Sexual dysfunction and drug use in women: A reciprocal etiologic relationship / Disfunción sexual y uso de drogas en mujeres: una relación etiológica recíproca

Objective: To reflect on the reciprocal etiologic relationship between female sexual dysfunction and drug abuse, and its implications for practice and research. Materials and Methods: A description of the effects and short-term and long-term consequences of drug use in women is presented together with an analysis of whether drug use is the cause of sexual dysfunction or on the contrary, if sexual dysfunction leads to drug abuse. The need to conduct further research into the relationship between these two variables and their clinical implications is also discussed. Conclusion: Drug use affects female sexual function, hence the importance of initial diagnosis and sexual rehabilitation following chronic use of psychoactive substances; Implementing prophylactic measures in order to reduce drug use during sexual activity and its associated consequences; and expanding research in this area of medical and psychological knowledge.

Objetivo: realizar una reflexión sobre la relación etiológica recíproca entre la disfunción sexual femenina y la drogodependencia, y sus implicaciones prácticas e investigativas. Materiales y métodos: se presenta una descripción de los efectos y las consecuencias a corto y a largo plazo del uso de drogas en mujeres y se analiza si el uso de drogas es la causa de la disfunción sexual o si, por el contrario, la disfunción sexual conduce al uso de drogas. Asimismo, se discute la necesidad de ahondar en la investigación que relaciona estas dos variables y sus implicaciones clínicas. Conclusión: el consumo de drogas afecta la función sexual femenina, por lo que es pertinente un diagnóstico inicial y la rehabilitación sexual tras el uso crónico de sustancias psicoactivas; asimismo, se hace indispensable implementar medidas profilácticas para disminuir el uso de drogas en la actividad sexual y sus consecuencias asociadas, y ampliar la investigación de esta área del conocimiento médico y psicológico.

Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese / Tradução e adaptação transcultural da Arizona Sexual Scale (ASEX) para a língua portuguesa

Abstract Introduction Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. Methods The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. Results The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. Conclusion The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.

Resumo Introdução A disfunção sexual é comum em indivíduos com doenças psiquiátricas e sob o uso de medicações como antidepressivos e antipsicóticos. Várias escalas foram desenvolvidas para avaliar a função sexual desses doentes. A Arizona Sexual Scale (ASEX) é uma escala de cinco itens de avaliação que quantifica desejo sexual, excitação, lubrificação vaginal/ereção peniana, capacidade para atingir o orgasmo e satisfação com o orgasmo. Este artigo descreve o processo de tradução e adaptação transcultural da escala ASEX para a língua portuguesa, com o objetivo de contribuir para a avaliação da função sexual dos doentes medicados com fármacos psicotrópicos nos vários países onde se utiliza essa língua. Métodos A tradução e a adaptação transcultural seguiram de forma detalhada os passos recomendados pelo grupo de trabalho da International Society for Pharmacoeconomics and Outcomes Research (ISPOR), nomeadamente: preparação, tradução inicial, reconciliação, retroversão, revisão da retroversão, harmonização, teste cognitivo, revisão do teste cognitivo, finalização, leitura final e versão final. Resultados O processo foi completado com sucesso, e não foram observadas diferenças grandes entre as fases de tradução, reconciliação e retroversão, tendo sido feitos apenas pequenos ajustes. Conclusão A tradução da escala ASEX foi bem-sucedida, seguindo orientações internacionais de referência. A aplicação dessas orientações é a garantia de uma versão em língua portuguesa que é qualitativa e semanticamente equivalente à versão original da escala. A existência desta nova versão da escala permitirá estudos que avaliem a função sexual dos doentes em países nos quais se fale a língua portuguesa. Estudos futuros poderão atestar a validade da escala para essas populações.

Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese.

INTRODUCTION: Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. METHODS: The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. RESULTS: The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. CONCLUSION: The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.

Sexual addiction in drug addicts: The impact of drug of choice and poly-addiction.

