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PubMed1993

Elective ovarian removal and estrogen replacement therapy--effects on sexual life, psychological well-being and androgen status.

Conflicting data have been reported on the psychosexual impact of hysterectomy combined with bilateral oophorectomy. Three age-matched, hysterectomized groups of women were investigated: Group A (n = 33): oophorectomized, not receiving estrogen replacement therapy (ERT); Group B (n = 33): oophorectomized, receiving ERT; and Group C (n = 35): ovaries preserved and not receiving ERT. The McCoy Sexual Rating Scale and the Psychological General Well-Being Index as well as a semi-structured interview were used to assess postoperative experience with respect to libido, vaginal lubrication, ability of getting pleasure from intercourse, and ability to achieve orgasm. Serum concentrations of total and free testosterone, insulin-like growth factor I (IGF-I), sex hormone binding globulin, dehydroepiandrosterone sulfate and 4-androstene-3,17-dione were determined. In oophorectomized women sexual life was impaired as compared to those with intact ovaries and these women complained about less pleasure from coitus, impaired libido and lubrication. Regardless of whether estrogens were administered or not a similar pattern was found, indicating that estrogens are of little value in treating these specific sexual dysfunctions. Oophorectomized women receiving ERT reported less anxiety and depression and more well-being similar to women whose ovaries had been preserved. No correlation was found between psychosexual variables and biochemical androgen markers. However, the IGF-I levels were strongly correlated to sexual activity and responsiveness.

Adaptation, Psychological↗
PubMed1998

Sexuality and sexual adjustment of patients with chronic pain.

PURPOSE: To describe sexual functioning and its relationship with psychological measures in chronic pain patients. METHOD: It is a self report survey with a convenience sample. Seventy consenting chronic pain patients responded to a questionnaire. Mean age was 49.9 years (range 29-74); mean pain duration was 146.7 months (range 6-624). Participants endorsed a wide variety of pain conditions. INSTRUMENTS USED: (1) Derogatis Inventory of Sexual Functioning; (2) Multidimensional Pain Inventory; (3) Center for Epidemiological Studies Depression Scale: (4) Multidimensional Health Locus of Control; (5) Hopkins Symptom Check List; (6) Vanderbilt Pain Management Inventory; (7) Coping Strategies Questionnaire. RESULTS: Sixty-six per cent of patients were interested in sex, 50% were satisfied with current sexual partner and 20% considered current sexual life to be adequate. Over 70% fantasized at least once a month. Only 44% experienced normal arousal during intercourse; 33% practiced masturbation and 47% were involved in sexual intercourse or oral sex at least once a month. The majority were dissatisfied with orgasmic activities. No relationship was found between pain severity, duration, frequency and sexual functioning. A relationship was found between disability status, age and several psychological variables and various domains of sexual functioning. CONCLUSIONS; Sexual problems are common in chronic pain patients. Patients who reported symptoms of depression and distress had more sexual problems.

Adaptation, Psychological↗
PubMedDate not supplied

Antidepressant-induced sexual dysfunction: review, classification, and suggestions for treatment.

Sexual function, an important component of quality of life, is often affected by antidepressant treatment. Reports associate antidepressant medications with a wide range of sexual disorders of desire, arousal, and orgasm, and with the occurrence of sexual pain. Fewer sexual dysfunctions have been reported with bupropion, nefazodone, and mirtazapine than with the monoamine-oxidase inhibitors, tricyclic antidepressants, selective serotonin-reuptake inhibitors, and venlafaxine. Sexual dysfunctions may occur in more than half of patients treated with selective serotonin-reuptake inhibitors, but patients may not readily divulge sexual information unless a clinician is knowledgeable and proactive in assessment. Once an antidepressant-induced sexual dysfunction is detected and its nature is characterized, an appropriate treatment intervention can be chosen in order to alleviate the sexual disorder and enhance treatment compliance. This review classifies antidepressant-induced sexual dysfunctions, discusses assessment and differential diagnosis, and describes currently reported treatment approaches.

Central Nervous System Stimulants↗
PubMed1994

Fatal methemoglobinemia due to inhalation of isobutyl nitrite.

