Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms.

BACKGROUND: Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD). AIM: To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. METHODS: One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire). OUTCOMES: Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. RESULTS: The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant. CLINICAL IMPLICATIONS: Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships. STRENGTHS AND LIMITATIONS: This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability. CONCLUSION: When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.

Validation of Qualisex questionnaire to evaluate sexual dysfunction in women affected by fibromyalgia.

OBJECTIVES: Fibromyalgia (FM) may have consequences on sexual life. The objective was to validate the Qualisex questionnaire in the assessment of sexual dysfunction in women affected by FM. METHODS: We consecutively enrolled FM women (American College of Rheumatology-ACR 2016) referring to our Fibromyalgia Clinic, from 2020 to 2022. Demographic, clinical data and evaluation of FM symptoms severity (Revised Fibromyalgia Impact Questionnaire (R-FIQ), Symptoms Severity Scale-SSS, Widespread Pain Index-WPI) were assessed. Hospital Anxiety and Depression Scale (HADS) and Qualisex questionnaire were anonymously administered. Qualisex includes 10 questions on different items of sexual life with higher scores suggestive of greater negative impact of the disease on sexuality. RESULTS: The cohort was composed by 373 FM women. Cronbach's alpha test was used to validate Qualisex questionnaire (0.878). Moreover, we observed higher values of Qualisex in married women (p<0.001), in women with lower grade of education (p=0.002) and with lower sexual feeling with partner (p<0.001). Higher values of Qualisex Total score showed a positive correlation with HADS-A/D (p<0.001 r=0.312; p<0.001 r=0.542 respectively), VAS pain, VAS fatigue, VAS dryness (p<0.001 r=0,438; p<0.001 r=0.375; p<0.001 r=0.370 respectively) and relationship duration (p<0.001 r=0.202). Multivariate analysis revealed a significant influence of relationship duration, VAS pain, fatigue, dryness, HADS-A/D, R-FIQ and all Qualisex items, on Qualisex Total score corrected for patients' age (p<0.001). CONCLUSIONS: This study validated Qualisex questionnaire as a good test for the sexual disorders' evaluation in FM women. Its use allows the assessment of different factors associated with sexual dysfunction, showing an impact of FM on sexuality. Moreover, due to demotivation feelings, sexual dysfunction contributes to worsen patients' quality of life.

Women and men with distressing low sexual desire exhibit sexually dimorphic brain processing.

Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects approximately 10% of women and 8% of men. In women, the 'top-down' theory of HSDD describes hyperactivity in higher-level cognitive brain regions, suppressing lower-level emotional/sexual brain areas. However, it is unknown how this neurofunctional disturbance compares to HSDD in men. To investigate this, we employed task-based functional MRI in 32 women and 32 men with HSDD to measure sexual-brain processing during sexual versus non-sexual videos, as well as psychometric questionnaires to assess sexual desire/arousal. We demonstrate that women had greater activation in higher-level and lower-level brain regions, compared to men. Indeed, women who had greater hypothalamic activation in response to sexual videos, reported higher psychometric scores in the evaluative (r = 0.55, P = 0.001), motivational (r = 0.56, P = 0.003), and physiological (r = 0.57, P = 0.0006) domains of sexual desire and arousal after watching the sexual videos in the scanner. By contrast, no similar correlations were observed in men. Taken together, this is the first direct comparison of the neural correlates of distressing low sexual desire between women and men. The data supports the 'top-down' theory of HSDD in women, whereas in men HSDD appears to be associated with different neurofunctional processes.

