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PubMed1999

Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: functional and cosmetic outcome.

PURPOSE: During male-to-female gender reassignment surgery we used an abdominal pedicled inverted penile skin technique to create a vagina and extra folds of skin to create a clitoral hood. Although patients had orgasms with that technique, there was a general request for the placement of a sensate, erectile clitoris. Therefore, in 10 such patients undergoing transsexual surgery a neoclitoris was fashioned from the glans penis. Surgical technique and results are described. MATERIAL AND METHODS: From 1980 to 1995, 57 male-to-female gender surgeries were performed at our university center. In the last 10 such patients undergoing transsexual surgery a neoclitoris was created. Glans volume is reduced to match that of a normal size clitoris and the entire length of the dorsal neurovascular bundle is preserved. The neoclitoris is placed through a buttonhole in the newly constructed introitus. There was minimal bleeding from the bundle intraoperatively. RESULTS: In 8 of 10 patients the neoclitoris remained intact postoperatively with good sensation to touch, vibration and light pressure (sexual sensation). The cosmetic and functional appearance was that of a normal clitoris, and patients were satisfied. In 2 patients the results were not satisfactory because of necrosis of the neoclitoris. CONCLUSIONS: This technique has excellent functional and cosmetic results in the majority of patients. Preservation of the somatic, tactile and vibratory sensation of the neoclitoris is surgically practical, and can afford the patient the possibility of a more functional outcome of gender reassignment surgery.

Adult↗
PubMed1976

[Pharmacological and psychosocial aspects of drug dependence].

Use and abuse of psychotropic drugs start with history, but toxicomania starts much later, with the discovery of morphine, in early XIXth. Century; and increases sharply after the 2nd. World War. The author reviews the general classifications of drug abuse, stressing the many differences among them, as well as the differences in clinical approaches to each one of them, and in criteria for treatment. Abuse of drugs takes many different forms roughly reduced to three: a) "traditional" addicts, with permanent and heavy intake of barbiturates, amphetamines, alcohol and narcotics; b) regular mass consumers of medicines, legally prescripted by doctors on grounds of unwise criteria or sheer complicity; c) members of the "Drug Culture" making of drug abuse a symbol of doctrinary social claims. Addictive drugs are classified, according to Lehmann, into three groups: 1. Expansive drugs: producing intense feeling and elation, according to three classes: a) Thrill drugs, causing an immediate deep pleasure, a jolt in the stomach and warm waves towards the abdomen and genitalia, with orgasmic effects; b) Easiness drugs, increasing energy and self-reliance and decreasing fatigue or ill-feelings; c) self-realization drugs, leading to deep and rich self-awareness, and heighted aesthetic and intellectual potential. 2. Reductive drugs: lowering the intensity of sensations and emotions, in three kinds: a) Releaser drugs, causing removal of inhibitions and production of phantasies; b) Sedation drugs, easing tensions and anxieties; c) Stupefying drugs, blurring all contact with the outer world. The author analyzes the patterns of intake, which include generally two or more different types of drugs, and vary in the same individual according to circumstances. Finally, several factors leading to addiction are considered, among them: biological and genetical endowment or predisposition; psychological conflicts or flaws; and social factors.

Emotions↗
PubMed1999

[Sexuality in menopause. Importance of adequate replacement therapy].

BACKGROUND AND AIMS: The harmful repercussions of estrogen deficiency in menopause on the female organism are also responsible for reduced libido and uncomfortable trophic disorders of the genitourinary tract leading to reduced vaginal lubrication and severe alterations affecting sexual function, as well as for the more commonplace vasomotor phenomena and psychoemotive changes. METHODS: The authors treated 102 menopausal patients who presented reduced libido and orgasmic difficulties, as well as other menopausal problems, with 17-beta estradiol+noretisterone acetate using a transdermal route. The main advantage offered by the transdermal route is that conjugated estrogens "bypass" the liver and reach the target organs in an unmodified manner. This treatment is well tolerated by almost all patients, even those suffering from slight gastroenteric and hepatic problems. RESULTS AND CONCLUSIONS: This study showed the good tolerability and almost complete innocuousness of the drug used. None of the patients receiving replacement therapy reported any collateral effects worthy of note or the onset of malignant lesions of the breast or pelvic organs. The results obtained show that the use of 17-beta estradiol+noretisterone acetate can effectively modify menopausal symptoms, improving both quality of life and sexual function.

