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PubMed2006

Categories of female sexual dysfunction.

Female sexual dysfunction is a complex and common problem. Several factors influence female sexual function, including biologic and psychosocial factors. Evaluation of female sexual dysfunction should include a complete medical and psychosocial history and a physical examination. Treatment should be multidisciplinary and depends on the etiology but may include education, psychotherapy or sexual therapy, and in some cases pharmacotherapy. Further research in this area will likely lead to a better understanding of the physiology of female sexuality and to novel therapies for female sexual dysfunction.

Dyspareunia↗
PubMed2003

[Sexual dysfunction--what is the primary physicians role?].

BACKGROUND: Sexual dysfunction is characterized by disturbances in sexual desire and/or psycho-physiological changes associated with the sexual response cycle in men and women. Studies suggest that it is prevalent in 10-52% of women and 25-63% of men, and could have a tremendous impact on the individual, interpersonal relations, and on the family quality of life. OBJECTIVE: To assess attitudes, knowledge and sexual dysfunction management by Israeli primary care physicians. METHODS: Two hundred and ninety-two physicians from approximately 800 participants who attended a Family Medicine and General Practice conference took part in the study. A self-reply questionnaire was distributed among the participants and 179 completed the full questionnaire (61%). RESULTS: Seventy nine percent of the physicians thought the primary care physician should be the address for treating most sexual dysfunction problems. Physicians indicated that only 12% of their patients treated for sexual dysfunction were female. Significant differences were found between male and female physicians, board certified family physicians, general practitioners and residents in family medicine regarding sexual dysfunction treatment. Board certified family physicians treated more patients with sexual dysfunctions than general practitioners (GP) and residents in family medicine [53% vs. 23% vs. 22% respectively, (p < 0.05)]. The main barriers for treating sexual dysfunctions noted by physicians were lack of time (62%) and knowledge (47%). CONCLUSIONS: Family physicians consider themselves to be the main address for the patient for sexual dysfunction problems. Physicians believe they need more training to overcome lack of knowledge barriers and they need to organize their time to adequately address their patients sexual dysfunction problems.

Attitude of Health Personnel↗
PubMed2004

Osteopathic approach to sexual dysfunction: holistic care to improve patient satisfaction and prevent mortality and morbidity.

Erectile dysfunction has multiple causes; most commonly the causes are mixed, a combination of physical and physiologic dysfunction. Two hypothetical case presentations provide the context for a discussion of the neurologic basis of erectile dysfunction and sexual dysfunction from the perspective of osteopathic medicine's holistic approach. Both offer osteopathic physicians the challenge of correcting structural, biological, and chemical defects to restore normal function. One of the cases is representative of patients who do not tell their physicians about sexual dysfunction unless their physicians specifically ask, and even then, these patients are most likely to lie to protect their self-esteem. The second hypothetical patient is representative of those patients who consult their physicians for any reason other than sexual dysfunction, expecting their physicians to figure out the real problem. Both of the hypothetical patients require not only support, but also education and counseling to motivate them to adopt healthier lifestyles and choices. Both would benefit from osteopathic manipulative treatment to correct structural abnormalities, and an oral medication such as a phosphodiesterase type 5 inhibitor offers both patients a good and easily accepted treatment option for erectile dysfunction.

Aged↗
PubMed2002

Efficacy and safety of sildenafil citrate in women with sexual dysfunction associated with female sexual arousal disorder.

OBJECTIVE: Sildenafil citrate (Viagra Pfizer, New York, NY) is indicated for the treatment of erectile dysfunction in men. The nitric oxide-cyclic guanosine monophosphate pathway (NO-cGMP) involved in penile erection and enhanced by sildenafil may also play a role in some components of the female sexual arousal response. The efficacy and safety of sildenafil were evaluated in estrogenized and estrogen-deficient women with sexual dysfunction that included female sexual arousal disorder (FSAD). METHODS: Patients were randomized to receive 10-100 mg sildenafil or matching placebo. To assess efficacy, patients completed two global efficacy questions (GEQ), the Life Satisfaction Checklist (LSC), an event log of sexual activity, and a 31-item sexual function questionnaire (SFQ). To assess safety, adverse event (AE) data were recorded. RESULTS: A total of 577 estrogenized and 204 estrogen-deficient women were randomized to treatment. All were diagnosed with FSAD, but it was the primary presenting symptom in only 46% and 50% of women, respectively. Differences in efficacy between sildenafil and placebo were not significant for any patient or partner end points (e.g., the two GEQ, the sexual event logs, the LSC, and the SFQ). The main AE were headache, flushing, rhinitis, nausea, visual disturbances, and dyspepsia, which were generally mild to moderate in nature. CONCLUSIONS: Any genital physiological effect of sildenafil was not perceived as improving the sexual response in estrogenized or estrogen-deficient women with a broad spectrum of sexual dysfunction that included FSAD. Whether more specific subgroups of women with FSAD could potentially benefit from treatment with sildenafil is an area for future research.