Analysis of sexual function of patients with dermatomyositis and polymyositis through self-administered questionnaires: a cross-sectional study / Análise da função sexual de pacientes com dermatomiosite e polimiosite através de questionários autoaplicados: um estudo transversal

Abstract Introduction: To date, there are no descriptions in the literature on gynecologic and sexual function evaluation in female patients with dermatomyositis (DM) and polymyositis (PM). Objective: To assess sexual function in female patients with DM/PM. Patients and methods: This is a monocentric, cross-sectional study in which 23 patients (16 DM and 7 PM), with ages between 18 and 40 years, were compared to 23 healthy women of the same age group. Characteristics on sexual function were obtained by applying the questionnaires Female Sexual Quotient (FSQ) and Female Sexual Function Index (FSFI) validated for the Brazilian Portuguese language. Results: The mean age of patients was comparable to controls (32.7 ± 5.3 vs. 31.7 ± 6.7 years), as well as the distribution of ethnicity and socioeconomic class. As for gynecological characteristics, patients and healthy controls did not differ with respect to age at menarche and percentages of dysmenorrhea, menorrhagia, premenstrual syndrome, pain at mid-cycle, mucocervical secretion, and vaginal discharge. The FSQ score, as well as all domains of the FSFI questionnaire (desire, arousal, lubrication, orgasm and satisfaction), were significantly decreased in patients vs. controls, with 60.9% of patients showing some degree of sexual dysfunction. Conclusions: This was the first study to identify sexual dysfunction in patients with DM/PM. Therefore, a multidisciplinary approach is essential for patients with idiopathic inflammatory myopathies, in order to provide prevention and care for their sexual life, providing a better quality of life, both for patients and their partners.

Resumo Introdução: Até o presente momento, não há descrições na literatura da avaliação ginecológica e da função sexual em pacientes do sexo feminino com dermatomiosite (DM) e polimiosite (PM). Objetivos: Avaliar a função sexual em pacientes do sexo feminino com DM/PM. Casuística e métodos: Estudo transversal unicêntrico em que 23 pacientes (16 DM e sete PM), entre 18 e 40 anos, foram comparadas com 23 mulheres saudáveis, com a mesma faixa etária. As características sobre a função sexual foram obtidas por meio da aplicação dos questionários Female Sexual Quotient (FSQ) e Female Sexual Function Index (FSFI) validados para a língua portuguesa do Brasil. Resultados: A média de idade das pacientes foi comparável à dos controles (32,7 ± 5,3 vs. 31,7 ± 6,7 anos), assim como a distribuição de etnia e da classe socioeconômica. Quanto às características ginecológicas, pacientes e controles saudáveis não apresentaram diferenças em relação à idade na menarca e às porcentagens de dismenorreia, menorragia, síndrome pré-menstrual, dor no meio do ciclo, secreção mucocervical e corrimento vaginal. O escore de pontuação do FSQ, assim como todos os domínios do questionário do FSFI (desejo, excitação, lubrificação, orgasmo e satisfação), estavam significantemente diminuídos nas pacientes comparativamente com os controles, 60,9% das pacientes apresentavam algum grau de disfunção sexual. Conclusões: Este foi o primeiro estudo que identificou disfunção sexual nas pacientes com DM/PM. Assim, uma abordagem multidisciplinar é essencial para pacientes com miopatias inflamatórias idiopáticas para fornecer medidas de prevenção e cuidados para sua vida sexual e propiciar uma melhor qualidade de vida das pacientes e de seus parceiros.

Sexual function, anxiety and depression in women with benign breast disease. A case-control study / Disfunção sexual, ansiedade e depressão em mulheres com câncer de mama benigno. Um estudo de caso-controle

Summary Introduction: Sexual dysfunction is highly prevalent, affecting 40% of the female population. The incidence of such dysfunction is known to be higher among women with malignant breast disease and in patients with depression or anxiety. However, there are few data regarding the prevalence of sexual dysfunction among women with benign breast disease (BBD). Objective: To evaluate the incidence of sexual dysfunction, depression and anxiety among women with BBD, in comparison with that observed for healthy women. Method: We evaluated the incidence of sexual dysfunction in 60 patients with benign breast disease (fibroadenomas, breast cysts, breast pain and phyllodes tumor) and 69 healthy women (control group). Participants completed the Sexual Quotient Questionnaire for Females (SQQ-F), the Beck Depression Inventory and the Beck Anxiety Inventory. Statistical analysis revealed that depression and anxiety were comparable between BBD and control groups (10.3 vs. 20.3% and 38.7 vs. 34.3%, respectively, p>0.05). The mean SQQ-F score (65.6±22.7 vs. 70.1±16.8; p>0.05) and sexual dysfunction (33.3 vs. 25.4%; p=0.324) were similar between BBD and control groups. Conclusion: We found no differences between women with BBD and healthy women in terms of the incidence of sexual dysfunction, anxiety and depression. Nevertheless, given the high prevalence of this condition, it is important to assess sexual quality of life, as well as overall quality of life, in women with BBD.

