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[Not Available].

The paper is focused on the theory of regression formulated by the Budapest School of psychoanalysis, first of all by Michael Balint, which is closely related to the idea of primary love, the dual union of the mother and the child. The contribution of the Budapest School to the establishment of object relational theory and self psychology is recapitulated. Based on the work of Freud, Ferenczi, Balint and Kohut, the history of the term regression from the initial negative connotations to its interpretation as an indispensable skill of the healthy Ego is surveyed. Finally, the issue whether regression is an enemy or a helper is addressed, its manifestations in everyday life and applicability in self psychology oriented psychoanalytic therapy are discussed. Self psychology investigates regression in the mirror of the integrity of self formation: it considers the capacity for benignant regression as an indispensable condition of the healthy self, and blames the defense against regression for certain problems, most particularly for sexual orgasm disorders. In the paper, this interpretation is traced back to the theory of Balint, postulating a close relation between self psychological approach and the Balintian theory of benignant regression. The author argues that the resulting consequnces can be directly applied in psychoanalytic therapy, and demonstrates this statment by two case reports.

History, 20th Century↗

Quality of life and sexuality changes in postmenopausal women receiving tibolone therapy.

OBJECTIVE: The goal of this study was to investigate the effects of hormone replacement therapy (HRT) and tibolone on the sexuality and quality of life of Taiwanese postmenopausal women. METHODS: Forty-eight postmenopausal women were enrolled and prospectively randomized to receive either HRT or tibolone for 3 months. At the end of the 3-month period, quality of life measures were assessed using the Greene Climacteric Scale and attitudes of sexuality were evaluated using the McCoy Sex Scale. RESULTS: Based on subjective qualitative scores, tibolone treatment was at least as effective as continuous combined HRT in improving quality of life. It also effectively prevented withdrawal bleeding, which may occur during HRT use. Compared with continuous combined HRT, tibolone treatment was also associated with perceived improvement of sexual performance, including general sexual satisfaction, sexual interest, sexual fantasies, sexual arousal and orgasm, with decreased frequencies of vaginal dryness and painful intercourse. CONCLUSIONS: The findings of this study indicate that both tibolone and continuous combined HRT have positive effects on the quality of life of Taiwanese postmenopausal women. Sexuality is affected more by tibolone than by HRT.

Adult↗

The effects of treating lower urinary tract symptoms on sexual function.

We prospectively evaluated the effect of the treatment of lower urinary tract symptoms (LUTS) on sexual function. The patients were assessed by using the International Index of Erectile Function (IIEF-15) inventory at baseline and three months after medical (alpha-blockers) or surgical treatment (transurethral resection of the prostate, TURP). Following treatment, there were improvement in erectile function and intercourse satisfaction while orgasmic, overall satisfaction and sexual drive were relatively unchanged in the medication group. Patients who had surgical treatment suffered retrograde ejaculation, dissatisfaction in sexual intercourse and overall sexual satisfaction compared to patients who were on alpha-blockers.

Adrenergic alpha-Antagonists↗

[Sexuality of the diabetic woman].

Diabetes Mellitus frankly increases the prevalence of sexual problems in men, mainly in the form of erectile dysfunctions. Its effects on sexual function of the diabetic women have been less objectively studied, due to cultural reasons and methodological difficulties. The different phases of the sexual cycle, as well as their physiological control, are similar in human males and females. Several studies suggest an increased prevalence of sexual problems also in diabetic females. Their rate seems similar to that of the males. An increased prevalence of Female Sexual Arousal Disorder has been found in 6 studies of 6 comparing diabetic to non diabetic females. Its main symptom was a deficient vaginal lubrication, making sexual intercourse unpleasant. This disorder is the female equivalent to erectile dysfunction. It probably results from similar mechanisms, involving damages in the vascular and autonomic nervous systems, as well as alteration in the nitric oxide production and efficacy. The prevalence of Hypoactive Sexual Desire Disorder was also increased in most studies (5 of 8, significantly in 3). This could result from the increased prevalence of depression in diabetic females. The Dyspareunia's prevalence was not significantly increased (0 of 6 studies). Available figures are not consistent as regards the orgasmic disorders (prevalence increased in only 4 of 8 studies). No significant correlation of female sexual dysfunction with diabetes duration, balance, or complications has been found. Conversely some significant correlations with depression or poor acceptance of diabetes have been found, supporting a causative role of psychological factors. Although still limited the therapeutic options should not be neglected. Merely prescribing a water soluble lubricating gel may greatly improve the sexual life of couples. Doctors should talk themselves about sexual function with their female diabetic patients. Most of these are too much embarrassed to ask themselves their doctor, although their sexual problems may seriously interfere with their quality of life and that of their partner.

