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PubMed1995

Preliminary results of a comparative study with intracavernous sodium nitroprusside and prostaglandin E1 in patients with erectile dysfunction.

We compared the effect of intracavernous administration of sodium nitroprusside, a nitric oxide donor and, therefore, stimulator of the cyclic guanosine monophosphate pathway, with the activity of prostaglandin E1, which is a stimulator of the cyclic adenosine monophosphate pathway. To date 105 patients with erectile dysfunction have entered the study. As part of the diagnostic evaluation every patient received an intracavernous injection of 20 micrograms prostaglandin E1 and a second injection of sodium nitroprusside at different concentrations (100 micrograms in 10 patients, 300 micrograms in 60 and 400 micrograms in 35). Sodium nitroprusside at a dose of 100 micrograms was not effective for inducing erections. Prostaglandin E1 induced better responses overall than sodium nitroprusside at 300 and 400 micrograms (p < 0.001). The overall duration of erections was also significantly longer with prostaglandin E1 (mean 88.5 minutes) than with 300 micrograms sodium nitroprusside (mean 50.8 minutes, p < 0.001) but did not reach statistical significance compared to 400 micrograms sodium nitroprusside (mean 42.2 minutes). Side effects were minimal with both drugs. Although sodium nitroprusside has several benefits over prostaglandin E1 for intracavernous use (such as lower cost, absence of local pain and shorter action, allowing detumescence after orgasm and decreasing the risk of priapism), prostaglandin E1 still remains the agent of choice for intracavernous use.

Alprostadil↗
PubMed1994

[The sexual behavior of the African ostrich (Struthio camelus)].

The African ostrich (Struthio camelus) is different from other birds not only because it is a running bird (Ratitae), but also because it urinates and the male bird has a penis. On a specialized farm in Israel the sexual behaviour of ostriches was studied. Courtship behaviour and mating have a very refined pattern. The copulation, which starts with an immission of the penis and ends with an orgasm, lasts about one minute. Most of the copulations take place during the morning morning hours. Occasionally, female ostriches demonstrate courtship behaviour to other females. Sometimes female ostriches mount other females as in the case of copulation.

Animals↗
PubMed1995

Effects of depression and antidepressants on sexual functioning.

With serotonergic antidepressants dominating the treatment of depressive disorders, antidepressant-induced sexual side effects have emerged as a major clinical issue. Surprisingly, the effects of depression on sexuality are less well established and more variable than previously thought. It is likely that antidepressants with strong serotonergic effects--selective serotonin reuptake inhibitors, clomipramine, and monoamine oxidase inhibitors--are associated with higher rates of sexual side effects, compared to other antidepressant classes. Orgasmic and ejaculation difficulties are prominent with these medications, although alterations in libido, arousal, and erectile function are also common. Treatment of these side effects includes both general strategies and specific antidotes, such as cyproheptadine, yohimbine, dopamine agonists, and buspirone.

Depressive Disorder↗
PubMedDate not supplied

Management of sexual problems in diabetic patients.

Sexual dysfunction is common in diabetes, with both male and female patients suffering problems with libido, arousal and orgasm. Erectile failure is particularly common and can be treated effectively by pharmacological and mechanical methods. However, psychological and relationship factors may still be important. A comprehensive diabetes care service should routinely offer treatment for sexual dysfunction.

Diabetes Complications↗
PubMed1994

[Supravaginal or total hysterectomy?].

There has been a decline in the rate of hysterectomies in Denmark in general over the last thirteen years, together with a rise in the number of supravaginal operations over the last two years. The literature concerning the relative merits of the supravaginal and the total abdominal operation is examined. It is concluded that the risk of developing carcinoma of the cervical stump is low, and no longer a weighty indication for the total in preference to the supravaginal hysterectomy as long as subsequent screening of the cervix is performed. At the same time it is important to inform the women carefully after the supravaginal operation in order to secure that subsequent screening actually is taking place. One must have a normal smear and offer a colposcopic examination before the operation. In general the rate of complications after both kind of hysterectomies is low. However, a few new studies indicate a reduced frequency of orgasm after the total hysterectomy compared with the supravaginal operation. When there are technical problems peroperatively with an increased urologic risk the supravaginal operation is recommended.

Adolescent↗
PubMed1994

[Differential sperm aspiration. Apropos our first clinical pregnancy].