Adult↗
PubMed2005

Reproductive and sexual dysfunction in men with epilepsy.

Disturbances of reproductive and sexual health are common in people with epilepsy. Their etiology is not well understood but appears to be multifactorial, and both epilepsy itself and drugs used to treat it are implicated. Physiologically, sex steroid hormone levels, the hypothalamic-pituitary axis, and testicular function can be affected in men with epilepsy. Psychosocial complications associated with epilepsy can also affect reproductive health and sexuality. Clinicians need to investigate such problems carefully, both because of their multifactorial nature and because patients and physicians alike may often fail to recognize or be reluctant to acknowledge them; in particular, patients whose epilepsy had its onset before puberty may lack subjective awareness of impairments of sexual response and function. Treatments for reproductive and sexual dysfunction in men with epilepsy have been inadequately studied. Modalities such as medications for erectile dysfunction and surgery may be useful. Therapy with exogenous testosterone and an aromatase inhibitor may be helpful for men with epilepsy and sexual dysfunction due to testosterone deficiency.

Anticonvulsants↗
PubMed2004

Pharmacotherapy for sexual dysfunction in women.

In the setting of multiple studies claiming a high prevalence of sexual problems amongst women, new conceptualisation of the sexual response in women and definitions of sexual dysfunction, which reflect the need for biopsychosocial management, are being developed. The biological underpinnings of the sexual response in women may be influenced by environmental factors, as well as by medications, disease processes and normative changes in endogenous hormones. Psychological factors can alter both the physiological processes and the experience of sexual response. The new models clarify the importance of sexual motivations other than desire, sexual arousability and subtypes of arousal disorder. The role of pharmacotherapy to potentially augment desire, arousability, genital congestion and to lessen the pain of chronic dyspareunia must be envisaged within the holistic biopsychosocial model.

Female↗
PubMed1985

Diagnosis and treatment of male sexual dysfunction.

This paper presents a critical review of recent work on diagnosis and treatment of male sexual dysfunction. One recent advance has been a focus on low sexual desire in males. Hormonal disorders are relatively uncommon in such men, with family-of-origin and couple-dynamic issues usually cited in the clinical literature as major etiologic factors. Recent work on erectile failure has focused on differential diagnosis of physiological and psychological factors in erectile failure. To date, no simple differential diagnostic procedure has been identified, and a complex and expensive multidimensional evaluation is required for accurate diagnosis. Treatment for premature ejaculation continues to be very effective, but an understanding of the mechanism underlying treatment effectiveness has remained elusive. The cause of inhibited ejaculation also continues to be unclear, although medication side effects have been recognized as a common contributing factor. Across all the male dysfunctions, clinical reports have outweighed empirical studies in the recent literature. Heterogeneity of patient groups, lack of objective outcome measures, lack of control groups, and other basic methodological problems, continue to plague this area of research.

Arousal↗
PubMed2005

Appetitive responses to sexual stimuli are attenuated in individuals with low levels of sexual desire.

Despite the high prevalence of sexual desire disorders, little is known about their biological underpinnings in humans. Animal studies suggest that dopamine is involved in appetitive sexual behavior; thus, one aim of this study was to elucidate that relationship in humans. This study used measurement of the acoustic startle response (ASR) and prepulse inhibition of the startle response (PPI) as psychophysiological indicators of changes in motivational states to assess the potential relation between sexual desire and appetitive motivation in humans. Responses to sexually provocative stimuli consisting of single nude men and single nude women in a sample of 153 participants (77 men, 76 women) were assessed. The results indicated that ASR was attenuated after exposure to appetitive stimuli (i.e., sexually provocative pictures of attractive individuals) to a greater extent among participants with higher levels of sexual desire, as measured by the Sexual Desire Inventory-2 (Spector, I. P., Carey, M. P., & Steinberg, L. (1996). Journal of Sex & Marital Therapy, 22, 175-190). In addition, PPI was inversely associated with subjective ratings across stimuli such that greater subjective levels of desire were correlated with lower levels of PPI. In general, these results suggest that individuals with lower levels of sexual desire may have a diminished physiological response to appetitive sexual stimuli.