Arousal↗

[Sexual life, future of the couple, and contraception after voluntary pregnancy termination. Prospective study in Geneva (Switzerland) with 103 women].

OBJECTIVE: Study the impact of termination of pregnancy on women sexuality, contraceptive behaviour and couple relationship. DESIGN: Prospective qualitative and quantitative study. SUBJECTS: 103 women requiring induced abortion by vacuum aspiration who were interviewed one to three weeks before the operation and again six months later. The interview was performed by a questionnaire including open and closed questions and psychological tests (Locke-Wallace and Horowitz' IES). RESULTS: A majority of women (n = 101) had already used contraception. During the cycle that had resulted in pregnancy, more than a half (n = 58) had actually used contraception and 1/3 had not use any contraception at all. Six months later, the majority (n = 86) used contraception, while only 16 did not. Condom was only rarely used (n = 11). After termination of pregnancy, 14 couples of 84 separated. The majority of women (n = 72) did not report changes in their sexual behaviour. On the other hand, 1/5 of women presented a decrease in sexual desire and orgasm troubles. About 1/3 described psychosomatic symptoms, but a majority (n = 92) was not traumatised. CONCLUSIONS: The great majority of women seems to tolerate well the termination of pregnancy. A minority presents sexual dysfunction, psychosomatic symptoms, which persist six months after intervention. As per contraception, the majority of women does protect herself from pregnancy but a percentage still does not protect itself at all or only in a noneffective or less effective way. After termination of pregnancy, the issue of protection from AIDS and sexuality-transmitted diseases seems to be less important.

Abortion, Induced↗

Female circumcision.

The letter on unsafe male circumcision by Dr. H. Gretahun (Africa Health, March 1997) brings into very clear focus the whole issue of genital mutilation. Circumcision, whether male or female, does not per se amount to genital mutilation unless performed unsafely. Female circumcision involves only reducing the rudimentary penis, the clitoris, in order to tuck it neatly and beautifully under the labia majora. When the operation involves slicing off the labia, it ceases to be circumcision. Any scar tissue formed, both in size and location, is never enough to interfere with childbirth, otherwise the Black race would have been extinct millennia ago. Orgasm is not impeded in any way or else the female population of the planet would have been 80% frigid. If an uncircumcised female exhibits greater excitability, it is to be expected; even the constant friction between the clitoris and the underpart sets off some amount of auto-arousal. African female anti-circumcision activists should stop to consider the real issues and recognize the ulterior motives of the Western world, where even males are not circumcised. They should worry more about AIDS, which the West created as a weapon against its Communist opponents using Africans as laboratory animals. Africans should be demanding compensation and free distribution of all available drugs and not condoms.

Africa↗

[Sexual knowledge, attitudes and behavior among young Danes. A questionnaire study].

INTRODUCTION: The aim of this study was to present selected key figures concerning the sexual knowledge, attitudes, and behaviour among Danish teenagers. MATERIAL AND METHODS: 7355 Danish adolescents (aged 13-25) participated in a comprehensive questionnaire survey concerning sexual knowledge, attitudes, and behaviour. RESULTS: The median age at coital debut was 16.8 and in all age groups > 13, girls were more experienced and active than boys. The coital frequency was increased by age, as was girls' experience with orgasm in the years following their debut. The prevalence of same-gender sex appeared to be modest, and anal sex was reported by less than 10 per cent. A significant and increasing amount of youngsters did not discuss sexual matters at home, whereas the vast majority had received sexual education in school. One fourth of the girls regarded doctors as desired sexual interlocutors. Almost one fourth of the youngsters did not use contraception at their sexual debut, and 7 per cent of the sexually experienced girls had had an induced abortion. 9 per cent of the girls and 5 per cent of the boys had been infected with chlamydia, and 17 per cent of those sexually active had taken at least one HIV test. DISCUSSION: The age at coital debut seems to be stable, whereas the prevalences of unsafe sex and STDs are still high. New didactic methods are incessantly needed, just as supplementary empirical studies are encouraged.

Abortion, Induced↗

[Naked on the lawn. The sexual life of 60-year-old Danish women].

