and to sexual dysfunction, though the sexual functioning of survivors of sexual abuse has not been studied in a chronic pain population. Sixty-three women with chronic pelvic pain completed measures of sexual function, sexual abuse, and pain. Using an index of the extent of sexual abuse experiences in childhood and adolescence/adulthood, higher scores were related to lower rates of sexual activity, less satisfaction with orgasm and feelings of closeness with sexual partners, and greater severity of and interference from pain. Findings point to the importance of controlling for relationship status in analyses of long-term effects of sexual abuse and of assessing chronic pelvic pain patients for histories of sexual abuse using measures that address the extent or severity of abuse.
Some of the special circumstances and issues involved in both the causes and treatments of sexual problems among gay men are discussed. Reported frequencies of specific dysfunctions are discussed, and desire, arousal, and orgasmic phases are used to describe the special problems gay men have. These categories are also used to explore some of the probable contributing factors and specific treatment issues and suggestions that have been found useful. Since there is some indication that inhibited ejaculation is a somewhat frequent problem among gay men and has been more difficult than some dysfunctions to treat, emphasis has been placed on possible causes and treatments that have been helpful. A category of sexually inexperienced gay men is also discussed.
An organized semi-public event for the exhibition of S/M (sadomasochistic) behavior is known as a "party" by the participants. Using a retrospective analysis of the author's experiences over the last 25 years, a description of these parties is presented. The present paper explores the structure, function, and purpose of these parties. The S/M behavior, sexual interactions, rules of etiquette, and structure of the party are summarized. The lack of genitally focused orgasm-seeking behavior at the party is discussed at length.
OBJECTIVE: To compare the benefits and risks of bupropion and selective serotonin-reuptake inhibitors (SSRIs) in adults with depression. DATA SOURCES: MEDLINE (1966-September 1999), Embase (1980-August 1999), PsyclNFO (1887-August 1999), International Pharmaceutical Abstracts (1970-August 1999), and CIANHL databases were searched. References from the selected citations, review articles, and the manufacturer were also screened. STUDY SELECTION: Included studies were randomized, double-blind, controlled trials evaluating bupropion versus SSRIs for depression in adults. Studies were assessed independently in duplicate. Discrepancies were resolved by consensus. DATA ANALYSIS: Data are reported as absolute weighted mean differences or relative risks and 95% confidence intervals comparing bupropion relative to SSRIs. Data not combined are presented qualitatively. DATA SYNTHESIS: Six full-length studies were included of 257 citations identified. SSRI comparators were fluoxetine, sertraline, and paroxetine. No differences in Hamilton Rating Scale for Depression (HAM-D) and Clinical Global Impressions Scale for Improvement of illness (CGI-I) were found, but data were not able to be quantitatively combined. The absolute weighted mean differences were 0.10 (95% CI -0.2 to 0.4) for the CGI for Severity of Illness and 0.37 (95% CI -0.85 to 1.6) for the Hamilton Rating Scale for Anxiety measurements. Relative risks of bupropion compared with SSRIs were 0.6 (95% CI 0.41 to 0.89), 0.31 (95% CI 0.16 to 0.57), and 0.27 (95% CI 0.15 to 0.48) for nausea, diarrhea, and somnolence, respectively. Sexual arousal disorder, orgasmic dysfunction, and sexual desire disorder occurred less with bupropion than with SSRIs, with relative risks of 0.46 (95% CI 0.26 to 0.83), 0.22 (95% CI 0.12 to 0.40), and 0.65 (95% CI 0.51 to 0.84), respectively. CONCLUSIONS: Bupropion and SSRIs have similar effectiveness; however, bupropion was associated with less nausea, diarrhea, somnolence, and sexual dysfunction.