Isobutyl nitrite is a popular recreational drug among both homosexuals and heterosexuals as it is alleged to enhance sexual pleasure and prolong orgasm. In contrast to the ingestion of this volatile nitrite, inhalation is associated only rarely with serious sequelae, though symptomatic methemoglobinemia may occur. The case reported is the first documented fatality from inhalation of isobutyl nitrite. The widespread use of isobutyl nitrite is a cause for concern and physicians should be aware of the potentially fatal consequence of abuse, particularly in those with ischemic heart disease, and its management.

Administration, Inhalation↗
PubMed2006

[Health perception, body image, sexual function and depression in menopausal women according to menopausal stages].

PURPOSE: The purpose of this study was to investigate the influences of health perception, body image and sexual function on depression according to the menopausal stage in Korean middle aged women. METHODS: Subjects were 182 perimenopausal and postmenopausal women who had not received hormonal replacement therapy. A five-item General HealthShort Form (SF-36) Health Survey Questionnaire (Ware and Sherbourne, 1992) was used to measure health perception. Body image was measured Semantic Differential scale, CES-D was used to measure the level of depression, and sexual function was measured by FSFI. RESULTS: The subjects rated their health as 'moderate', their body image as 'moderate, and level of depression as 'high'. However, there were no significant differences in health perception, body image, and depression between perimenopasual and postmenopausal women. Postmenopausal women experienced lower levels of sexual function than perimenopausal women in sexual arousal, lubrication, orgasm, satisfaction, and pain. In stepwise regression analysis, 21.7% of variance in depression was shown to be perceived health and body image in postmenopausal women. However, in perimenopausal women, perceived health and sexual function explained 34.5% of variance in depression. CONCLUSION: These findings indicate that nurses must consider the menopasusal stage when counseling their patients.

Body Image↗
PubMed1998

Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction.

BACKGROUND: Serotonin reuptake inhibiting antidepressants (SRIs) are reported to cause sexual dysfunctions, including reduction in desire, arousal, and orgasm. This study evaluates the efficacy of bupropion in ameliorating sexual dysfunctions in patients receiving SRIs. METHOD: Forty-seven patients in an outpatient psychiatric practice who complained of SRI-induced sexual dysfunction accepted a trial of bupropion as an adjunct to their SRI, either as a p.r.n. or as a fixed-dose scheduled medicine. Patients received 75 mg or 150 mg of bupropion 1 to 2 hours before sexual activity. If this was insufficient to reduce their complaints, dose was increased gradually to 75 mg t.i.d. and sustained for 2 weeks. This regimen was then continued if successful. RESULTS: Bupropion successfully reversed a variety of sexual dysfunctions caused by SRIs in 31 (66%) of 47 patients. Fifty-two (69%) of 75 sexual complaints improved with bupropion treatment. The p.r.n. use of bupropion assisted 18 (38%) of 47 patients. Side effects of anxiety and tremor led to discontinuation of bupropion in 7 (15%) of 47 patients. Otherwise, bupropion was well tolerated. CONCLUSION: Bupropion administration may be a safe and effective method of treating SRI-induced sexual dysfunction. Placebo-controlled, double-blind studies are needed.

Adult↗
PubMed2001

Reemergence of sexual dysfunction in patients with major depressive disorder: double-blind comparison of nefazodone and sertraline.