Resumo Introdução: A disfunção sexual é altamente prevalente, afetando 40% da população feminina. A incidência de tal disfunção é conhecida por ser maior entre as mulheres com câncer de mama e pacientes com ansiedade e depressão. No entanto, existem poucos dados sobre a prevalência de disfunção sexual entre mulheres com doença benigna da mama (BBD). Objetivo: Avaliar a incidência de disfunção sexual, depressão e ansiedade em mulheres com BBD, em comparação a mulheres saudáveis. Método: Avaliamos a incidência de disfunção sexual em 60 pacientes com doença benigna da mama (fibroadenomas, cistos mamários, dor mamária e tumor phyllodes) e 69 mulheres saudáveis (grupo controle). As participantes completaram o Questionário de Quociente Sexual para Mulheres (SQQ-F), o Inventário de Depressão de Beck e o Inventário de Ansiedade de Beck. A análise estatística revelou que a depressão e a ansiedade eram comparáveis entre os grupos BBD e controle (10,3 vs. 20,3% e 38,7 vs. 34,3%, respectivamente, p>0,05). O escore médio de SQQ-F (65,6±22,7 vs. 70,1±16,8; p>0,05) e a disfunção sexual (33,3 vs. 25,4%; p=0,324) foram semelhantes entre os grupos BBD e controle. Conclusão: Não encontramos diferenças entre mulheres com BBD e mulheres saudáveis em termos de incidência de disfunção sexual, ansiedade e depressão. No entanto, dada a alta prevalência dessa condição, é importante avaliar a qualidade de vida sexual, bem como a qualidade de vida global, em mulheres com BBD.

Anorgasmia masculina como síntoma inicial de mielitis transversa / Male anorgasmia as initial symptom of transverse myelitis

No disponible

Increased sexual arousal in patients with movement disorders / Exacerbação do impulso sexual em pacientes com distúrbios do movimento

ABSTRACT Increased of sexual arousal (ISA) has been described in different neurological diseases. The purpose of this study was present a case series of ISA in patients with movement disorders. Method Fifteen patients with different forms of movement disorders (Parkinson’s disease, Huntington’s disease, Tourette´s syndrome, spinocerebellar ataxia type 3), were evaluated in the Movement Disorders Unit of the Federal University of Paraná. Results Among Parkinson’s disease patients there were seven cases with different forms of ISA due to dopaminergic agonist use, levodopa abuse, and deep brain stimulation (DBS). In the group with hyperkinetic disorders, two patients with Huntington’s disease, two with Tourette’s syndrome, and four with spinocerebellar ataxia type 3 presented with ISA. Conclusions ISA in this group of patients had different etiologies, predominantly related to dopaminergic treatment or DBS in Parkinson’s disease, part of the background clinical picture in Huntington’s disease and Tourette’s syndrome, and probably associated with cultural aspects in patients with spinocerebellar ataxia type 3.

RESUMO A exacerbação do impulso sexual (EIS) tem sido descrita em diversas doenças neurológicas. O objetivo deste estudo foi apresentar uma série de casos de EIS em pacientes com distúrbios do movimento. Métodos Quinze pacientes com diferentes formas de distúrbios do movimento (Doença de Parkinson, doença de Huntington, síndrome de Tourette, ataxia espinocerebellar tipo 3), foram avaliados na Unidade de Distúrbios de Movimento-Universidade Federal do Paraná. Resultados Entre os pacientes com doença de Parkinson houve sete casos com diferentes formas de EIS devido ao uso de agonista dopaminérgico, abuso de levodopa ou estimulação cerebral profunda (DBS). No grupo com distúrbios hipercinéticos, dois pacientes com doença de Huntington, dois com síndrome de Tourette, e quatro com ataxia espinocerebelar tipo 3 apresentaram EIS. Conclusões EIS nesses pacientes decorreu de diferentes etiologias, relacionadas com o tratamento dopaminérgico ou DBS na doença de Parkinson, parte do quadro clinico na doença de Huntington e síndrome de Tourette, e provavelmente relacionado com aspectos culturais em pacientes com ataxia espinocerebelar tipo 3.