It is now one year since we started our microsurgical venture. The idea was to round-off the care coverage of our Reproduction Unit since, in June 92, we had launched the FIV-TE program. The Unit Incorporates professionals from different services (urology, gynaecology, laboratory) imbued by the notion that it is not the isolated individual but the couple who, at any particular time, have a fertility problem. Approach to the study is, therefore, done in an integrate and concurrent way to both members of the couple, progressing then to establishment of diagnosis and the outline of a therapeutic alternative. We introduce below the case of a couple which may well be an example of the above statements. The couple refers a 4-year evolution of primary sterility. The 34-year-old male is a long-evolution insulin-dependent diabetic with erectile dysfunction and backward ejaculation. The erectile dysfunction is successfully managed with PGE1 self-injections. In their wish for fertility and after failure of spermatozoa recovery both in urine following orgasm and intravesical Menezo, we attempt MAE (12 million of spermatozoa with motility, after swim-up) + FIC-TE in a FSHp- and HCG-induced cycle, securing the uptake, by ultrasound-guided follicular puncture under local anaesthetics, of 5 mature ovocytes 4 of which were fertilized; the same four undergoing intrauterine transferral with the result of pregnancy, this being the second one to be accomplished in the country and the first one In our Unit, by microaspiration of spermatozoa at the deferent level In a situation of primary sterility by plain male factor.

Adult↗
PubMed1993

[Sexual activity after pelvic irradiation for cancer of the prostate. Evaluation by questionnaire].

In order to determine the influence of pelvic radiotherapy on potency, a questionnaire has been sent to all living patients who had been treated for a prostate carcinoma with exclusive external beam radiotherapy from 1980 to 1991 in Centre Hospitalier Lyon Sud. One hundred and six patients have been asked about the frequency of intercourse prior to and after treatment, and about possible modifications of their sexual activity after radiotherapy. At the time of the study, median follow-up was of 47 months. 5 and 10 years survival rates were respectively 76 and 53% for overall survival, and 65 and 33% for disease-free survival. Severe complications rate related to radiotherapy was 2%. Among the 56 patients who returned a completed questionnaire, 12 (21%) were impotent prior to treatment. During the first year after radiotherapy, 10 patients were given an hormonal treatment and became impotent. Among the other 34 evaluable patients, 20 (59%) patients were still potent one year after radiotherapy, and sexual activity was unchanged for 3 patients (15%), slightly altered for 11 patients (55%) and altered for 6 patients (20%). Erection capacity was modified for 82% of the patients, ejaculation for 59%, orgasm for 47% and libido for 6%. In order to determine prognostic factors of conservation of sexual activity, we analyzed the distribution of potent and impotent patients according to age, tumor stage, Gleason score, frequency of intercourse prior to treatment and size of the radiation fields. Only age < or = 64 was associated with a higher percentage of preservation of potency: 76% versus 59% in patients older than 64 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Sexual behavior in the elderly].

With the improvement of quality life in the elderly of technologically developed countries, sexuality has become an important aspect of aging. In the elderly there is a progressive decline of organic functions; the decrease of sexual and procreating activity is linked with the impaired male hormonal production. The four stages of sexual function are modified: 1. delayed erection; 2. plateau prolongation; 3. orgasm modifications; 4. fast penis detumescence. In addition to organic impairment, aesthetic, social, environmental and psychological factors can restrict sexual activity, as well as past sexual experiences and co-morbidity. There are specific aspects concerning sexuality in the elderly, such as the increased chances of public relations and emotional involvement, the more intense psychic activity and the stronger process of removal and sublimation of impulses. In conclusion the best way to deal with sexuality in the elderly is the multidimensional assessment.

Aged↗
PubMed1993

Cervical removal at hysterectomy for benign disease. Risks and benefits.

An assessment of the risks and benefits of total and subtotal hysterectomy for benign disease was performed using the published literature, including a MEDLINE search, on all studies dealing with hysterectomy and related topics from 1946 to 1992. The shift from subtotal to total hysterectomy occurred before cytologic screening was accepted. Currently, SIL is diagnosed by cytology, evaluated by colposcopy and treated preferentially with cone biopsy. Prophylactic removal of the cervix does not eliminate the risk of cancer: it may shift the risk to the vaginal epithelium. The cervix has a role in sexual arousal and orgasm, probably due to stimulation of the Frankenhauser uterovaginal plexus. Bladder and bowel dysfunction following total hysterectomy may be related to loss of nerve ganglia closely associated with the cervix. Increased operative and postoperative morbidity, vaginal shortening, vault prolapse, abnormal cuff granulations and oviductal prolapse are other disadvantages of total hysterectomy. The cervix is not a useless organ and should not be removed during hysterectomy without a proper indication.

Cervix Uteri↗
PubMed1993

[Sexual possibilities following total penis amputation].

A male aged 45 was subjected to total penis amputation because of a penile carcinoma; a perineal urethral stoma was created. The postoperative course was uneventful. One month after the last operation the patient for the first time felt the need for sexual contact, but his wife hesitated. After medical-sexological counselling, the partners achieved satisfactory sexual functioning with the husband occasionally having an orgasm.