BACKGROUND: Several different classes of antidepressants have been associated with sexual adverse effects. This double-blind, randomized trial compared the effects of nefazodone and sertraline on reemergence of sexual dysfunction in depressed patients who had experienced sexual dysfunction as a result of sertraline treatment. Depressive symptoms were also monitored. METHOD: One hundred five patients with DSM-III-R major depressive episode who were experiencing sexual dysfunction attributable to sertraline (100 mg/day) were screened for entry. Eligible patients entered a 1-week washout period that was followed by a 7- to 10-day single-blind placebo phase. Patients without symptoms of sexual dysfunction at the end of the single-blind placebo phase were randomly assigned to receive double-blind treatment with either nefazodone (400 mg/day) or sertraline (100 mg/day) for 8 weeks. RESULTS: Nearly 3 times more sertraline-treated patients (76%; 25/33) experienced reemergence of sexual dysfunction (ejaculatory and/or orgasmic difficulty) than did nefazodone-treated patients (26%; 10/39) (p < .001). In addition, patients treated with nefazodone were more satisfied with their sexual functioning than were patients treated with sertraline. Both treatment groups demonstrated a similar and sustained improvement in depressive symptoms. Both drugs were well tolerated, and the overall incidence of adverse reactions was similar for both treatment groups; however, 9 sertraline-treated patients (26%) discontinued because of adverse events compared with 5 nefazodone-treated patients (12%). Of the patients discontinuing therapy for adverse events, 5 of the sertraline-treated patients did so because of sexual dysfunction reported as an adverse event, whereas only 1 of the nefazodone-treated patients discontinued therapy secondary to sexual dysfunction. CONCLUSION: In this sample of patients with major depression who had recovered from sexual dysfunction induced by treatment with sertraline, nefazodone treatment resulted in significantly less reemergence of sexual dysfunction than did renewed treatment with sertraline and provided continued antidepressant activity.

Adolescent↗
PubMed2002

Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine: a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects.

BACKGROUND: This study was designed to evaluate the effect of combining bupropion sustained release (SR) with venlafaxine, paroxetine, or fluoxetine in patients who reported unacceptable sexual dysfunction when treated with monotherapy with the latter 3 agents. METHOD: Following a minimum of 6 weeks of antidepressant treatment with a selective serotonin reuptake inhibitor (SSRI) or venlafaxine (a serotonin-norepinephrine reuptake inhibitor), eligible subjects received a further 8 weeks of monitored combination therapy with bupropion SR at a dose of 150 mg/day with no alterations to index antidepressant dosing. RESULTS: There was a clinically significant benefit in 14 (78%) of 18 partial responders or nonresponders, and 33% (N = 6) achieved a full response (chi2= 8.06, df = 2, p = .017). Sexual dysfunction, particularly a decrease in orgasmic delay, was also significantly improved with combination therapy (men: paired t = -2.1, df = 6, p = .08; women: paired t = -3.0, df = 7, p = .02). Plasma monitoring of drugs and their metabolites revealed a statistically significant increase in venlafaxine levels (F = 6.89, df = 4,24; p = .001) accompanied by a decrease in O-desmethylvenlafaxine (F = 14.26; df = 4,24; p < .0005) during combined treatment with bupropion SR. There were no statistically significant changes in plasma levels of SSRIs (paroxetine and fluoxetine) during the trial. CONCLUSION: Bupropion had an effect on the pharmacokinetics of venlafaxine but not those of the SSRIs. Further investigation of combination treatments under randomized, double-blind conditions is recommended.

Adult↗
PubMed2004

A placebo-controlled trial of bupropion SR as an antidote for selective serotonin reuptake inhibitor-induced sexual dysfunction.

OBJECTIVE: This study reports the results of a placebo-controlled, double-blind comparison of bupropion sustained release (SR) as an antidote for sexual dysfunction versus placebo in 42 patients with selective serotonin reuptake inhibitor (SSRI)-induced sexual dysfunction. Exploratory analyses of the association of testosterone and sexual functioning in women in the study were also performed. METHOD: Patients with DSM-IV major depression who experienced a therapeutic response to any SSRI and were experiencing medication-induced global or phase-specific sexual dysfunction, as measured by the Changes in Sexual Functioning Questionnaire (CSFQ), were randomly assigned to receive either bupropion SR 150 mg b.i.d. or placebo for 4 weeks in addition to the SSRI. Total testosterone levels were assessed at baseline and week 4. RESULTS: The difference in global sexual functioning, based on the total CSFQ score, was not statistically significant between the 2 groups at week 4, nor were differences in orgasm, desire/ interest as measured by sexual thoughts, or self-reported arousal. There was a statistically significant difference between the 2 groups at week 4 in desire as measured by self-report feelings of desire and frequency of sexual activity. Desire/ frequency showed a significantly greater improvement among those patients receiving bupropion SR compared with placebo (Wilk's F = 5.47, df = 1, p =.024). Frequency was significantly correlated to total testosterone level at baseline (r = 0.36, p =.027) and at week 4 (r = 0.41, p =.025). CONCLUSIONS: Bupropion SR, as an effective antidote to SSRI-induced sexual dysfunction, produced an increase in desire to engage in sexual activity and frequency of engaging in sexual activity compared with placebo. A larger study is needed to further investigate this finding.