OBJECTIVE:: To compare the risk of comorbid sexual addiction in a sample of individuals with a diagnosis of substance dependence, stratifying the sample by drug of choice as well as by mono versus polysubstance addiction. METHOD:: All data were collected at Santa Casa de São Paulo, Brazil. The study sample comprised all alcohol or drug dependents admitted to the Addiction Treatment Unit between November 2013 and August 2014. A generalized linear model with a binomial distribution was performed to compare the odds of having a Sexual Addiction Screening Test (SAST) score greater than 6 points in the subgroups analyzed. RESULTS:: A total of 133 participants were included in our analysis, all reporting cocaine/crack and/or alcohol as drug of choice. Polysubstance addicts had a significant higher risk of a positive screening for sexual addiction compared to monosubstance addicts, age-sex adjusted odds ratios of sexual addiction being respectively 2.72 (95CI 1.1-6.71) and 0.37 (95CI 0.15-0.91). The odds of a SAST score greater than 6 was not statistically different between the cocaine/crack and alcohol groups, respectively 0.38 (95CI 0.14-1.02) and 2.67 (95CI 0.98-7.25). We found a significant relation between stronger drug addiction and greater levels of sexual addiction in the cocaine/crack group (p=0.0012), but not in the alcohol group. CONCLUSION:: Our study reinforces the importance of assessing sexual behavior of drug addicts in clinical practice, especially considering users of multiple substances or with severe dependence.

Sexual addiction in drug addicts: The impact of drug of choice and poly-addiction / Dependência sexual em dependentes químicos: o impacto de diferentes drogas de escolha e de polidependência

Summary Objective: To compare the risk of comorbid sexual addiction in a sample of individuals with a diagnosis of substance dependence, stratifying the sample by drug of choice as well as by mono versus polysubstance addiction. Method: All data were collected at Santa Casa de São Paulo, Brazil. The study sample comprised all alcohol or drug dependents admitted to the Addiction Treatment Unit between November 2013 and August 2014. A generalized linear model with a binomial distribution was performed to compare the odds of having a Sexual Addiction Screening Test (SAST) score greater than 6 points in the subgroups analyzed. Results: A total of 133 participants were included in our analysis, all reporting cocaine/crack and/or alcohol as drug of choice. Polysubstance addicts had a significant higher risk of a positive screening for sexual addiction compared to monosubstance addicts, age-sex adjusted odds ratios of sexual addiction being respectively 2.72 (95CI 1.1-6.71) and 0.37 (95CI 0.15-0.91). The odds of a SAST score greater than 6 was not statistically different between the cocaine/crack and alcohol groups, respectively 0.38 (95CI 0.14-1.02) and 2.67 (95CI 0.98-7.25). We found a significant relation between stronger drug addiction and greater levels of sexual addiction in the cocaine/crack group (p=0.0012), but not in the alcohol group. Conclusion: Our study reinforces the importance of assessing sexual behavior of drug addicts in clinical practice, especially considering users of multiple substances or with severe dependence.

Resumo Objetivo: Comparar o risco de dependência sexual em uma amostra de indivíduos com diagnóstico de dependência química, estratificados por droga de escolha e por dependência única ou de múltiplas substâncias. Método: Todos os dados foram coletados na Santa Casa de São Paulo, Brasil. A amostra estudada correspondeu a todos os indivíduos dependentes de álcool ou outras substâncias admitidos no Ambulatório de Dependência Química entre novembro de 2013 e agosto de 2014. Modelos lineares generalizados com distribuição binomial foram utilizados para comparar o risco de escores maiores que seis na Escala de Rastreamento para Dependência de Sexo (SAST) nos subgrupos analisados. Resultados: Foram analisados os dados de 133 pacientes usuários de cocaína/crack e/ou álcool. Usuários de múltiplas substâncias apresentaram risco significativamente maior de um screening positivo para dependência sexual comparados com usuários de uma única substância. Os odds ratios de dependência sexual ajustados por sexo e idade obtidos nos dois grupos foram, respectivamente, 2.72 (IC95% 1.1-6.71) e 0.37 (IC95% 0.15-0.91). O risco de dependência sexual entre usuários de cocaína/crack e álcool foi estimado, respectivamente, em 0.38 (IC95% 0.14-1.02) e 2.67 (IC95% 0.98-7.25), não indicando diferença significativa. Foi encontrada uma relação significativa entre severidade de dependência química e maiores níveis de dependência sexual entre dependentes de cocaína/crack, mas não de álcool. Conclusão: Nosso estudo reforça a importância de avaliar o comportamento sexual de dependentes químicos na prática clínica, especialmente considerando usuários de múltiplas substâncias, ou casos de maior severidade.

Sexual function and chemotherapy in postmenopausal women with breast cancer.