Acoustic Stimulation↗
PubMed2006

Sexual health in women treated for cervical cancer: characteristics and correlates.

OBJECTIVE: A large proportion of women with a history of cervical cancer experience sexual problems as a result of treatment. The present study examined whether differences in sexual health between cervical cancer survivors and women with no history of cervical cancer could be explained by selected demographic, clinical, and psychosocial and physical factors. METHODS: Women treated between 1 and 5 years previously for stage 0 to II cervical cancer and age- and education-matched women with no history of cancer undergoing routine cervical cancer screening were recruited to participate. All participants had a partner with whom they had ever been sexually active. Women completed measures of sexual health, vaginal changes, partner relationship quality, perceived physical appearance, and sexual self-concept. RESULTS: Cervical cancer survivors reported significantly (p<.05) less sexual interest, more sexual dysfunction, and lower sexual satisfaction. The most consistent predictors of sexual health after treatment among survivors were time since diagnosis, receipt of radiotherapy, partner relations, and perceived physical appearance, as well as vaginal changes. These variables accounted for about 50% of the variance in sexual health outcomes. CONCLUSION: The findings suggest that efforts to improve sexual health in women with a history of cervical cancer must move beyond the direct effects of cancer treatment on vaginal anatomy and physiology. Sexual rehabilitation interventions should consider partner relationships, perceived physical appearance, and women's attitudes toward themselves as sexual beings, in addition to vaginal changes. Future research should use prospective longitudinal research designs incorporating appropriate comparison groups to further explore this issue.

Adult↗
PubMed2001

Sex, drugs, and hypertension: a methodological approach for studying a sensitive subject.

Sexual dysfunction is a recognized side effect of hypertension and antihypertensive medications in men, but is not established as a side effect in women, due to the lack of established methodology. An ambulatory medical record-based, case-control study was designed to study sexual function in treated and untreated hypertensive women and healthy controls. The research was performed in a teaching hospital with satellite clinics in upstate New York. There were 3312 medical records reviewed, 640 premenopausal Caucasian women in heterosexual relationships subjects were eligible for participatic diagnosis of mild hypertension (BP > or =140/90 mmHg and < 160/100 mmHg) for cases; no other significant medical history. A total of 241 women agreed to participate, 224 (35%) completed both a self-administered questionnaire and a telephone interview (112 healthy, 112 hypertensive). There was an initial 74% response rate among those eligible to participate, with 35% completing the entire study. Age and average blood pressure were not significant between 224 participants and 416 nonparticipants by 2-tailed t-test analysis. Seven composite variables were formed from a 47-item sexual response questionnaire. Initial unadjusted chi2 results reported women with hypertension had more difficulty than did healthy controls achieving lubrication and orgasm. Seven questions, each with the highest correlation to its respective composite variable (by Spearman's correlation), formed an abbreviated questionnaire. Quality of female sexual function was quantified in an ambulatory outpatient setting. A method was described to address hypertension, pharmacotherapy, and sexual functioning by employing self-administered questionnaires and telephone interviews. Initial analysis suggested that hypertensive women may have an impaired physiological sexual response. The abbreviated questionnaire generated from questions with the highest correlation to their respective composite variables may be useful in further evaluating this issue.

Adult↗
PubMed2003

Female sexuality.

Female sexuality is an extraordinarily complex process. The physician needs to be aware of the patient's sexuality and whether or not there are sexual concerns. Physiologic changes over the lifespan can interact with sexual performance as can a variety of disease processes. Partner and relationship issues must also be taken into account. Physicians need to include a sexual history as part of their general history and should not be judgmental of their patients' sexual practices. Sexual disorders in women are defined and delineated by those issues causing personal distress. Again, one person's distress may be quite normal to another. The important aspects of care consist of listening, educating, and providing support to the patient. There is increasing interest but a continued need for data in the use of testosterone in women with decreased libido. The use of sildenafil for female sexual dysfunction remains controversial as a benefit. Overall, there is a need for the development of well-organized, randomized, controlled studies on appropriate assessment and intervention for sexual dysfunction in women.

Activities of Daily Living↗
PubMed1980

[Sexuality over sixty (author's transl)].