Sexualidad y climaterio: una mirada integral / Sexuality and climacteric: a comprehensive approach

Cuando hablamos de sexualidad humana debemos saber que estamos hablando de una compleja y cambiante interacción de factores biológicos y socioemocionales altamente influenciables por la familia, la religión y los patrones culturales. Esto se ve en los hombres y en las mujeres, especialmente en las mujeres. La sexualidad es un concepto intuitivo que cuesta definir. Según la Organización Mundial de la Salud, se define salud sexual como "un estado de bienestar físico, emocional, mental y social relacionado con la sexualidad, la cual no es solamente la ausencia de enfermedad, disfunción o incapacidad". Es una definición que tiene en cuenta varios conceptos, muy importantes todos ellos. La respuesta sexual consiste en una serie de cambios neurofisiológicos, hemodinámicos y hormonales que involucran al conjunto del organismo. Si bien es similar en ambos sexos, en las mujeres no siempre el inicio y la progresión se correlacionan en forma sistemática o lineal como en los hombres. Y de ese intrigante devenir de la respuesta sexual femenina surge la dificultad del diagnóstico de la "disfunción sexual femenina". Podríamos resumirla en "un conjunto de trastornos en los que los problemas fisiológicos o psicológicos dificultan la participación o la satisfacción en las actividades sexuales; lo cual se traduce en la incapacidad de una persona para participar en una relación sexual de la forma que le gustaría hacerlo"16. La menopausia es percibida por muchas mujeres como el fin de la sexualidad, y no solo como el fin de la vida reproductiva. Si bien es cierto que en esta etapa la actividad sexual suele declinar y puede verse afectada por una serie de factores hormonales, psicológicos y socioculturales, para la mayoría de las mujeres la sexualidad sigue siendo importante. Debemos comprender que la disfunción sexual femenina, en cualquier etapa de la vida, es multicausal y multidimensional. A la hora de realizar el abordaje de una paciente, debemos tener en cuenta todos los factores involucrados y saber con qué herramientas contamos. El abordaje terapéutico clásicamente incluye la terapia psicológica y la terapia hormonal. Sin embargo, recientemente se ha incorporado una nueva droga recientemente aprobada por la FDA de los Estados Unidos para el tratamiento del deseo sexual hipoactivo en la mujer: el flibanserín, un psicofármaco que actúa a nivel de mediadores del deseo sexual en el sistema nervioso central, favoreciéndolo. (AU)

When we talk about human sexuality, we know that we are talking about a complex and changing interaction between biological and socioemotional factors, which are highly influenced by society, family, religion and cultural norms. This can be seen in men and women especially in women. Sexuality is an intuitive concept difficult to define. According to the World Health Organization, it is defined as "A state of physical, emotional, mental and social well being related to sexuality, which is not merely the absence of disease, dysfunction or disabilityˮ. It is a definition that takes into account several concepts, all very important. Sexual response is a series of neurophysiological, hemodynamic and hormonal changes involving the whole body. While similar in both sexes, women are not always the onset and progression correlate systematically or linearly as in men. And that intriguing evolution of the female sexual response, the difficulty of diagnosis of "female sexual dysfunctionˮ. We could summarize it in "a group of disorders in which the physiological or psychological problems impede participation or satisfaction in sexual activities; which results in the inability of a person to participate in a sexual relationship the way she or he would like to do itˮ16. Menopause is perceived by many women as to the end of sexuality, not only as the end of reproductive life. Sexual activity declines with age, and may be affected by a number of hormonal, psychological and sociocultural factors, but, for most women it continues to be important. We must understand that female sexual dysfunction, at any stage of life is multicausal and multidimensional. When approaching a patient, it is important to know all the factors that are involved, and which tools we have for deal with it. Classically, the therapeutic approach has consisted of psychological therapy and hormone therapy. However, we have to consider a recently approved drug by the FDA for the treatment of hypoactive sexual desire in women: Flibanserin. It is a psychotropic substance that acts on the mediators of sexual desire on the central nervous system favoring it. (AU)