BACKGROUND: This cross-sectional, nested cohort study assessed Female Sexual Function Index (FSFI) scores in postmenopausal women with breast cancer receiving primary chemotherapy. METHODS: The FSFI questionnaire was administered to 24 postmenopausal women one month after diagnosis of breast cancer (post-diagnosis group) and one month after completion of the first cycle of primary anthracyclin-based chemotherapy (post-chemotherapy group). Scores were compared to those of 24 healthy postmenopausal women seeking routine gynecological care (control group). All patients were sexually active at the time of enrollment. Mean age was 57.29 ± 11.82 years in the breast cancer group and 52.58 ± 7.19 years in the control group. RESULTS: Scores in all domains of the FSFI instrument were significantly lower in the post-diagnosis group than in controls (-41.3%, p < 0.001). A further major reduction in FSFI scores was evident on completion of one cycle of primary chemotherapy (down 46.7% from post-diagnosis scores, p < 0.003), again in all domains. Six patients (25%) ceased all sexual relations, in a significant change from baseline (p < 0.001). After one chemotherapy cycle, a further five patients ceased sexual activity, for a total of 11 (45.8%) participants--a borderline significant difference (p = 0.063). CONCLUSION: The present study shows that female sexual function as assessed by the FSFI declines significantly at two distinct points in time: upon diagnosis of breast cancer and after administration of systemic chemotherapy.

Agomelatine: an antidepressant without deterioration of sexual response.

Sexual dysfunctions caused by the use of antidepressants are relatively common. Agomelatine has demonstrated antidepressant properties in comparative studies with sertraline, fluoxetine, and venlafaxine as active controls. The aim of this study was to evaluate the effects of agomelatine on sexual response. Acutely depressed patients (n = 25) treated with agomelatine (25-50 mg/day) were evaluated over 12 weeks. Agomelatine showed a favorable response on depressive symptoms using the Montgomery-Åsberg Depression Rating Scale throughout the study. The Clinical Global Impression improvement score at the end of the study was 1.70 (SD = 0.89). The author assessed sexual response using the Arizona Sexual Experiences Scale, the International Index of Erectile Function, and a Visual Analogue Scale for desire, arousal, time, and intensity of orgasm and vaginal lubrication. Arizona Sexual Experiences Scale scores improved after 3 weeks of treatment, mainly attributable to an improvement in women rather than in men. The Visual Analogue Scale showed improvement in all stages of sexual response in women, with minimal changes in men. Clinical Satisfaction Scores at the end of the study for all patients were 7.00 (SD = 1.53). In conclusion, agomelatine appears to be a good option for the treatment of depression because it would not have adverse effects on sexual function.

Frequency of treatment-emergent sexual dysfunction and treatment effectiveness during SSRI or duloxetine therapy: 8-week data from a 6-month observational study.

BACKGROUND: In randomised controlled trials, the frequency of treatment-emergent sexual dysfunction (TESD) in patients with major depressive disorder (MDD) at week 8 was lower with duloxetine than selective serotonin reuptake inhibitor (SSRI) therapy. METHODS: This 6-month, prospective, observational study compared the frequency of TESD (using the Arizona Sexual Experience [ASEX] scale) in MDD patients treated with duloxetine or SSRI monotherapy in the first 8 weeks in normal clinical practice. RESULTS: Physician-assessed TESD frequency at week 8 was comparable with duloxetine and SSRI monotherapy (23.9 and 26.2%, respectively; P = 0.545). Improvements in Clinical Global Impressions of Severity (CGI-S), 16-item Quick Inventory of Depressive Symptomatology (Self-Report) (QIDS-SR(16)), Integral Inventory for Depression (IID) total scores and remission rates were statistically significantly greater with duloxetine than SSRI monotherapy (P < 0.001, 0.010, <0.001, and 0.002, respectively), but TESD attenuated improvements in quality of life measures (EuroQoL questionnaire-5 dimensions [EQ-5D] and Sheehan Disability Scale [SDS] scores: ≤0.012). Several factors were significantly (P ≤ 0.05) associated with TESD at week 8 in this study. CONCLUSIONS: TESD rates with duloxetine and SSRIs at week 8 were comparable, however, significant differences in effectiveness were observed in favour of duloxetine. Antidepressant tolerability with respect to TESD must be managed to maximize remission of depressed patients.

Treatment-emergent sexual dysfunction with SSRIs and duloxetine: effectiveness and functional outcomes over a 6-month observational period.