Administration, Oral↗
PubMed2004

An open-label trial of sildenafil addition in risperidone-treated male schizophrenia patients with erectile dysfunction.

BACKGROUND: Sexual dysfunction frequently occurs in treated and untreated patients with schizophrenia. Sildenafil is used for treatment of erectile dysfunction caused by diverse factors. The aim of our study was to evaluate its potential value, safety, and effect on compliance with anti-psychotic medications in risperidone-treated male schizophrenia patients suffering from erectile dysfunction. METHOD: In a 6-week open-label trial, sildenafil was administered to 12 male schizophrenia (DSM-IV) patients, treated with risperidone and reporting erectile dysfunction. The starting dose was 25 mg with the possibility to increase the dose to 75 mg. Three patients who did not respond stopped sildenafil treatment after 3 weeks. The effect on sexual function was assessed by the International Index of Erectile Function and the Valevski-Weizman Male Sexual Function scale. RESULTS: Nine (75%) of the 12 patients completed the 6-week trial, and 3 patients (25%) stopped taking sildenafil after 3 weeks due to lack of response. We observed statistically significant improvements in all sexual function domains (desire, erectile function, orgasmic function, intercourse satisfaction, and overall satisfaction) in the 9 patients who completed the trial and in most of the domains for all 12 study participants. More than half (8/12; 67%) of the patients exhibited partial or much improvement. CONCLUSION: Sildenafil is a useful agent for the treatment of erectile dysfunction in risperidone-treated male schizophrenia patients.

Administration, Oral↗
PubMed2000

Sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi.

OBJECTIVE: To evaluate the effectiveness of sildenafil (Viagra) in the treatment of male erectile dysfunction in Nairobi. DESIGN: Prospective open label extension study. SETTING: Urology clinics at the Nairobi Hospital, Kenyatta National Hospital and the author's private clinic in Hurlingham, Nairobi. PARTICIPANTS: Two hundred and nineteen adult male patients with erectile dysfunction. RESULTS: The age range was 33-80 years with a mean of 62.5 years and a peak incidence in the 60-69 year age group. One hundred and nineteen patients (54.34%) had organic causes, 85 patients (38.81%) had psychogenic causes and 15 patients had mixed causes. Two hundred patients (91.32%) had improved sexual function after treatment with viagra. This improvement was sustained during the study period of sixteen weeks and included improved erectile and orgasmic functions and overall sexual satisfaction. One hundred and fifty seven of these patients responded to therapy with 50 mg of viagra; 40 patients with 25 mg and three patients with 100 mg of therapy. Nineteen patients (8.68%) had no improvement in sexual function after viagra administration. Seven patients (3.2%) had adverse effects which were mild and transient. They included mild headaches in three patients, mild dyspepsia in two patients and facial flushing and nausea and vomiting in one patient, respectively. CONCLUSION: Oral sildenafil (Viagra) is an effective well tolerated and simple treatment for male erectile dysfunction in the majority of cases. The cost of treatment at about ten United States dollars for the 50 mg tablet is prohibitive and may limit its wide use by many deserving patients in this locality.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed1999

Erectile dysfunction in the community: a prevalence study.