Successfully treatment of intercourse anejaculation with psychosexual counseling: a very rare case of situational anejaculation specific to penetrative sex with the wife / Tratamiento exitoso de la aneyaculación sexual con asesoramiento psicosexual: un caso muy raro de aneyaculación situacional específica en relaciones sexuales de penetración con la esposa

Situational anejaculation means that a man can ejaculate in some situations but not in others. Intercourse type of anejaculation means existence of ejaculation by masturbation, but not during sexual intercourse. In some cases, men may be able to ejaculate and attain orgasm with one partner but not with another. Performance anxiety, hostility toward the partner, dysfunctional psychosexual development, and unconscious desire to avoid pregnancy are the possible underlying conditions. We herein reported a case of wife-specific intercourse anejaculation succesfully treated with sexual therapy. According to our best knowledge, this is an important case study in literature about intercourse type of situational anejaculation specific to the patient's wife that was treated with psychosexual counseling. The authors conclude that this clinical course of situational intercourse anejaculation suggests a psychological problem in these patients and sexual therapy is effective

La aneyaculación situacional significa que un varón puede eyacular en algunas situaciones, pero en otras no. El tipo de aneyaculación sexual implica la existencia de eyaculación mediante la masturbación, pero no durante las relaciones sexuales. En algunos casos, los varones pueden ser capaces de eyacular y alcanzar el orgasmo con un compañero, pero no con otro. La ansiedad subyacente, la hostilidad hacia la pareja, el desarrollo psicosexual disfuncional y el deseo inconsciente de evitar el embarazo son las posibles situaciones de fondo. En este documento, informamos de un caso de aneyaculación sexual específica de la esposa tratada con éxito con terapia sexual. Según nuestro mejor conocimiento, este es el primer estudio de caso en la bibliografía sobre el tipo de relación sexual de la aneyaculación situacional específica de la esposa del paciente que fue tratado con asesoramiento psicosexual. Los autores concluyen que este curso clínico de aneyaculación del coito situacional sugiere un problema psicológico en estos pacientes y la terapia sexual es efectiva

Agonismo parcial dopaminérgico en la disfunción sexual secundaria a antipsicóticos / Dopamine partial agonism in antipsychoticinduced sexual dysfunction

Introducción. La disfunción sexual es un efecto secundario frecuente de los antipsicóticos. Ha sido relacionada con la hiperprolactinemia producida por el antagonismo dopaminérgico D2 propio de los fármacos antipsicóticos. El agonismo parcial dopaminérgico D2 del aripiprazol podría explicar por qué su utilización no suele producir ese efecto secundario y que incluso lo revierta al añadirse aripiprazol al tratamiento con otros antipsicóticos. Casos clínicos. Se presentan dos casos clínicos con un primer episodio psicótico en tratamiento con antagonistas dopaminérgicos D2, que desarrollan amenorrea y disfunción eréctil respectivamente. Tras añadir aripiprazol a su tratamiento antipsicótico previo remiten estos efectos secundarios manteniendo adherencia y eficacia terapéutica. Conclusiones. Los fármacos que pueden disminuir los efectos secundarios en la esfera sexual pueden mejorar la aceptación al tratamiento y la calidad de vida, especialmente en pacientes jóvenes con primeros episodios psicóticos. En los casos presentados, el uso de aripiprazol como fármaco adyuvante, se tradujo en una mejoría en los efectos secundarios de la esfera sexual, sin comprometer la eficacia terapéutica (AU)