INTRODUCTION: The sexuality of older women has attracted little scientific interest. In a literature search only 29 fairly representative cross-sectional studies were found. There was a single population study of elderly Danish women. The aim of our study was to describe the sexual life of a group of 60-year-old women from the Copenhagen area. MATERIAL AND METHODS: A random sample of 122 women was taken from a cohort found to be fairly representative of 60-year-old women in the County of Copenhagen. The women were asked about their attitudes and sexual experiences in a semi-structured interview. Socio-demographic data were collected. RESULTS: Half the women felt sexual desire once a month or more and had intercourse once a month or more. Two thirds had had no more than three sexual partners, and 85 per cent had a regular partner at the time of the study. The most common dysfunction was vaginal dryness, which one third had. 25 per cent said they seldom or never achieved orgasm. Most of the women had experienced different sexual practices and were tolerant toward prostitution and pornography, but took exception to a number of perversions. DISCUSSION: These elderly women have developed and maintained their sexual life in step with the changes in the sexual norms occurring during their adult life, despite prejudices against elderly people's sexuality.

Cohort Studies↗

Marital discord, sexual problems, and depression.

Systematic studies of relationships among depression, sexual function, and martial discord in hemodialysis patients and their spouses arelacking; existing studies focus upon only one of these three topics, or deal with patient or spouse as individuals rather than as a couple. We studied 17 chronic, medically stable hemodialysis patients and their husbands or wives. Although couples rated their degree of marital discord as low, the investigators rated it as high, based on the number and type of specific problems reported by the couple. The couples' evaluation may not represent denial, as has been commonly assumed. Instead their evaluation may imply that the disease and its treatment overshadow marital problems, even though couples recognize and react to these problems. Couples showed a high prevalence of sexual problems--in terms of overall satisfaction, frequency of intercourse, and specific dysfunctional symptoms (difficulty becoming excited, maintaining excitement, or having orgasm). We found a strong relationship between severity of depression and severity of sexual dysfunction in patients, but not in their mates. No strong relationship existed between a patient's depression score and marital discord, although spouses showed a trend toward correlation between severity of depression and martial discord. Younger couples, especially, seem not to want intercourse when severe martial discord exists. Patients' depression scores were comparable to thoseof psychiatric patients, while spouses' depression scores resembled those of normals. While psychosocial phenomena such as marital discord, sexual dysfunction, and depression are clear, causal chains are not. Despite disadvantages inherent in using questionnaires, short, self-administered, easily scored instruments may elicit problems with sex, marriage, and mood which might otherwise be overlooked by caretaking personnel.

Adult↗

[Effect of aging on male sexual function in 93 patients using international index of erectile function].

OBJECTIVES: To investigate the influence of aging on male sexual function. METHODS: The study selected 93 ED patients, aged from 23 to 64, who responded to the International Index of Erectile Function (IIEF) questionnaire. The questionnaire includes 15 items related to male sexual activity, which are organized into 5 domains, namely, erectile function (EF), orgasmic function (OF), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). For statistical analysis, ANOVA with DUNCAN test was conducted, and statistical significance was set at P < 0.05. Some other risk factors of ED such as hypertension, diabetes etc. had been excluded. RESULTS: According to the age, the subjects were divided into 5 groups. With age increasing, the proportion of moderate and severe in each group increased from 16.17% to 57.14%, whereas EF score decreased from (19.50 +/- 4.64) to (15.27 +/- 5.64), OF score decreased from (6.93 +/- 2.86) to (5.62 +/- 2.94), SD score decreased from (6.33 +/- 1.63) to (4.50 +/- 2.94), IS score decreased from (10.17 +/- 1.94) to (6.93 +/- 2.90), OS score decreased from (5.00 +/- 0.89) to (3.15 +/- 1.84). The tendency took on linearity (P < 0.01). Aging was negatively correlated to above mentioned scores (r = 0.98, P < 0.01). CONCLUSION: Aging could be thought as a risk factor of ED, which is negatively correlated with male's EF, OF, IS, OS and SD scores, furthermore. IIEF questionnaire is a useful tool assessing epidemiology of ED.

Adult↗

Measurement of steroid levels in saliva in a population-based survey of lifestyle, medical conditions, marriage, sex life and hormone status in aging men: a feasibility study.

