Importancia de una intervención psicoeducativa sobre sexualidad en mujeres sometidas a una histerectomía: una revisión de la literature / Importance of a psychoeducational intervention on sexuality in women undergoing a hysterectomy: a review of the literature

RESUMEN: La Histerectomía es uno de los procedimientos quirúrgicos ginecológicos más frecuentes en el tratamiento de patologías uterinas. La literatura destaca al útero como un símbolo de identidad femenina y aunque existen diferencias individuales de afrontamiento, su extirpación puede causar alteraciones en la dimensión psicológica, física, social y sexual. El objetivo del estudio es determinar la importancia de una intervención psicoeducativa en mujeres ginecológicas histerectomizadas, para prevenir el riesgo potencial de presentar alteraciones emocionales y disfunciones sexuales post cirugía. METODOLOGÍA: Se revisaron 106 artículos originales de fuente primaria, en inglés, español, francés y portugués, publicados entre los años 2004 y 2016, en PubMed, Scielo, CINAHL, Ciber Index Cuiden, Lilacs, Elsevier y Scopus. RESULTADOS: El 100% de artículos reconocen en mujeres histerectomizadas, el riesgo de sufrir alteraciones emocionales y trastornos sexuales y el 61% reconoce, además la importancia de entregar educación sexual formal a la mujer y pareja, para prevenir trastornos sexuales, especialmente en histerectomizadas oncológicas, considerando intervinientes individuales y multidimensionales, temáticas de interés y capacitación de profesionales sanitarios en educación sexual. CONCLUSIONES: Una intervención psicoeducativa en la mujer y pareja, puede prevenir especialmente en histerectomizadas oncológicas la aparición de alteraciones emocionales y disfunciones sexuales, propiciar la recuperación física y emocional, un retorno a una vida sexual activa satisfactoria. Se sugieren estudios que comprueben la magnitud de esta intervención, para ser incorporada en un futuro al protocolo de atención de Garantías Explicitas en Salud en mujeres con cáncer cérvico uterino.

ABSTRACT: Hysterectomy is one of the most frequent gynecological surgical procedures in the treatment of uterine pathologies. Literature stands out uterus as a symbol of female identity and although there are individual differences in confronting, their extirpation can cause alterations in the psychological, physical, social and sexual dimensions. The objective of the study is to determine the importance of a psychoeducational intervention in hysterectomized gynecological women in order to prevent the potential risk of presenting emotional alterations and sexual dysfunctions after surgery. METHODOLOGY: 106 original articles of primary source in English, Spanish, French and Portuguese, published between 2004 and 2016, in PubMed, Scielo, CINAHL, Ciber Index Cuiden, Lilacs, Elsevier and Scopus were reviewed. RESULTS: 100% of articles recognize in hysterectomized women, the risk of suffering emotional alterations and sexual disorders, and 61% also recognize the importance of providing formal sexual education to women and partners in order to prevent sexual disorders, especially in oncological hysterectomized, considering individual and multidimensional interveners, topics of interest and training of health professionals in sexual education. CONCLUSIONS: A psychoeducational intervention in the woman and couple can prevent, especially in oncological hysterectomized, the appearance of emotional alterations and sexual dysfunctions, to propitiate the physical and emotional recovery, a return to an active satisfactory sexual life. Studies to prove the magnitude of this intervention are suggested in order to be incorporated in future to the care protocol for Explicit Health Guarantees in women with cervical cancer.

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.

Recomendaciones de GEAM/SPNS sobre el tratamiento de las alteraciones metabólicas y morfológicas en el paciente con infección por VIH / Recommendations of the Study Group for Metabolic Alterations/Secretariat for the National AIDS Plan (GEAM/SPNS) on the management of metabolic and morphologic alterations in patients with HIV infection

Objetivo. Efectuar una puesta al día de las alteraciones metabólicas y morfológicas presentes en los pacientes con infección por virus de la inmunodeficiencia humana (VIH), ahondando en su manejo clínico y tratamiento. Métodos. Estas recomendaciones han sido consensuadas por un comité de expertos en alteraciones metabólicas y en la atención al paciente con VIH, bajo los auspicios de la Secretaría del Plan Nacional sobre el Sida (PNS). Para ello se han revisado los últimos avances clínicos, epidemiológicos y fisiopatológicos reseñados en estudios publicados en las revistas médicas y/o presentados en los congresos. Resultados. Las alteraciones metabólicas que con mayor frecuencia aparecen en los pacientes con infección por VIH y en tratamiento antirretroviral (TAR) son la dislipidemia con perfil aterogénico y las alteraciones del metabolismo hidrocarbonado/resistencia a la insulina. Se ha descrito una elevada prevalencia de factores de riesgo cardiovascular, especialmente el tabaquismo. Para su manejo se han utilizado los mismos criterios que para la población general, con matices específicos. La dieta y el ejercicio deben ser la primera recomendación terapéutica. En los pacientes con dislipidemia y necesidad de tratamiento farmacológico, estarían indicadas las estatinas y/o los fibratos. En el tratamiento de la resistencia a la insulina las glitazonas han demostrado su eficacia. El abordaje del reparto anómalo de la grasa sigue siendo controvertido. El cambio de TAR, la cirugía reparadora, el soporte psicológico y los cambios de estilo de vida son las bases para abordar este problema en el momento actual. La acidosis láctica es una complicación infrecuente pero muy grave, siendo la primera actitud terapéutica la retirada del TAR. En cuanto a las alteraciones del metabolismo óseo son fundamentales la prevención y la detección precoz, especialmente en mujeres perimenopáusicas y niños. La disfunción sexual es un problema frecuente tanto en varones como en mujeres; la diversidad de causas obliga a un tratamiento individualizado. Conclusiones. La prevalencia de alteraciones metabólicas y morfológicas ha aumentado desde la introducción del tratamiento antirretroviral de gran actividad (TARGA). Es fundamental el conocimiento de los diversos aspectos relacionados con su diagnóstico y tratamiento para una correcta atención de los pacientes con infección por VIH (AU)

Objective. To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. Methods. These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. Results. The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and /or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. Conclusions. The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection (AU)

Sexualidad / Sexuality

El presente folleto brinda información sobre el significado de la sexualidad, las formas de expresarla, así como tambien sobre la relación sexual y que es el orgasmo y la frigidez