Estrogen Replacement Therapy↗
PubMedDate not supplied

[Sexual dysfunction with antidepressive agents. Effect of the change to amineptine in patients with sexual dysfunction secondary to SSRI].

UNLABELLED: Sexual dysfunction secondary to the use of antidepressants, especially clomipramine or SSRI's is an adverse effect that is often underestimated and according to earlier studies, this can affect approximately 60% of the patients. This presents as a decrease in libido, alterations in the ability to reach orgasm/ejaculation, and an erectile dysfunction or a decreased vaginal lubrication. This dysfunction appears to be related with the resulting increase in serotonin and with the stimulation of serotonin 5HT2 receptors. OBJECTIVES: 1) Evaluate the effect of amineptine, a drug with an increased dopamine transmission and scant serotonin transmission, on the sexual function of depressed patients who begin treatment, and 2) evaluate whether the change to amineptine improves the sexual function in patients who presented sexual dysfunction after beginning treatment with a SSRI. MATERIAL AND METHODS: Prospective, observational, open and multicentric design. 111 patients with an average age of 41.3 years (36 men, 75 women) were distributed into three groups: Group 1 (n= 26): patients with depression (DSM IV) who begin de novo treatment with amineptine 200 mg/day. Group 2 (n= 47): depressed patients undergoing treatment with a SSRI who show a favorable response and who present sexual dysfunction secondary to a poorly tolerated treatment, so the treatment is changed to 200 mg/day of amineptine. Group 3 (n= 38): patients with the same characteristics as those of group 2, but whose treatment was changed to 20 mg/day of paroxetine. The < > (Montejo et al, 1996) was used together with the Hamilton Depression Scale, the IGC Scale, and an adverse events scale, over a 6 months follow up period during which visits took place at: baseline, month 1, month 2, month 3, and month 6. RESULTS: In group 1, treated with amineptine from the beginning, of the 5 patients who showed a decrease in the libido at the beginning of the treatment, only one still presented this in the 6th month. The Hamilton Scale decreased from 23.12 (baseline) to 5.25 after 6 months. After substituting amineptine for SSRI's in patients with sexual dysfunction, the incidence of any type of sexual dysfunction decreased significantly from 100% (baseline) to 55.3% after 6 months. (P< 0.001). The incidence of delayed orgasm dropped to 15.8%, anorgasmia to 17.4%, and impotence dropped to 15.8% in this group, with the antidepressant effect that had already been achieved with the SSRI being maintained. However, in group 3 there was barely any improvement on the sexual function after changing to paroxetine (20 mg/day), with the baseline incidence being 100% and the incidence after 6 months being 89.7%. In this last group the antidepressant effect present at the baseline level, was maintained. CONCLUSIONS: Amineptine was shown to be an effective antidepressant in the patients studied, and did not cause secondary sexual dysfunction, and even improved the dysfunction that was present in some patients. In those patients previously treated with SSRI's, amineptine is able to significantly improve the sexual dysfunction and yet maintain the efficacy of the antidepressive treatment used before these 6 months. On the other hand, Paroxetine did not improve the sexual dysfunction of the people in whom this drug substituted another SSRI, as this is an adverse effect common to the entire group of selective serotonin re-uptake inhibiting drugs. Amineptine showed a good safety and tolerance profile. Its most common side effect (anxiety/restlessness) disappeared 2 months after the beginning of the treatment.

Adult↗
PubMed1999

Care of the sexually active depressed patient.

There are several possible causes of sexual dysfunction in depressed patients. A core symptom of depression is anhedonia, including loss of libido. Therefore, determining a cause of sexual dysfunction in a depressed patient can be very difficult, and the differential diagnosis must include a primary sexual dysfunction, sexual dysfunction associated with general medical and psychiatric disorders, and sexual dysfunction associated with treatments for psychiatric disorders. Of particular clinical interest is sexual dysfunction associated with different classes of antidepressant drugs, such as tricyclic antidepressants, selective serotonin reuptake inhibitors, or venlafaxine. Sexual dysfunction's pharmacologic basis is thought to be stimulation of 5-HT2 receptors. Antidepressant-induced sexual dysfunction, most frequently presenting as a reduction in libido or delayed orgasm, may not pose a large burden for patients in acute treatment. However, in long-term treatment, patients are generally well, and anything that interferes with sexual functioning will be a greater problem and will contribute strongly to noncompliance. Different strategies are advised when dealing with sexual dysfunction in depressed patients treated with antidepressant drugs: waiting for a spontaneous resolution of a problem, reduction in antidepressant drug dosages, drug holidays, adjunctive pharmacotherapy, or switching antidepressants. Perhaps the best way is to avoid sexual dysfunction by starting treatment with an antidepressant with proven acute and long-term efficacy that is devoid of sexual side effects, for example, mirtazapine, bupropion, or nefazodone.