Introduction. Sexual dysfunction is a frequent side effect associated with antipsychotic treatment. It is known to be caused by the hyperprolactinemia that results from the D2 receptor blockade that is characteristic of antipsychotic drugs. The D2 partial dopaminergic agonism of aripiprazole could explain why its use does not usually cause this side effect, and may even revert it when added to another antipsychotic. Case reports. We present the cases of two patients treated with D2 dopaminergic antagonists for a first episode of psychosis, who complained of amenorrhea and erectile dysfunction during follow-up. After the addition of aripiprazole to their previous antipsychotic treatment, these side effects reverted without a negative impact on treatment adherence or therapeutic efficacy. Conclusions. Pharmacological treatments with the potential of reverting sexual dysfunction secondary to antipsychotic treatment can improve compliance and quality of life of our patients, especially in those who are younger and are being treated for a first psychotic episode. In the cases reported here, the use of aripiprazole as an adjunctive treatment resulted in the disappearance of the undesirable effects without affecting the efficacy already achieved with the previous antipsychotic treatment (AU)

Actualización sobre el trastorno del deseo sexual hipoactivo femenino / Update on hypoactive sexual desire disorder in women

El deseo sexual hipoactivo (DSH) es la disfunción sexual femenina más común. Los autores han escogido las publicaciones más relevantes para analizar este tema. El diagnóstico de DSH requiere la presencia de malestar o dificultades interpersonales asociadas a un deseo sexual disminuido que no puede explicarse por otra afección psiquiátrica, y que no se debe exclusivamente a una enfermedad o sustancia. El DSH puede afectar gravemente al bienestar emocional y a las relaciones y sucede en mujeres premenopáusicas y posmenopáusicas. Hasta hace poco, el diagnóstico de DSH requería un extenso examen de un médico experimentado en diagnósticos de disfunción sexual femenina (DSF). La prueba del deseo sexual inhibido (PDSI) es un método de diagnóstico abreviado concebido para ayudar a los médicos que no son especialistas en DSF a diagnosticar el DSH adquirido en las mujeres. Es necesario profundizar en el estudio del DSH para comprender mejor la etiología y valorar las distintas opciones terapéuticas (AU)

Hypoactive sexual desire disorder (HSDD) is the most common type of female sexual dysfunction (FSD). A diagnosis of HSDD requires evidence of personal distress or interpersonal difficulty associated with low sexual desire that cannot be better accounted for by another psychiatric condition and is not due exclusively to a medical condition or substance. HSDD can have a major impact on women's emotional wellbeing and relationships and occurs in both pre- and post-menopausal women. Until recently, diagnosis of HSDD required an extensive diagnostic interview conducted by a clinician with experience in the diagnosis of FSD. The decreased sexual desire screener (DSDS) is a brief diagnostic instrument that has been developed to aid clinicians who are not experts in FSD to diagnose generalized acquired HSDD in women. There is a need for greater understanding of the etiology of HSDD and for more therapeutic options (AU)

Permanência das representações do gênero em sexologia: as inovações científica e médica comprometidas pelos estereótipos de gênero / Permanence of gender stereotypes in sexology: when scientific innovations are challenged by traditional gender stereotypes

Numerosas mudanças surgiram no domínio da pesquisa em sexologia, notadamente no que concerne à função e disfunções sexuais e seus tratamentos. A disfunção erétil foi reconceitualizada como uma disfunção com origem orgânica, uma transformação em relação às abordagens anteriores acerca da impotência psicogênica, desenvolvidas nos anos 1960 e 1970. Essa mudança se baseia em muitas descobertas científicas e no avanço farmacológico realizado sob influência de urologistas norte-americanos. A disponibilização no mercado do sildenafil, em 1998, acionou novos tipos de tratamentos, centrados na atividade peniana. Os mesmos grupos de urologistas passaram recentemente a repensar as "disfunções sexuais femininas" segundo o mesmo modelo orgânico da função sexual. Novos produtos farmacêuticos estão em testagem clínica, tendo em vista a proposta de tratamentos da nova categoria de transtornos sexuais. A colocação no mercado do sildenafil não provocou reações contrárias às novas abordagens dos transtornos sexuais masculinos. Inversamente, o surgimento de novos conceitos da função sexual feminina suscita importantes debates. O British Medical Journal veiculou uma discussão, estabelecendo que a função sexual feminina não possuía origem orgânica, mas fundava-se em fatores psicológicos e relacionais da atividade sexual das mulheres. O debate centrou-se na "simplicidade" da sexualidade masculina, em oposição à "complexidade" da sexualidade feminina. Este artigo apresenta a analisa as novas concepções da função sexual masculina e feminina, e evidencia a permanência de estereótipos tradicionais da sexualidade masculina e feminina, e sua influência sobre as pesquisas científicas mais avançadas nessa esfera1.