OBJECTIVE: To review the pathophysiology and psychology of female sexual dysfunction (FSD) and describe potential prevention and treatment strategies for the disorder. DATA SOURCES: Articles identified from a MEDLINE search (1966-June 2002) using the term female sexual dysfunction. Additional references were obtained from cross referencing retrieved articles. STUDY SELECTION AND DATA EXTRACTION: After evaluating various review articles, clinical trials, and investigational studies, all information that was deemed relevant by the reviewers was included. DATA SYNTHESIS: FSD is a multicausal and multidimensional problem combining biological, psychological, and interpersonal factors. The American Foundation for Urological Disease classifies FSD into 4 broad categories: sexual desire disorders, arousal disorder, orgasmic disorder, and sexual pain disorders. Depending on specific individual characteristics and category of disorder, a variety of potential treatments are available. Pharmacists can play a role in identifying and managing medication-related adverse effects that may be exacerbating FSD and educating women on treatment modalities. CONCLUSIONS: FSD is a complicated disorder that is often difficult to identify, classify, and treat appropriately. Pharmacists should have an understanding of the potential causes of FSD and the treatment options available so that they may make appropriate recommendations and counsel women effectively.
OBJECTIVE: To report a case of premature ejaculation occurring subsequent to citalopram discontinuation. CASE SUMMARY: A 43-year-old white man being treated for depression with citalopram wished to discontinue treatment. Four or 5 days after stopping citalopram he reported that, during sexual intercourse, his genitals seemed to be extremely sensitive and orgasm was achieved within approximately 1 minute. These symptoms continued over the next 3-4 weeks and remitted after citalopram was restarted. Several subsequent attempts to discontinue citalopram resulted in a return of these symptoms despite using a slow tapering regimen. An objective causality assessment revealed a probable relationship between drug withdrawal and the observed symptoms. DISCUSSION: The ability of selective serotonin-reuptake inhibitors (SSRIs) to delay ejaculation has been well documented; however, discontinuation of these agents generally results in a return to baseline function. Although discontinuation of SSRI therapy has been associated with a number of withdrawal symptoms, this is the first report (MEDLINE, September 2003), to our knowledge, of the emergence of sexual adverse effects in someone with no previous history of these symptoms. CONCLUSIONS: Premature ejaculation is a possible withdrawal effect after SSRI discontinuation. Since patients are usually reluctant to spontaneously report sexual adverse effects, it is important to specifically inquire about them both when starting and stopping treatment with an SSRI.
BACKGROUND: Obesity has become a modern epidemic, increasingly affecting the general population worldwide. Obese people are vulnerable to a variety of co-morbidities, including cardiovascular and pulmonary disease, osteoarthritis, diabetes, cancer and psychiatric conditions, that not only diminish life expectancy but also impair quality of life. Research has shown that obesity is further linked to sexual dysfunction, although relevant studies are limited and further investigation is needed. METHODS: We assessed the sexual function of 60 obese women scheduled to undergo bariatric surgery and 50 healthy controls matched by age, education and marital status. All participants were administered the Female Sexual Function Index (FSFI). Additionally, participants completed the Hospital Anxiety and Depression Scale (HADS). RESULTS: Obese women reported significant impairment on most domains of sexual function, including sexual desire, arousal, lubrication, orgasm, and satisfaction, compared to healthy controls. The observed sexual impairment was associated with BMI but was not entirely attributed to the presence of anxiety or depression. CONCLUSION: Obese women complain of significant sexual impairment. Obesity-related sexual dysfunction appears to be a complex condition linked to a range of social, psychological and biological factors. Clinicians are encouraged to evaluate routinely sexual function in this patient population in order to detect those who are in need of intervention.
Weight loss following vertical banded gastroplasty (VBG) is well established. Herein the effect of weight loss on sexuality was examined. Twenty-seven females and seven males (mean age 39 years) underwent VBG and returned completed questionnaires regarding preoperative and postoperative sexuality. There was a mean interval follow-up of 33 months, with a mean weight loss of 48.6 kg. In general, there was an overall increase in frequency, quality, and enjoyment of sex. Similarly, an improvement in body image, an increase in initiating sexual intercourse, and an increase in the number of sexual partners was found. A small number of patients developed psychosocial problems that limited sexual enjoyment. In conclusion, weight loss after VBG improves sexual life, though not uniformly, as new sexual problems can occur. Decreased sexual inhibition, increased sexual enjoyment and frequency, and increased frequency of orgasm characterizes many of the changes occurring after VBG with resultant weight loss. To help provide a holistic approach to the care of morbidly obese patients after VBG, the potential alterations in their sexual lives should be considered.