OBJECTIVE: To investigate the prevalence of erectile dysfunction (ED) in the South Australian community, and the influence of demographic and other risk factors. DESIGN: Survey by mailed questionnaire (based on the University of California, Los Angeles prostate cancer index) of a subset (men who agreed to participate) of a probability sample of the South Australian community who completed a multiuser interview survey. PARTICIPANTS AND SETTING: Men over the age of 40 in South Australia. MAIN OUTCOME MEASURES: Sexual desire, orgasm, ability to have an erection, adequacy (firmness) of erections for intercourse, frequency of erections when wanted, frequency of intercourse, nocturnal or morning erections, and history of prostate surgery; total sexual function score based on these. RESULTS: 612 men (86.7%) agreed to answer the sexual function survey; 427 (69.8%) returned questionnaires. ED was strongly correlated with age in all seven domains of sexual function. Erections inadequate for intercourse affected 3% of 40-49-year-olds, increasing to 64% of 70-79-year-olds. The frequency of intercourse considered normal for age by men 50-69 years was 1-6 times weekly; the disparity between this and reported frequency increased in men over 60 years, as did the difference between sexual desire and potency. A history of vigorous exercise was protective across all ages. High triglyceride levels, blood pressure medication and non-cancer surgery for prostate disease were independent predictors of poor sexual function at older ages. High cholesterol level was an independent predictor of impotence. CONCLUSIONS: We found similar or higher levels of ED than in comparable overseas studies. Disparity between potency and desire was greatest, and hence the age group in whom demand for treatment may be highest, in those 60 years and older. Cardiovascular risk factors were predictors of ED in these older men, suggesting that prevention may benefit sexual function. Non-cancer prostate surgery may be a greater contributor to ED than previously realised.

Adult↗
PubMedDate not supplied

Sexual activity and background variables among Finnish middle-aged women.

OBJECTIVE: To characterize the associations of sexual experience, orgasm experience, and lack of sexual desire with background variables. METHODS: Questionnaire was mailed to population-based samples (n=5510, 70% response) of soon-to-be-menopausal (aged 42-46 years) and menopausal (aged 52-56 years) women. RESULTS: Being married/having a spouse meant more sexual activity for both groups but also the likelihood to experience lack of sexual desire. Hormones emerged as the most important perceived reason for lack of sexual desire. CONCLUSION: The findings indicated a discrepancy between the reported frequencies of sexual experiences/orgasms with spouse and lack of desire.

Adolescent↗
PubMed1997

Survey of sexual concerns among organ transplant recipients.

This study identified frequency of sexual dysfunction, degree of satisfaction with sexual relationship, differences in sexual function, overall satisfaction and life quality, and desire for and receipt of instruction regarding sexual dysfunction in kidney, pancreas/kidney, and liver transplant recipients. Of the 768 adult recipients surveyed by mailed questionnaire, 39% responded. Intimate relationships were reported by 69.9%; 66.7% indicated satisfaction with their relationship. Twenty-six percent were not sexually active. Transplant groups did not differ significantly regarding satisfaction, sexual function, or quality of life. Satisfaction groups differed significantly regarding intimacy and expected future life and health quality. Frequency of intercourse, desire, orgasm, erection dysfunctions, and the acceptance of partners' advances related to relationship satisfaction. Sixty-seven percent received no instruction concerning sexuality or fertility. Education efforts could validate and support sexual identity among this patient population.

Adult↗
PubMed2003

Sexual function in men older than 50 years of age: results from the health professionals follow-up study.

BACKGROUND: Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. OBJECTIVE: To describe the association between age and several aspects of sexual functioning in men older than 50 years of age. DESIGN: Cross-sectional analysis of data from a prospective cohort study. SETTING: U.S. health professionals. PARTICIPANTS: 31 742 men, age 53 to 90 years. MEASUREMENTS: Questionnaires mailed in 2000 asked about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Previous biennial questionnaires since 1986 asked about date of birth, alcohol intake, and other health information. RESULTS: When men with prostate cancer were excluded, the age-standardized prevalence of erectile dysfunction in the previous 3 months was 33%. Many aspects of sexual function (including overall function, desire, orgasm, and overall ability) decreased sharply by decade after 50 years of age. Physical activity was associated with lower risk for erectile dysfunction (multivariable relative risk, 0.7 [95% CI, 0.6 to 0.7] for >32.6 metabolic equivalent hours of exercise per week vs. 0 to 2.7 metabolic equivalent hours of exercise per week), and obesity was associated with higher risk (relative risk, 1.3 [CI, 1.2 to 1.4] for body mass index >28.7 kg/m2 vs. <23.2 kg/m2). Smoking, alcohol consumption, and television viewing time were also associated with increased prevalence of erectile dysfunction. Men who had no chronic medical conditions and engaged in healthy behaviors had the lowest prevalence. CONCLUSIONS: Several modifiable health behaviors were associated with maintenance of good erectile function, even after comorbid conditions were considered. Lifestyle factors most strongly associated with erectile dysfunction were physical activity and leanness.