Major changes have occurred in male and female sexual function/dysfunction research and treatments. Male erectile dysfunction has been re-conceptualized as an organic dysfunction, which marks a dramatic shift from previous conceptions of psychogenic impotence developed during the 60' and the 70's. This shift is based on major scientific discoveries, and pharmacological advances that took place since the early 80's under the influence of North American urologists. The release of sildenafil in 1998 was the corner stone of a new paradigm of treatments focusing on male penile activity, far remote from any psychological approaches. More recently, the same group of urologists started to reconsider Female Sexual Dysfunction using the same organic/biological model of sexual function. New pharmaceutical products are currently under trial for the treatment of this new category of female sexual disorder. But as opposed to the absence of public adverse reaction to the development of this approach of male function, many voices raised to oppose this new conception of female function. A major discussion took place in the British Medical Journal stating that female sexual function was not organically driven, but rather determined by the social, psychological and interpersonal context of female sexual activity and relations. One of the major dimensions of this discussion opposed the so-called "simplicity" of male sexual function to the "complexity" of female sexual function. This paper demonstrates the permanence of traditional social scripts of male and female sexuality and their influence in the most advanced scientific research in this field.

La eyaculación prematura / Premature ejaculation

Los trastornos eyaculatorios son una de las áreas menos estudiadas dentro de las disfunciones sexuales masculinas. Los avances recientes sobre la eyaculación han permitido ahondar en el conocimiento de este proceso fisiológico de máxima importancia para la reproducción. La eyaculación consiste en una serie coordinada de fenómenos neurológicos y musculares, que dan lugar al depósito de los constituyentes del eyaculado en la uretra posterior para su evacuación anterógrada a través de la uretra. Recientemente se han dado a conocer estudios sobre la posible implicación genética en la etiopatogénia de este trastorno. También están apareciendo nuevas moléculas para el tratamiento farmacológico de esta condición que ayudarán a mitigar el sufrimiento de estos pacientes y sus parejas (AU)

Within the field of male sexual dysfunctions, ejaculation disorders are among the less studied areas. Recent developments have deepened our understanding of the physiologic process of ejaculation, so extremely important for reproduction. Ejaculation consists in a co-ordinated series of neurological and muscular phenomena that cause deposition of the ejaculate constituents into the posterior urethra for their antegrade expulsion through the urethra. Recently, studies have been published on potential genetic participation in the pathogenesis of premature ejaculation. New molecules are also emerging for the pharmacological treatment of this condition, and they will undoubtedly help to alleviate the suffering of these patients and their partners (AU)

Função sexual da mulher na transição menopausal: estudo transversal / Sexual function of woman in menopause transition: transversal study