Antidepressive Agents, Second-Generation↗
PubMed1999

Sildenafil citrate after radical retropubic prostatectomy.

PURPOSE: Erectile dysfunction continues to be a significant problem for men after radical retropubic prostatectomy despite nerve sparing techniques. Sildenafil citrate (Viagra) has proved effective for erectile dysfunction in many men. We determine the efficacy of sildenafil in men with erectile dysfunction after radical retropubic prostatectomy and examine variables that may impact the response to treatment. MATERIALS AND METHODS: A total of 84 men were prescribed sildenafil after radical retropubic prostatectomy and asked to complete a series of questionnaires, including the International Index of Erectile Function (IIEF), on erectile function before and after sildenafil administration. The importance of factors, such as patient age, time since surgery, degree of cavernous nerve sparing, preoperative prostate specific antigen, Gleason score, clinical and pathological stage, and baseline postoperative erectile function, was examined. RESULTS: Of the 84 patients 45 (53%) had improved erections and 34 (40%) had improved ability for intercourse while taking sildenafil. Mean IIEF score for the erectile function domain increased from 9 to 14 (p <0.001). Orgasmic function (p = 0.004) and intercourse satisfaction (p = 0.009) also significantly improved. The degree of nerve sparing and baseline postoperative erectile dysfunction had a significant impact on the ability of sildenafil to improve erectile function (p = 0.010 and p <0.001, respectively) and total IIEF questionnaire responses (p = 0.031 and p <0.001, respectively). Age and pathological stage also appeared to have a significant effect. CONCLUSIONS: Sildenafil improved erectile function and the ability to have intercourse in more than half of men after radical retropubic prostatectomy. Baseline postoperative erectile function, which is dependent on the degree of nerve sparing technique, significantly impacts the likelihood that patients will respond to sildenafil.

Aged↗
PubMed2000

Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.

PURPOSE: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. MATERIALS AND METHODS: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. RESULTS: Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. CONCLUSIONS: We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

Female↗
PubMedDate not supplied

[Sexual male dysfunction].

Disorders of libido, erection orgasm and ejaculation are the most important reasons for male sexual dysfunction (MSD), because of organic reasons, medical therapies and social stressing factors, MSD is increasingly evaluated more precisely and it is not limited on erectile dysfunction any longer. With the appearance of the first oral acting substance on the market and the presence of media a great pressure arose to the medical doctors to do prescriptions. Therefore, it is very important to have consultation, diagnostics and treatment of the MSD done with elaborated medical criteria.

Erectile Dysfunction↗
PubMed2000

The high prevalence of sexual concerns among women seeking routine gynecological care.

BACKGROUND: Sexuality is an important part of health, quality of life, and general wellbeing. Studies indicate that less than half of patients' sexual concerns are known by their physicians, and physicians are unaware of how common these sexual concerns are in their practices. Our objective was to determine the prevalence and type of sexual concerns among women seeking routine gynecological care. METHODS: We mailed the survey in waves. Of 1480 women seeking routine gynecological care from the departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center between August 1992 and January 1993, 964 responded. The main outcome measures were self-reported sexual concerns and their experiences with discussing these concerns with a physician. RESULTS: A A total of 98.8% of the women we surveyed reported one or more sexual concerns. The most frequently reported concerns were lack of interest (87.2%), difficulty with orgasm (83.3%), inadequate lubrication (74.7%), dyspareunia (71.7%), body image concerns (68.5%), unmet sexual needs (67.2%), and needing information about sexual issues (63.4%). More than half reported concerns about physical or sexual abuse, and more than 40% reported sexual coercion at some point in their lives. CONCLUSIONS: Our results suggest that sexual health concerns are prevalent for women seeking routine gynecological care. Sexual health inquiry should be a regular and important part of health care maintenance.

Adolescent↗
PubMed1999

[Sexual disorders in epilepsy. Results of a multidisciplinary evaluation].