Some population-based studies on male aging measure testosterone and cortisol in saliva instead of serum, but very few measure estradiol and dehydroepiandrosterone sulfate (DHEA-S), suggesting further testing is needed for reliability and comparative validity. In addition, the effects of interview stress and circadian hormone secretion need to be checked. In a pilot study on the overall sexual capacity of aging men, 48 randomly selected, healthy, heterosexual, cohabiting men aged 50-80 years, from Mannheim, Germany, and 50 from the State College, Pennsylvania, USA, were administered a standardized interview covering medical biography, present and previous life and work, marriage and emotional status. Two saliva samples were collected from each subject for measurement of testosterone, cortisol, estradiol and DHEA-S levels before and after the interview, and each subject completed a confidential self-administered questionnaire on intercourse, masturbation, orgasm, fantasies, libido and arousal. Questionnaires, hormone measurement techniques and the survey protocol had been extensively pretested. Prior to the pilot study, the kits for measuring testosterone and DHEA-S in saliva were checked for comparative validity against established measuring techniques in serum in 31 cases for testosterone and in 24 different cases for DHEA-S. These 55 cases underwent clinical diagnosis and were not otherwise involved in this study. The cases had been referred to the Andrology Unit of the University Hospital, Marburg, for reasons unrelated to this study. Given the biological differences for both steroids between their presence in blood and in saliva, a perfect correspondence between the two values was not expected and was not observed. The correlations obtained, however, support the assumption that all statistical relationships between testosterone and DHEA-S values in serum and clinical, as well as behavioral, variables reported to date may be replicated for testosterone and DHEA-S values in saliva.

Aged↗

[Female sexual dysfunction].

OBJECTIVE: Comprehensive information about female sexual dysfunctions and possibilities of their treatment. DESIGN: Review article. SETTING: Institute for Postgraduate Medical Education, Prague. METHODS: Analysis of the literary data (texts in medical journals, monographies, textbooks, internet--"Medline") and author's clinical experience. CONCLUSIONS: Female sexual dysfunctions are highly prevalent but not well defined and understood. Existing definitions and classifications of female sexual dysfunctions are reevaluated and revised at present. Contemporary classification was expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. The female sexual response cycle is initiated by neurotransmitters which increase pelvic blood flow, vaginal lubrication, clitoral and vaginal reactivity. The effect of the therapy consists in the stabilization of the hormonal levels. New drugs with vasocongestive effect on genital are discussed.

Female↗

Sexual problems in gay men: an overview of empirical research.

This article summarizes the findings and theoretical perspectives of 19 empirical studies of sexual problems in gay men. In order to understand these problems better, various differences between male homosexual and heterosexual functioning are discussed first. The studies included differ widely in terms of the issues explored, the populations studied, and the way data have been collected. In a few studies, researchers generally have looked at the prevalence and experience of sexual problems. In other studies, researchers have focused on the etiology and treatment of specific problems, such as sexual desire disorders, sexual aversion, excitement and arousal problems, orgasm disorders, sexual pain disorders and sexual compulsivity. Overall it is surprising how little is known about these problems in gay men. This is also true, however, for same-sex sexuality in general. Suggestions are made for studies that will enable us to obtain a better understanding of sexual problems in gay men.

Adult↗

Relationship of sexuality with psychological and hormonal features in the menopausal period.

Women may experience some mental and sexual problems between the ages of 40 years and 60 years due to serious changes in the hormonal system. The aim of this study was to examine the relationships between the changes in sex hormones, sexual behaviours, depression and anxiety levels of women who were in either the premenopausal, perimenopausal or postmenopausal period. The subjects of this cross-sectional study consisted of 324 women who attended the Gynaecology and Obstetrics Out-Patient Ward of Celal Bayar University Hospital. Of this group, 37.0% (n = 124) were postmenopausal, 27.2% (n = 84) perimenopausal and 35.8% (n = 116) premenopausal. Beck Depression Inventory (BDI), State and Trait Anxiety Inventories (STAI-I and II) and a questionnaire on sexual behaviour which was prepared for this study by the authors, were applied to all of the attendees and serum sex hormone levels were analyzed. Beck Depression Anxiety, STAI-I and STAI-II scores and sexual behaviours did not show any statistically significant difference among these three groups. The frequency of sexual intercourse was lower in women with high BDI scores. The rate of painful intercourse was higher in women with high STAI-I scores. The frequency of sexual intercourse, sexual desire and orgasm decreased and painful intercourse increased in women with high STAI-II scores. The frequency of sexual intercourse decreased significantly as the age or follicle stimulating hormone level of women increased. These findings have revealed that the menopausal state did not affect the sexual behaviour, and psychological state of women between the ages of 40 and 60 years, but the increase in anxiety and depression scores affected the sexual life in a negative manner.

Adult↗

Role of oxytocin in the ejaculatory process.