Amputation, Surgical↗
PubMed1977

[Psychological and sexual acceptance of vaginal hysterectomy for sterilization (author's transl)].

Psychological and sexual sequelae of hysterectomy were studied in 1007 cases between 1 1/2 and 8 years following the operation. Younger women had more often vaginal and older women more ofter abdominal hysterectomies. 78% of the patients thought they had been fully informed about the operation. 4.1% of the patients regretted the hysterectomy. 8% of the patients regretted the loss of menstruation. Most of these did not think they were fully informed. Full information on the type of operation can reduce negative postoperative sequelae. As many patients gained as lost weight following the hysterectomy. Postoperative coital difference did not show any relationship to the type of hysterectomy. In 57% of the cases, improvement occured one year later and in 10% of the cases improvement occurred 2 years later. Sexual relationships were not adversely affected by hysterectomy. Deterioration of the sexual relationship regarding libido and frequency of orgasms was a more frequent complaint in the control group. Improvement of libido and frequency of organsms can still occur 2 years following hysterectomy. Covert and overt depression was as frequent in the hysterectomized group as in the control group. The adverse effects of sterilization by tubal ligation were identical to those found in our group of hysterectomies according to the literature. Therefore we prefer vaginal hysterectomy for voluntary sterilization to tubal ligation.

Adult↗
PubMed1993

[Sexual asphyxiophilia (Koczwarism)].

The author discusses the definition, history, anthropological data and sexual differences of a deviant sexual activity, asphyxiophilia (Kocwarism), the objective of which is stimulation or enhancement of sexual excitation or induction of orgasm by induced hypoxia. The author draws attention to the basic features which provide evidence of this life threatening and so far inadequately diagnosed sexual practice in both sexes, in particular in women. These features can be used in forensic psychiatry and sexuology and in forensic medicine.

Adolescent↗
PubMed1993

[Unintended urine loss in women during sexual activities; an exploratory study].

Urinary incontinence can have a profound negative impact on female sexuality. Not only feelings of shame and loss of libido are important; complaints of urine loss during sexual activity can also exist. The prevalence of this phenomenon was examined in a study of 245 patients complaining of urinary incontinence. We also analysed the evoking moments and the impact of the complaint on the sexual relation. 20% of the patients had no partner. 66 (34%) of the remaining women reported losing urine during sexual activity. It was often experienced during pressure on the abdomen and deep vaginal penetration. Non-mechanical factors played an important part as well. Neither the history nor the urodynamic diagnosis had a clear relationship with evoking moments during intercourse. Incontinence was frequently (also) experienced during orgasm and sexual excitement. We found a strong negative effect of this complaint on the sexual lives of many women and their partners. Adequate relief of stress incontinence by colpo-suspension will also stop urine loss during intercourse.

Adult↗
PubMed1993

[Successful artificial insemination in a patient with retrograde ejaculation following retroperitoneal lymph node dissection for testicular cancer: a case report].

A 24-year-old man underwent right radical orchiectomy for testicular teratocarcinoma in May 1982, which was followed by retroperitoneal lymph node dissection. The patient showed no evidence of recurrent disease at followup examinations. The patient later reported a complete loss of ejaculation postoperatively. Erection and orgasm remained normal. Prior use of a sympathomimetic agent, imipramine hydrochloride, was unsuccessful in producing an antegrade ejaculation. Pregnancy was achieved following the fifth attempt at artificial insemination using semen retrieved from the bladder by the modified Hotchkiss method. A healthy male infant, weighing 3,150 g, was delivered. The treatment modality for male infertility due to retrograde ejaculation after retroperitoneal lymph node dissection for testicular cancer is discussed.

Adult↗
PubMed1995

[Sexual myths in an adult population].

BACKGROUND: Clinical observation ratifies the existence of commonly accepted erroneous beliefs (EB) in relation to sexuality. In the health care sector, reinforcing factors of these beliefs are the professionals who are not specifically trained to manage, or detect the same in addition to the variability of the criteria available on sexual health care. METHODS: The EB on sexuality were studied in 260 individuals (14-18 years) who are users of primary health care services. Four consultation offices of General Medicine were randomly selected, one by health care center (Area 20, Valencian Community, Spain). Subsequently, a structured interview was given to the users of these consultations over the period of one day. The interviews were carried out after receiving consent and guarantee of confidentiality. On the other hand, the results were compared with those previously obtained from the 44 health care professionals (HCP). The results are reported, the proportions compared (chi-square) to determine differences according to age, sex and level of education and the odds ratio was calculated to determine the probability of participation in EB according to sex. The response rate in users was 97.4% and is HCP 58%. RESULTS: The proportion of EB ranged from 16.9% who believed coitus as the only "normal" sexual relationship and 63.8% who believed in the existence of two types of female orgasm. Depending on the beliefs, statistically significant differences were observed according to age (from p = 0.03 to p < 0.0000) and the level of education (from p = 0.01 to p < 0.0000) and between the user adult population and the HCP (from p = 0.01 to p < 0.0000). CONCLUSIONS: There are numerous erroneous beliefs regarding sexuality in both primary health care users and, to a lesser extent, Spanish health care professionals. The influence of moral criteria, centered on reproduction, and prevalent sociocultural norms and values is of note. It was found that erroneous beliefs do not decrease with the educational level, but rather, change.