Eleven epileptic men who complained of epilepsy and sexual dysfunction were submitted to a multidisciplinary evaluation. Mean age was 27 years (20-34), mean epilepsy duration was 19 years (0.5-32) and the mean seizure frequency was two by week (0-7). Ten patients had partial seizures and one other had myoclonic epilepsy. Ten patients were treated with antiepileptic drugs (phenytoin--1, carbamazepine--8, clonazepam--3, clobazam--2, valproic acid--3, vigabatrin--1). As defined in the DSM III-R, the complaints were: erectile disorder (9), hypoactive sexual desire disorder (4), frotteurism (4), inhibited orgasm (3), premature ejaculation (3), fetishism (2), voyeurism (2), exhibitionism (2), pedophilia (1) and sexual aversion disorder (1). Two patients showed hypogonadotropic hypogonadism on endocrinologic screening. Urological evaluation disclosed organic erectile dysfunction in other two. One patient had a diagnosis of psychogenic sexual disorder. In six patients a conclusive etiologic diagnosis was not reached. This report shows the multifactorial nature of sexual disorder in epilepsy and underlies the need of a multidisciplinar evaluation.

Adult↗
PubMed2000

Female sexual dysfunction: evaluation and treatment.

Sexual dysfunction includes desire, arousal, orgasmic and sex pain disorders (dyspareunia and vaginismus). Primary care physicians must assume a proactive role in the diagnosis and treatment of these disorders. Long-term medical diseases, minor ailments, medications and psychosocial difficulties, including prior physical or sexual abuse, are etiologic factors. Gynecologic maladies and cancers (including breast cancer) are also frequent sources of sexual dysfunction. Patient education and reassurance, with early diagnosis and intervention, are essential for effective treatment. Patient history and physical examination techniques, normal sexual responses and the factors that influence these responses, and the application of medical and gynecologic treatments to sexual issues are discussed. Basic treatment strategies, which may be successfully provided by primary care physicians for most sexual dysfunctions, are outlined. Referral can be reserved for patients who do not respond to therapy.

Estrogen Replacement Therapy↗
PubMedDate not supplied

[Psychometric characteristics of the psychotropic-related sexual dysfunction questionnaire. Spanish work group for the study of psychotropic-related sexual dysfunctions].

BACKGROUND: The presence of sexual function impairment in patients with psychiatric disorders is very common and could be an effect of the medication (mainly antidepressant and neuroleptics). The patient frequently has difficulties to communicate this adverse effect and the assessment of these changes by the physician should be encouraged. The real SD incidence is underestimated and the use of a specific questionnaire is needed. METHODS: The authors analyse psychometric characteristics of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) that includes questions about libido, orgasm, ejaculation, erectile function and general sexual satisfaction. The questionnaire was applied to 62 patients who were taking nefazodone "de novo" (n = 18) or were switched to nefazodone (n = 44) due to bad tolerated sexual dysfunction secondary to other antidepressant. RESULTS: The PRSexDQ has shown an excellent feasibility with nil percentage of patients with missing responses on all items except on items 1 and 2 (1.7% and 15.5% of patients with missing response). Cronbach's alpha value was 0.93, which indicates adequate reliability. The PRSexDQ also showed adequate construct validity. As it may be expected, the PRSexDQ showed a high correlation with a Clinical Global Impression scores on Sexual Dysfunction (r = 0.79) and moderate correlation with Hamilton Depression scores (r = 0.63). PRSexDQ also showed good discrimination between naive and pretreated depressed or dysthymic patients, with statistically significant differences between those groups of patients. Finally, the instrument showed adequate sensitivity for detecting clinical changes on sexual dysfunction with greater changes in the patients treated previously with antidepressants and who were switched to nefazodone than in naive patients (SES = -3.77 in patients switching to nefazodone; SES = -0.64 in naive patients).

Adult↗
PubMed2001

Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction.