OBJECTIVE: To evaluate frequencies of treatment-emergent sexual dysfunction (TESD) in patients with major depressive disorder (MDD) treated with duloxetine or selective serotonin reuptake inhibitor (SSRI) monotherapy for up to 6 months in a prospective, observational study. METHODS: Sexually active MDD patients without sexual dysfunction at entry were enrolled from twelve countries (N = 1,647). TESD was assessed over the study period using the Arizona sexual experience (ASEX) scale. A priori-specified secondary 6-month clinical endpoints were also examined. RESULTS: The frequency of TESD at 6 months with duloxetine was comparable to that with SSRI monotherapy (23.4 and 28.7%, respectively; P = 0.087). Improvements in Clinical Global Impressions of Severity (CGI-S), 16-item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR(16)), Integral Inventory for Depression (IID) total scores, remission and sustained remission rates were statistically significantly greater with duloxetine than SSRI monotherapy at 6 months (P < 0.001 for each), but TESD attenuated improvements in quality of life measures. Four factors were consistently significantly (P ≤ 0.05) associated with TESD at week 8 and 6 months. CONCLUSIONS: Six-month TESD rates were comparable between duloxetine and SSRIs, with greater MDD effectiveness in favour of duloxetine. Improved recognition and management of TESD may improve quality of life for MDD patients in usual clinical practice.

Hiperprolactinemia y disfunción sexual en el primer episodio psicótico tratado con risperidona / Hiperprolactinaemia and sexual disfunction in first psychotic episode treated with risperidone

Hyperprolactinemia and Sexual dysfunction are frequent, yet seldom studied, complications of the use of risperidone Objectives: To determine the prevalence and clinical correlates of sexual dysfunctions and hyperprolactinemia in a sample of young people with schizophrenia treated with risperidone. Methods: 40 outpatients (19 females; mean age: 27 years) with schizophrenia treated with risperidone, participated in the study Sexual dysfunction and quality of life were assessed with the Massachusetts General Hospital Sexual Functioning Questionnaire (MGH-SFQ) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), respectively All patients were evaluated with the Positive and Negative Syndrome Scale and the UKU side effect rating scale. Blood samples were analyzed for prolactine. Results: Hyperprolactinemia was found in 90 percent of patients, with levels significantly higher in women. Sexual dysfunctions occurred in 25 (62.5 percent) patients. Patients with and without sexual dysfunction, did not significantly differ in gender, age or years of treatment. Although no association was found with prolactinemia or the dose of risperidone, patients with sexual dysfunction reported more psychic and neurologic side effects, and had higher scores in the negative symptoms and general psychopatology subscales of the PANSS and lower scores in the physical health and mood items of the Q-LES-Q. Conclusions: Results confirm the high prevalence of hyperprolactinemia and sexual dysfunctions in people with schizophrenia. Further study is warranted in order to clarify the association between sexual dysfunction and risperidone treatment in clinical practice and its impact in the quality of life of the patients.

La hiperprolactinemia y las disfunciones sexuales son complicaciones frecuentes, pero poco estudiadas del tratamiento con risperidona. Objetivos: Determinar la prevalencia de hiperprolactinemia y disfunciones sexuales en un grupo de personas jóvenes con esquizofrenia, tratadas con risperidona. Métodos: Un total de 40 pacientes (19 mujeres, edad promedio: 27 años) completaron el Cuestionario de Funcionamiento Sexual del Hospital General de Massachussets y el Cuestionario sobre Calidad de Vida: Satisfacción y Placer. Todos los pacientes fueron evaluados con las escalas PANSS y UKU y se determinó su nivel plasmático de prolactina. Resultados: El 90 por ciento de los pacientes presenta hiperprolactinemia, con valores significativamente más altos para las mujeres. El 62,5 por ciento de los pacientes, informó padecer alguna disfunción sexual, sin diferencias con la contraparte no afectada, en cuanto a género, edad ni tiempo de tratamiento. Aunque no se encontró relación con la prolactinemia, ni con la dosis de risperidona, quienes reportaron alguna disfunción sexual obtuvieron mayores puntajes de efectos adversos psíquicos y neurológicos en la escala UKU. Las disfunciones sexuales se asociaron con los síntomas negativos y generales de la PANSS y con menores puntajes en las subescalas de salud física y ánimo del Cuestionario sobre Calidad de Vida: Satisfacción y Placer. Conclusiones: Los resultados confirman la elevada frecuencia de disfunciones sexuales e hiperprolactinemia en las personas enfermas de esquizofrenia. Nuevos estudios se requieren para clarificar, en la práctica clínica habitual, la asociación entre disfunción sexual y el empleo de la risperidona, y su impacto en la calidad de vida de los pacientes.