Adolescent↗
PubMed1996

The outcome of patients with classic bladder exstrophy in adult life.

PURPOSE: We determined the outcome of 20 older adult bladder exstrophy patients regarding urinary continence, sexual function, fertility and psychosocial integration. MATERIALS AND METHODS: A total of 16 men and 4 women completed an anonymous questionnaire and the charts were reviewed for medical history. RESULTS: Of 9 patients who void spontaneously 6 are dry for 4 hours and 3 for 2 hours. Among the remaining 11 patients 5 are dry on clean intermittent catheterization, 3 who had undergone uterosigmoidostomy are dry for more than 4 hours and 3 had an incontinent stoma. Four men and 2 women are married, including 2 men and 1 women who had a total of 7 children. Ten of 16 men (63%) reported that they ejaculate a few cubic centimeters in volume, 3 ejaculate only a few drops and 3 have no ejaculation (2 of whom underwent cystectomy). Semen analyzed in 4 patients (3 with azoospermia and 1 with oligospermia) and average volume of ejaculate was 0.4 cc (range 0.2 to 1). All women reported regular and normal menstrual periods. A total of 15 patients experienced normal erections that were described as satisfactory by 8 and not satisfactory by 6 due to a small penis, with dorsal chordee in 1. Of the 16 men 12 (75%) experienced satisfactory orgasms while 10 had participated in sexual intercourse with complete partner satisfaction in 9. Half of the men and all women describe intimate relationships as serious and longterm. Of the 20 patients 15 (75%) achieved a high level of education. CONCLUSIONS: Bladder exstrophy patients generally achieve good results but the fertility of most men is in doubt.

Adolescent↗
PubMed1996

How do antidepressants affect serotonin receptors? The role of serotonin receptors in the therapeutic and side effect profile of the SSRIs.

The serotonin selective reuptake inhibitors (SSRIs) have proved to be an important development in the treatment of depression because of both their greater practical ease of use and their selective primary action on a single binding site. Their efficacy in depressive illness of a range of severities, but also in obsessive-compulsive disorder and panic, is largely established. The onset of action of the SSRIs may be delayed by autoinhibition at the cell bodies of raphe neurons. This suggests that blockade of autoreceptors may speed the onset of antidepressant action by SSRIs. The main unwanted effects of the SSRIs occur in relation to gastrointestinal, sleep, and orgasmic disturbances. However, the total side effect burden is less than that associated with the older, less selective compounds, and there are clear hypotheses for how the side effects that do occur may be mediated and hence how they may be reduced by either adjunctive treatment or design of new compounds.

Autoreceptors↗
PubMed1996

Sexuality and fertility concerns of dialysis patients.

OBJECTIVES: The purposes of this study were to identify the frequency of sexual and fertility dysfunctions and satisfactions experienced by patients on dialysis therapy and their relationships to life quality variables, and whether patients desired to or received instruction regarding possible sexuality and fertility problems. DESIGN: The study used a descriptive, survey design. SAMPLE/SETTING: A convenience sample was obtained from 7 hospital-based dialysis centers in the state of Iowa. METHOD: A mailed questionnaire, composed of 7 instruments, was used to survey demographic and medical variables, activity level, fertility and sexual dysfunction, intimacy patterns, sexual attitudes, life and health quality, and satisfaction with sexual relationships of patients treated with dialysis therapy. RESULT: Sixty-five percent of the subjects (n = 135) were dissatisfied with their sexual relationship, 40% no longer engaged in intercourse or sexual activity, yet only 25% had received instruction regarding possible dysfunctions. Subjects satisfied with their sexual relationships differed significantly (p < .05) from those who were dissatisfied in activity level, intimacy patterns, and life and health quality with frequency of arousal, orgasm, and acceptance of partner's advances significantly related to sexual satisfaction. CONCLUSION: The standards of care identified by the American Nephrology Nurses' Association regarding sexuality had not been achieved in the sample measured.

Adult↗