Oxytocin (OT) is a neurohypophysial hormone with overall unclear physiological functions in the male. Several studies indicated that OT has a key role in the central regulation of penile erection. In this mini-review we summarize its possible involvement in another aspect of the male sexuality: the ejaculatory process. Because OT is released by posterior pituitary at the time of orgasm, we postulate that OT might help sperm progression during ejaculation. Our recent studies indicate that OT receptors (OTR) are present in rabbit and human epididymis and mediate contractility. Accordingly, they are immuno-localized in the smooth muscle cells of the epididymis. However, they are also present in the epithelial compartment of the tubules. In epididymal epithelial cells in culture, OT induces the release of another potent stimulator of epididymal contractility, endothelin-1 (ET-1), which most probably amplifies OT-induced contraction. Sex steroids regulate the density of OTR in epididymis. In fact, in an experimental model of hypogonadotropic hypogonadism (hypo) induced in rabbits, estrogens, but not androgens, fully restored OT-induced epididymal contractility, up-regulating OTR gene and protein expression. In addition, deprivation of endogenous estrogens, by blocking their formation using the aromatase inhibitor letrozole, induced OT hypo-responsiveness comparable to that observed in hypo rabbits. These findings suggest a new function of estrogens in the male: regulation of OT responsiveness in epididymis.

Animals↗

Management of sexual dysfunctions in women.

The deeper understanding of female physiology changed the perspective used to evaluate sexual difficulties. Systems like: vascular, neurological, biochemical, and endocrine are investigated as their modifications for aging or medical conditions may alter the sexual responsivity of women. New data imply that pharmacological interventions may become suitable for women. Gonadal steroids influence mood, wellbeing, and genital physiology but evidence of actions is controversial. Hormone imbalance provokes symptoms that may also derive from other conditions. Clinicians must exclude dismetabolism, depression and family crisis before diagnosing gonadal problems. The female androgen insufficiency syndrome was defined in July 2001 as altered mood, memory and wellbeing, and loss of desire. Estrogen maintains wellbeing and healthy genitals, influencing mood and sexuality. Progesterone provokes tension and nervousness, causing premenstrual syndrome. Hormone replacement is indicated in the treatment of endocrine deficiency. In research projects women receiving one preparation containing androgen reported improvement of mood, and arousal. Sildenafil cures approximately 25% of sexually dysfunctional, menopausal patients; being more effective with hormone replacement therapy (HRT) and consistently active against the block of antidepressants on orgasm. Added to psychiatric regimens, sildenafil ameliorates excitement. Sex therapy helps patients change behavior, overcome anger, communicate needs and redefine sex. We strongly believe that such crucial aspects must be addressed in therapy, even when the etiology is organic.

Androgens↗

Female sexual dysfunction.

Female sexual dysfunction (FSD) is defined as a disorder of sexual desire, arousal, or orgasm, and/or sexual pain, which results in personal distress and has an impact on quality of life and interpersonal relationships. It is a compilation of problems that has both biologic and psychosocial components and is multifactorial in etiology. Improved understanding of the structures and substances involved in normal sexual function, as well as age-related changes, helps practitioners proactively evaluate and appropriately manage women with FSD. Addressing FSD in a clinical setting should begin with an open discussion about relational, situational, and psychological issues. Clinicians should emphasize nonpharmacologic and behavioral therapies with the goal of achieving satisfying and pleasurable experiences. The continued quest to understand female sexual function and dysfunction requires more education and research on treatment of underlying medical conditions and use of pharmacologic therapies.

Adult↗

[Disseminated sclerosis and sexuality].

Since the onset of multiple sclerosis (MS) mainly occurs in younger persons between the age of 20 and 40, sexual dysfunctions have great impact on their quality of life. About 50% of all female and about 75% of all male patients complain of sexual dysfunctions. The primary symptoms among males are erective and ejaculative dysfunctions and reduced libido, while female patients mainly complain of reduced libido, problems achieving orgasm, decreased vaginal lubrication and changes in vaginal sensitivity. Secondary organic symptoms include fatigue, spasticity, muscular weakness, bladder problems, pain, cognitive and behavioural changes. Tertiary dysfunctions refer to general psychosocial problems in relation to chronic, progressive disease. One third of all couples in which either the man or the woman suffers from MS complain of problems in sexual and marital life, where especially the healthy female partner in general has sexual problems. Diagnosing and treating sexual dysfunctions in MS should ideally be carried out by a specialized "MS-team" with the core professionals being the neurologist, urologist, (neuro) psychologist and the nurse. Information about symptoms and their possible causes is an important part of the treatment, and not least learning more efficient coping strategies. Both for the patient and for the couple honest and open informative communication including information about sexual aids and perhaps also medical treatment will often result in minimizing the sexual problems and increasing quality of life.

Adaptation, Psychological↗