BACKGROUND: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), venlafaxine, and clomipramine, are frequently associated with sexual dysfunction. Other antidepressants (nefazodone, mirtazapine, bupropion, amineptine, and moclobemide) with different mechanisms of action seem to have fewer sexual side effects. The incidence of sexual dysfunction is underestimated, and the use of a specific questionnaire is needed. METHOD: The authors analyzed the incidence of antidepressant-related sexual dysfunction in a multicenter, prospective, open-label study carried out by the Spanish Working Group for the Study of Psychotropic-Related Sexual Dysfunction. The group collected data from April 1995 to February 2000 on patients with previously normal sexual function who were being treated with antidepressants alone or antidepressants plus benzodiazepines. One thousand twenty-two outpatients (610 women, 412 men; mean age = 39.8 +/- 11.3 years) were interviewed using the Psychotropic-Related Sexual Dysfunction Questionnaire, which includes questions about libido, orgasm, ejaculation, erectile function, and general sexual satisfaction. RESULTS: The overall incidence of sexual dysfunction was 59.1% (604/1022) when all antidepressants were considered as a whole. There were relevant differences when the incidence of any type of sexual dysfunction was compared among different drugs: fluoxetine, 57.7% (161/279); sertraline, 62.9% (100/159); fluvoxamine, 62.3% (48/77); paroxetine, 70.7% (147/208); citalopram, 72.7% (48/66); venlafaxine, 67.3% (37/55); mirtazapine, 24.4% (12/49); nefazodone, 8% (4/50); amineptine, 6.9% (2/29); and moclobemide, 3.9% (1/26). Men had a higher frequency of sexual dysfunction (62.4%) than women (56.9%), although women had higher severity. About 40% of patients showed low tolerance of their sexual dysfunction. CONCLUSION: The incidence of sexual dysfunction with SSRIs and venlafaxine is high, ranging from 58% to 73%, as compared with serotonin-2 (5-HT2) blockers (nefazodone and mirtazapine), moclobemide, and amineptine.

Adolescent↗
PubMed2001

Strategies for the treatment of antidepressant-related sexual dysfunction.

Sexual dysfunction and dissatisfaction are common symptoms associated with depression. Optimal antidepressant treatment should result in remission of the symptoms of the underlying illness and minimize the potential for short- and long-term adverse effects, including sexual dysfunction. Sexual dysfunction and dissatisfaction are frequently persistent or worsen with the use of some antidepressant medications; this sexual dysfunction and dissatisfaction can have negative impact on adherence to treatment, quality of life, and the possibility of relapse. Successful management of sexual complaints during antidepressant treatment should begin with a systematic approach to determine the type of sexual dysfunction, potential contributing factors, and finally management strategies that should be tailored to the individual patient. The basic physiologic mechanisms of the normal sexual phases of libido, arousal, and orgasm and how these mechanisms may be interrupted by some antidepressants provide a framework for the clinician to utilize in order to minimize sexual complaints when initiating and continuing antidepressant treatment. This article provides guidelines, based upon this type of model, for the assessment, management, and prevention of sexual side effects associated with antidepressant treatment.

Antidepressive Agents↗
PubMed2001

The prevalence and importance of sexual concerns among female military beneficiaries.

BACKGROUND: Sexuality is an important part of health, quality of life, and general well-being, yet studies suggest that less than half of patients' sexual concerns are known by their physicians and that physicians are unaware of how common sexual concerns are among patients. The objective of this study was to determine the type and prevalence of sexual concerns among a randomly selected sample of women enrolled for health care at a military community hospital. METHODS: A randomized mail survey was used. Of 593 eligible participants, 232 responded (39%). Main outcome measures were self-reported sexual concerns and sociodemographic data. RESULTS: A total of 90.9% of women reported one or more sexual concerns. Most frequently reported sexual concerns were lack of interest (88.6%), difficulty with orgasm (81.2%), body image concerns (80.4%), inadequate lubrication (76.1%), dyspareunia (75.1%), needing information about sexual issues (75.1%), and unmet sexual needs (63.4%). More than half (65.2%) reported concerns of physical or sexual abuse, and more than half (53.1%) reported sexual coercion at some point in their lives. CONCLUSIONS: The results demonstrate a high prevalence of sexual health concerns for women enrolled for health care in a military community hospital. The implication for clinical practice is that sexual health inquiry should be a regular and important part of health care maintenance.

Adolescent↗
PubMed2000

Sexual dysfunction after traumatic brain injury.