CONTEXT: Clinical management of intersex conditions is controversial because the available evidence is limited and conflicting, with no long-term population based studies comparing matched controls. OBJECTIVE: To assess the long-term psychological, sexual and social outcomes of patients with intersex compared with two matched control populations. DESIGN, SETTING AND PARTICIPANTS: Three different aged-matched (18-32 years) patient groups completed a self-administered questionnaire of established quality of life and well-being inventories measuring physical' health, psychological adjustment and sexuality, following a mail-out to all identified patients. The intersex group (n = 50) and the Hirschsprung disease, a congenital disorder, control group (n = 27), were patients who had attended the Royal Children's Hospital, a tertiary centre, for their clinical care. The insulin dependent diabetes mellitus control group was recruited from an adult tertiary hospital. The study was conducted at the hospital-based Murdoch Childrens Research Institute. MAIN OUTCOME MEASURES: Psychological, sexual and social outcomes. RESULTS: The intersex group did not differ from controls on physical or mental health, depression, state anxiety, neuroticism, psychoticism or stressful life events. Intersex participants were satisfied with their overall body appearance, although intersex males were less satisfied than controls with the size (p <0.05) and appearance (p <0.01) of their sex organs. The intersex group was less likely to experience orgasm (p <0.05), tended to experience more pain during intercourse (p = 0.06), had more difficulties with penetration (p <0.01) and were less likely to have sexual activity several times or more a week (p <0.05) than the combined control groups. Intersex participants did not differ from controls in level of sexual desire or enjoyment of sexual activities. CONCLUSIONS: Most patients with intersex had positive psychosocial and psychosexual outcomes, although some problems were reported with sexual activity. These results overall suggest that a model of care including early genital surgery carried out at a centre of excellence with a multidisciplinary team can minimize long-term complication rates.
Orally administered phosphodiesterase type 5 (PDE5) inhibitors have become the first-line treatment option for erectile dysfunction (ED). Vardenafil is a potent and highly selective PDE5 inhibitor developed as an oral therapy for ED. Two pivotal, randomised, double-blind, multi-centre studies have evaluated the use of vardenafil in men with ED. Vardenafil improved the rate of achieving and maintaining an erection during sexual intercourse. Improvement was also noted in other aspects of sexual function, including confidence, orgasmic function and overall satisfaction. Vardenafil produces clinically and statistically significant improvements in erectile function regardless of age, baseline severity and aetiology and is efficacious for the treatment of ED in diabetic and postradical prostatectomy patients. Vardenafil has a rapid onset of action, in which erections sufficiently rigid for eventual intercourse completion can be achieved as early as 16 min after ingestion. Vardenafil 20 mg has sustained long-term efficacy by providing up to 92% of patients with improved erections during > 2 years of treatment. Vardenafil is well-tolerated, with an adverse event profile typical of this class of PDE5 inhibitors. The most common adverse events were headache, flushing, rhinitis and dyspepsia, which were mild-to-moderate in severity and they generally attenuated with continued use. Vardenafil may be associated with transient reductions in blood pressure and commensurate increases in heart rate, with the overall incidence of cardiovascular-related adverse events similar to that of placebo. Although claims can be made about potential features of benefit for each of the currently marketed PDE5 inhibitors, there are at present, no non-pharmaceutical company sponsored, peer-reviewed, head-to-head trials that have been published.
The social status and gender-role behavior of women has changed periodically over history, depending on a variety of socio-cultural, economic, and religious factors. Classical psychoanalytic views concerning "normal" feminine psychology and sexuality, based on Freud's original postulates were derived from his experiences and observations as a late-19th and early-20th century middle-European male. This article explores the errors involved in these traditional hypotheses concerning "penis envy," "normal" feminine masochism and passivity, female super-ego development and female psychosexuality, including orgasm and gender-role behavior.
To examine the effects of alcohol consumption on female sexuality and contraceptive use, 69 sexually active women between the ages of 18 and 34 completed daily logs of their drinking behavior, sexual activity and contraceptive use over three consecutive menstrual cycles. In addition, participants completed a post-study questionnaire that assessed personal beliefs regarding alcohol use and sexual behavior. Although the results from the daily logs failed to show any significant effects of alcohol on subsequent sexual arousal, sexual pleasure or orgasm, female-initiated sexual activity appeared to be inversely related to alcohol use with women initiating significantly fewer sexual activities following the consumption of alcohol. On the contrary, the retrospective questionnaire data indicated that women believed alcohol enhanced sexual desire, enjoyment and activity. The findings further indicated that alcohol consumption immediately prior to sexual intercourse did not significantly alter the use of coitus-dependent contraceptives. These data suggest that women view alcohol as an aphrodisiac despite their physiological and reported behavioral responses.