[Assessment of sexual function from a psychopharmacological viewpoint]. / La evolución de la función sexual desde la óptica psicofarmacológica.

The aim of this paper is to discuss aspects linked to the assessment of sexual activity in mental health patients. Traditionally, and to this day, this assessment has received insufficient consideration by intervening professionals. Emphasis is made on determining the onset of sexual dysfunction with respect to the disorder prompting the visit. Schizophrenia is taken as the paradigm of the pathology least considered as regards assessment of the sexual activity of those suffering from this disorder.

Antidepresivos y disfunción sexual / Antidepressants and sexual disfunction

The purpose of this work is to check the existing information in literature about the relationship between antidepressant medication and sexual dysfunctions, in order to optimize the selection of a therapeutical plan that avoids these side effects. A method of manual revision of the publications related to the topic was used utilizing the data bases available. Results: tricycles are the drugs that present the most undesired symptoms in the sexual area; the reversible IMAO compromise the sexuality in a minor way, in comparison to classical IMAO s, but they have less antidepressant effectiveness; SSRIs and venlafaxine involve the sexual response in all its phases; bupropion, nefaxodone and mirtazapine are the safest drugs in this respect; according to animal samples, various neurotransmitters, hormones and endogens opioids are directly or indirectly involved in the sexual response of antidepressants; the finding of new drugs with different action profiles has allowed amplifying the alternatives for treatment. This knowledge permits the establishment of better decision taking in the management and monitoring of these unwanted side effects.

El objetivo de este trabajo es revisar la información en la literatura sobre la relación entre la medicación antidepresiva y las disfunciones sexuales, con la finalidad de optimizar la elección de un esquema terapéutico que evite estos efectos secundarios. Se utilizó un método de revisión anual de las publicaciones relacionadas con el tema en diversas bases de datos disponibles. Resultados: los triciclicos son los fármacos que presentan mayores síntomas adversos en la esfera sexual; los IMAO reversibles si bien comprometen en menor forma la sexualidad en comparación con los irreversibles, poseen una menor eficacia antidepresiva; ISRS y venlafaxina comprometen la respuesta sexual en todas sus fases; Bupropion, nefazodona, mirtazapina se constituyen como los fármacos más seguros respecto, según modelos animales diversos neurotransmisores, hormonas y opiodes endógenos están involucrados de forma directa o indirecta sobre la respuesta sexual de los antidepresivos; La aparición de nuevos fármacos con distintos perfiles de acción ha permitido contar con un mayor número de alternativas de tratamiento cuyo conocimiento permite establecer conductas útiles en el manejo y monitorización de estos efectos adversos.

Tratamento das disfunçöes sexuais conseqüentes ao uso de antidepressivos / Sexual dysfunction treatment as a complication of antidepressives use

A disfunçao sexual é um dos efeitos adversos, mais freqüentes, induzidos pelo uso de antidepressivos. Diminuiçao da libido, disfunçao erétil, alteraçoes do orgasmo e da ejaculaçao, dor, anestesia vaginal e peniana sao relatos mais comuns. Estratégias para reverter a disfunçao sexual induzida pelos antidepressivos sao usadas com freqüência, entre elas destacam-se: tempo de tolerância para o desenvolvimento, reduçao da dosagem, suspensao do tratamento no final da semana, troca do antidepressivo ou o acréscimo de um novo medicamento. A escolha para que se proceda uma destas intervençoes dependerá das queixas do paciente.

Disfunçäo sexual associada ao uso de antidepressivos / Sexual dysfunction associated with antidepressant therapy

A disfunçÝo sexual é um efeito colateral bastante conhecido relacionado ao uso de antidepressivos. Noventa pacientes em uso de vários antidepressivos foram avaliados. Observou-se que a maioria dos casos nÝo cumpriam seus programas terapêuticos devido à disfunçÝo sexual. As principais alteraçSes encontradas foram diminuiçÝo da libido, retardo ou inibiçÝo da ejaculaçÝo, inibiçÝo do orgasmo, disfunçÝo erétil e orgasmo doloroso