Objective: The frequency of self reported sexual difficulties was examined in a group of 322 individuals with traumatic brain injury (TBI) ($N = 193$ men; 129 women) and contrasted with reports of sexual difficulties in 264 individuals without disability (152 men; 112 women) residing in the community. Physiological, physical, and body images problems impacting sexual functioning were examined individually and then summed into a sexual dysfunction score. Mood, quality of life, health status and presence of an endocrine disorder were examined as predictors of sexual difficulties post TBI. Study design: In this retrospective study, data about sexual difficulties were analyzed separately for men and women with TBI and without disability. ANOVAs with post hoc analysis for continuous variables, chi-square analyses for categorical variables, and ANCOVAs for predictors of sexual difficulties were utilized. Results: When contrasted to individuals without disability, individuals with TBI reported more frequent: (1) physiological difficulties influencing their energy for sex, sex drive, ability to initiate sexual activities and achieve orgasm; (2) physical difficulties influencing body positioning, body movement and sensation, and (3) body image difficulties influencing feelings of attractive and comfort with having a partner view one's body during sexual activity. Additional gender specific TBI findings were observed. In comparison to gender matched groups without disability, men with TBI reported less frequent involvement in sexual activity and relationships, and more frequent difficulties in sustaining an erection; women with TBI reported more frequent difficulties in sexual arousal, pain with sex, masturbation and vaginal lubrication. While groups differed in core demographic variables, age was the only demographic variable that was related to reports of sexual difficulties in individuals with TBI and men without disability. Age at onset and severity of injury were negatively related to reports of sexual difficulties in individuals with TBI. In men with TBI and without disability, the most sensitive predictor of sexual dysfunction was level of depression. For women without disability, an endocrine disorder was the most sensitive predictor of sexual dysfunction. For women with TBI, an endocrine disorder and level depression combined were the most sensitive predictors of sexual difficulties. Conclusion: Individuals post TBI report frequent physiological, physical and body images difficulties which negatively impact sexual activity and interest. For men post TBI, predictors of sexual difficulties included age at interview, age at injury, and having milder injuries, however, depression was the most sensitive predictor of sexual dysfunctions. For women post TBI, predictors of their sexual difficulties included age at injury and having milder injuries, however, depression and an endocrine disorder combined were the most sensitive predictors of sexual dysfunction. Implications of this study include the need for broad-based assessment of sexual dysfunction, and the implementation of treatment studies to enhance sexual functioning post TBI.

Journal Article↗
PubMed2001

[Assessment of erectile dysfunction in patients with Parkinson's disease].

Thirty men having Parkinsons disease (PD) and 30 controls were studied prospectively by the use of the International Index of Erectile Function (IIEF) to assess erectile dysfunction (ED). Of the patients with PD (mean age of 59 years), 46.66% referred to the practice of sexual activity. All of the parkinsonians were using antiparkinsonian medication. In the control group (mean age of 63 years), 76.66% referred to the practice of sexual activity, 46.60% to arterial hypertension and 6.66% to diabetes mellitus. The median score for the PD group according to the IIEF was 34, and that for the controls 50. The main differences between the two groups were in the erectile function, orgasmic function and satisfaction with the sexual relationship. The IIEF is a multidimensional scale widely accepted to assess the ED. The data obtained suggest that ED is more frequent among parkinsonians and points out to the role of DP in the genesis of ED.

Adult↗
PubMed1996

[On femininity, masculinity and biology at the turn of the century 1800].

This study examines the constructions of sex/gender present in medical manuals on sexuality and marriage, published in Sweden 1790-1830. The findings confirms Thomas Laqueur's thesis that a "one-sex-model" shaped the understanding of the human body until the eighteenth century. The ancient medical tradition is evident in the instructions on how to achieve health, and the reproduction-theories are influenced by the Hippocratian/Galenian tradition as well as the Aristotelian tradition. According to the manuals, sexualality should be connected to love and marriage, for the sake of both the young couple in love and of their future children. The parents' "fluids" and emotions at the moment of conception are believed to be crucial for the quality of the offspring. Children are also believed to inherit acquired characteristics, which makes the behaviour of the parents-to-be very important. The norms for proper conduct can be related to a bourgeois ideology of the relations between the sexes in which femininity and masculinity are defined as complementary categories. Furthermore, male domination and female subordination are inherent in "womanliness", manliness", romantic love and sexual attraction. "Nature" is--in contrast to civilisation--a normative ideal. The "natural" active male and passive female behaviour are not, however, legitimised by biological theories. Women and men are both regarded as "natural" sexual beings and the female orgasm is considered crucial for conception, although women who shows lustful feelings are considered despicable and "unnatural". ...

Biology↗