The quality of the sexual relationship between alcoholic male veterans admitted to an alcohol treatment program and their stable nonalcoholic female partners was assessed in relation to time intervals of abstinence and drinking. Repeated measures analyses performed on the LoPiccolo Sexual History Form provided information on sexual problems associated with the desire, arousal and orgasm phases of the sexual response cycle and other kinds of information relevant to sexual functioning. Results indicate that the sexual relationship varies in relation to drinking or abstinence. Sexual intimacy appears quite normal and satisfactory during abstinent periods; however, female partners present an internally consistent picture of neither desiring nor enjoying sex during drinking periods, though accepting sex reluctantly. For male alcoholics, satisfaction with sex while drinking continues to be reported despite awareness of their partner's negative emotional reactions during sex. Clinicians and researchers are cautioned to differentiate drinking and abstinent periods when assessing the sexual relationship of alcoholic couples.
Eleven consecutive patients with large prolactinomas were treated for 6 months with bromocriptine, (7.5 mg/day). Nine had invasion of the sphenoidal sinus, one a visual field defect and one a secondary trigeminal neuralgia. At the end of the treatment period 8 of the first 9 patients showed radiographical signs of bone remodelling and/or actual reduction of the tumour size. The last 2 patients had complete disappearance of their symptoms. The remissions could be observed as early as 3 weeks after the start of the treatment. Two patients suffered acute, reversible (partial in one case) episodes of loss of vision during the study. During the treatment the prolactin values decreased in all patients to an average of 1.7% of the baseline levels. There was a steep rise in the serum prolactin concentrations after withdrawal of the drug. After one month there was a plateauing at a high level, although lower than basal level. Libido and potency were restored in all 3 males studied. Two of the females experienced orgasm for the first time in their lives after some years of primary frigidity. It is concluded that bromocriptine reproducibly reduces the size of prolactinomas. This effect can be observed shortly after the beginning of the treatment and is at least partially reversible. Episodes of pituitary apoplexy may occur during the treatment of large tumours despite an otherwise favourable response.
Ephebiatric sexual medicine is a specialty that still awaits its Vesalius. The age of onset of puberty has decreased by four years in the past two centuries, without a concordant change in social and legal institutions governing sexual and economic autonomy. Concomitant with the reintroduction of the ancient European betrothal system, the adolescent age of first coitus has lowered and averages two years earlier than first contraception. The hiatus is attributed to the moral sanctions against open access to contraception in adolescence. The neglect of sexual learning in teenage allows cases of suicidal and homicidal lovesickness to be undetected and likewise the mental template or "lovemap" of paraphilic pathology in adolescence lacks both preventive measures and treatment. The newest treatment of the paraphilias is with antiandrogen combined with counseling. Positive or negative preparedness for first orgasm or first coitus correlate with positive or negative outcome in subsequent sexuoerotic health. Knowing the sexology of syndromes, for example genetic and endocrine syndromes of childhood, expedites the delivery of sexological health care service in adolescence.
This paper discusses the role of medicine, ranging from the normative and technological control of women's sexuality ad reproductive process (childbirth, breastfeeding, contraception, and treatment of infertility) through the construction of a new (biological and social) reproductive model, based on a radical change of identities, relations, and forms of union between the sexes (a break with the traditional concept of marriage, growth of open unions, serial monogamy, etc.). This model is sustained by a radical distinction between sexuality and reproduction, related to a unique and horizontal model of sexuality (in opposition to the hierarchical 19th-century two-sexes model); the new model focuses mainly on pleasure and moves progressively away from social ties and affection. In addition to the contribution of medicine (notably through assisted reproduction) and sexology (universalization of the orgasm imperative), the paper also discusses the contribution of epidemiology (through AIDS-related research) to the transformation of a moral sexual norm into an abstract and merely statistical standard