Introdução: O período de transição entre os anos reprodutivos e não reprodutivos da mulher, que acontece na meia-idade, é conhecido como transição menopausal ou climatério. Este é caracterizado por alterações crônico-degenerativas devido ao hipoestrogenismo, entre eles alterações atróficas do tecido urogenital, causando diminuição do suporte pélvico e da lubrificação dos tecidos urogenitais acarretando vaginite, prurido vaginal, disfunções miccionais e distúrbios sexuais. Objetivo: Avaliar a função sexual de mulheres na transição menopausal. Casuística e Método: Foram avaliadas 40 mulheres sexualmente ativas, com idades entre 45 e 55 anos e que se encontravam na perimenopausa (grupo A) ou pós-menopausa natural, não fazendo (grupo B) ou fazendo (grupo C) uso de terapia hormonal, através do questionário ôQuociente Sexual - Versão Femininaõ, composto por 10 questões classificadas em escala de 5 pontos. Resultados: O grupo C apresentou uma média de 39,67 pontos, ou seja, ôruim a desfavorávelõ. Já o grupo B permaneceu com uma média de 52,00 pontos, ou seja, ôdesfavorável a regularõ e o grupo A obteve média total de 62,70 pontos, sendo um escore ôregular a bomõ. Conclusão: As mulheres que estão em transição menopausal possuem déficits na esfera da função sexual, principalmente as mulheres na pós-menopausa, fazendo ou não uso de TH, quando comparadas às pacientes na perimenopausa.

Interictal hyposexuality in male patients with epilepsy

The purpose of this study was to compare the serum levels of androgens between hyposexual and non-hyposexual patients with epilepsy. Adult male patients with epilepsy were investigated. Serum levels of testosterone (T) and free-T, estradiol, and sex hormone binding globulin (SHBG) were measured and the free androgen index (FAI) was calculated. While there were no differences between hyposexual and non-hyposexual patients in the serum levels of T, free-T, and estradiol, or to the FAI, the serum levels of SHBG were significantly higher in hyposexual patients than in non-hyposexual patients. Thus, the effects of increased SHBG upon serum levels of testosterone biologically active in patients with epilepsy and hyposexuality were not detected by the methods used in this study. Four (44 percent) of nine hyposexual patients who were re-evaluated after two years follow-up improved sexual performance. Thus, clinical treatment that results in good seizure control may improve sexual performance in some patients with epilepsy

Matrimonio no consumado durante diez años y vaginismo crónico / Ten-year unconsummated marriage and chronic vaginismus

Presentamos un caso de matrimonio no consumado durante 10 años y vaginismo crónico en una mujer de 30 años. Se le practica himenectomía y plastia de Pozzi (AU)

We report a case of unconsummated marriage for 10 years and chronic vaginitis in a 30-year-old woman. Hymenectomy and Pozzi's plasty were performed (AU)

Papel del sildenafilo en disfunción sexual femenina / Rol of sildenafil in female sexal dysfunction

No disponible

Factores cognitivos de la función sexual / Cognitive factors of the sexual function

Los factores cognitivos están asociados a múltiples estados emocionales; entre ellos, es importante la relación de la actividad cognitiva y la sexualidad humana. Así la identidad de género (masculino o femenino) es el producto de un aprendizaje ubicado en lo más profundo de esquemas auditivos. La actividad cognitiva está asociada a la activación del deseo sexual, tanto como lo están la percepción de los estímulos sexuales y la asociación mental de sexo y placer. Diferentes autore han desarrollado métodos de terapia cognitiva para el manejo de la ansiedad cognitiva influye de manera determinante en la calidad de la respuesta sexual. Tanto las investigaciones como las prácticas clínicas han establecido una clara correlación entre los factores de la sexualidad humana y, así mismo, ese conocimiento ha permitido incorporar técnicas que mejoran el pronostico de la terapia sexual

Disfunción sexual femenina / Female sexual dysfunction

: La disfunción sexual femenina (DSF) constituye un grupo de trastornos frecuente, que afecta a una de cada tres mujeres. Sin embargo, el conocimiento sobre la fisiología de la respuesta sexual femenina y sus alte-raciones es limitado. En la actualidad, el abordaje de la DSF es multidisciplinario, constituyendo un desafío para la investigación básica, la evaluación diagnóstica y las distintas opciones de tratamiento. En la esta revisión presentamos los diferentes aspectos relacionados con la función y disfunción sexual que involu-cran la clasificación actual de la DSF, la fisiopatología de los trastornos sexuales, la evaluación diagnóstica ac-tual y los distintos abordajes terapéuticos. Aún es necesario unificar criterios para continuar con la investigación >en esta área de la salud, fundamental para llevar a cabo los ensayos categorizados como Fases 11, 111 y IV en DSF.