In spite of the heterogenous composition of the two groups, the results regarding the different behaviour of men and women of advanced age are rather similar. The differences that do exist are, however, not genuine and sex-specific, rather they attributable to socio-cultural factors which have shaped the traditional sexual roles of men and women belonging to these age groups. In view of the changes that have taken place in contemporary society, we can expect that these differences will gradually disappear in the near future, as shown by the example of the younger generation. In spite of the frequent physical disorders and regressive changes developing in both sexes because of old age, the physiological situation must not be neglected. Even people of advanced age require a full psychological assessment as soon as they begin suffering from sexual disorders. Besides substitution therapy based on hormones, psychotherapy plays an important role in the treatment of such conditions. Since life expectancy continues to rise in all developed countries, the knowledge of the sexual behaviour of older people is becoming more and more important. The physician should, therefore, be conversant with the basic factors of this stage of life and enhance his knowledge on the sexuality of people of advanced age and related problems in order to be able to understand the problems of this group of people who have the same rights as young people, and to assist them, if help is required.

Aged↗
PubMed2006

An effect on the subjective sexual response in premenopausal women with sexual arousal disorder by bremelanotide (PT-141), a melanocortin receptor agonist.

INTRODUCTION: Melanocortins affect multiple physiological responses, including sexual behaviors. Bremelanotide is a synthetic peptide melanocortin analog of alpha-melanocyte-stimulating hormone that is an agonist at melanocortin receptors MC3R and MC4R. AIM: To evaluate a single intranasal dose of bremelanotide for potential effects on physiological and subjective measurements of sexual arousal and desire in premenopausal women with sexual arousal disorder. MAIN OUTCOME MEASURES: Change in vaginal pulse amplitude during neutral and erotic videos after treatment with bremelanotide or placebo and subjects' perceptions of physiological and sexual response within 24 hours of treatment with bremelanotide or placebo. METHODS: Eighteen premenopausal women with a primary diagnosis of female sexual arousal disorder were randomly assigned to receive a single intranasal dose of 20 mg bremelanotide or matching placebo in a double-blind manner during the first in-clinic treatment session, and the alternate medication during the second in-clinic treatment session. During each session, subjects viewed a 20-minute neutral video followed by a 20-minute sexually explicit video. Vaginal photoplethysmography was used to monitor vaginal vasocongestion and questionnaires were used to evaluate perceptions of sexual response within the following 24-hour period. RESULTS: More women reported moderate or high sexual desire following bremelanotide treatment vs. placebo (P = 0.0114), and a trend toward more positive responses regarding feelings of genital arousal occurred after bremelanotide compared with placebo (P = 0.0833). Among women who attempted sexual intercourse within 24 hours after treatment, significantly more were satisfied with their level of sexual arousal following bremelanotide, compared with placebo (P = 0.0256). Vaginal vasocongestion did not change significantly while viewing erotic videos following bremelanotide administration compared with placebo. CONCLUSION: This preliminary evaluation suggests the potential for bremelanotide to positively affect desire and arousal in women with female sexual arousal disorder and indicates that bremelanotide is a promising candidate for further evaluation in an at-home study.

Adult↗
PubMed1999

Sexual dysfunction in the United States: prevalence and predictors.

CONTEXT: While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. OBJECTIVE: To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. DESIGN: Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. PARTICIPANTS: A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. MAIN OUTCOME MEASURES: Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. RESULTS: Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being. CONCLUSIONS: The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.

Adult↗
PubMed2005

Relevance of an evidence-based ejaculation time cutoff point for neurobiological research of premature ejaculation.

The Diagnostic and Statistical Manual (DSM)-IV definition of premature ejaculation is not based on evidence-based studies. In particular, the absence of a well-defined quantitative measure of the intravaginal ejaculation latency time (IELT) makes the DSM definition inadequate. Therefore, the DSM-IV definition should be replaced by a medical definition that incorporates both quantitative as qualitative parameters of premature ejaculation. An evidence-based medical definition should include a cutoff point of the IELT at the 0.5 and 2.5 percentiles of the IELT distribution in the general male population. Such a definition has recently been proposed on the basis of a stopwatch study of the IELT in 491 men from five different countries. Similarly, a cutoff point of ejaculation frequency in laboratory rats enhances the probability to distinguish genuine rapid-ejaculator rats. Only by the strict application of these cutoff points is the probability enhanced that human and animal neurobiological research can prove whether these sexual endophenotypes differ in brain activation, have particular genetic genotypes (polymorphisms), are strictly under genetic control, or are dependent on environmental conditions and/or genotypic/environmental interactions.

Animals↗