Aged↗
PubMed1976

Marital sexual dysfunction: ejaculation disturbances.

The three clinically encountered disturbances of the male orgasmic phase--that is, premature ejaculation, inability to ejaculate, and retrograde ejaculation--are discussed. The problem of defining premature ejaculation is explained and the possible pathogenic mechanisms of its origin are reviewed. The classic premature ejaculator is described. Also included are an elaboration of the newer therapeutic approaches to the problem and a suggested clinical protocol for screening patients. The other two, less common dysfunctions are briefly discussed.

Ejaculation↗
PubMed1976

[Disorders of libido from the gynecological view point].

Sexual dysfunctions are differentiated according to the following symptoms: libido dysfunction, orgasmic dysfunction, vaginism, algopareunia and polysymptomatic dysfunction. In the out-patient service for sexual and other psychosomatic disorders of the University of Heidelberg's Women's Hospital 90 women with libido dysfunction were treated with conflict-centered psychotherapy after exclusion of organic diseases which could explain the reduction of libido and after exclusion of a depression where the loss of libido is a regular symptom. The success-rate was 63%. It was attempted to reinforce the ego of the patient which enables him to experience his surroundings with less conflicts. Neurotic anxieties and symptoms are decreased and loos their importance so that the patient is able to handle his sexual disturbance. Among the psychosocial factors, i.e. focal causes, responsible for the libido dysfunction we found: In 48% of the cases the relationship between parents and children had been disturbed, which caused difficulties in the identification process (lack of father or mother, cool mother, divorce, borken home). Problems with the partners were found in 42%. 2/3 of these women had not grown up in intact families, which seems to predestinate difficulties in communication later on. Psychodynamically the loss of libido means sexual resistance which can lead to aversion or disgust. When there is no excitement the vasocongestion and lubrication do not take place: cohabitation pain (algopareunia) results. On the other hand the reduction of libido can also be a result of chronic algopareunia, i.e. secondary. Psychogenic bleedings ("aversion-bleeding") during or after intercourse occasionally occur in combination with algopareunia and lack of libido.

Dyspareunia↗
PubMed1999

Multiple sclerosis and the urologist.

PURPOSE: We provide an updated reference detailing the neurological and urological state of the art approach to multiple sclerosis (MS) with special emphasis on the pathology and physiology, effects on the genitourinary tract, diagnostic evaluation, and treatment of neurological and urological manifestations. MATERIALS AND METHODS: A MEDLINE computerized reference search and manual bibliography review were performed to find pertinent peer reviewed articles on the neurological and urological manifestations and treatment of MS. A meta-analysis was performed on the urodynamic findings of 22 studies involving 1,882 patients from well-defined MS populations. RESULTS: The majority of patients with MS have genitourinary symptoms ranging from urgency, urge incontinence and frequency to urinary retention. Symptoms do not accurately reflect the underlying urological pathology but parallel pyramidal tract dysfunction. Urodynamic evaluation has an important role in determining proper bladder management. The most common urodynamic finding is detrusor hyperreflexia in 62% of these patients, followed by detrusor-sphincter dyssynergia in 25% and hypocontractility in 20%. Less than 1% of patients has renal deterioration and most may be treated with conservative measures. If conservative measures fail, new forms of bladder reconstruction and diversion may be effectively used. The incidence of sexual dysfunction is up to 80% in men and 72% in women, and treatment focuses on improvement of overall disability and erectile or orgasmic function. CONCLUSIONS: Although the genitourinary consequences of MS are rarely life threatening, they can cause significant morbidity and patient frustration. With the rapid advances in the medical management of MS the urologist should be actively involved in multispecialty treatment of these patients.

Female↗