Personal factors that contribute to or impair women's ability to achieve orgasm.

This work aims to identify factors that contribute and those that impair the ability to experience orgasm during sexual activity. It compared women (n=96) aged 18-61 (M=38.5 years) in a stable relationship that, after a normal arousal phase, do not have an orgasm (OD) with those that do (OA) regarding sociodemographic data, sexual frequency, talking about sex with their physician, talking about sex with their partner, sexual education, masturbation, sexual desire, sexual satisfaction, depression and anxiety. We found differences between the OD and OA groups with regard to level of education (P=0.022), sex education during childhood and/or adolescence (P<0.001), masturbation (P=0.017), sexual satisfaction (P<0.001), anxiety (P<0.001) and sexual desire (P<0.001). The final model of logistic regression for orgasm problems included the variables 'masturbation', 'high school', 'sexual desire' and 'anxiety'. Orgasm difficulties are influenced by personal factors, such as anxiety and low sexual desire. Increased levels of anxiety also increase orgasmic difficulties. Women who masturbate and/or have completed high school are considerably more likely to reach orgasm during sexual activity.

Effects of the addition of methyltestosterone to combined hormone therapy with estrogens and progestogens on sexual energy and on orgasm in postmenopausal women.

OBJECTIVE: To evaluate the effect of the addition of methyltestosterone to estrogen and progestogen therapy on postmenopausal sexual energy and orgasm. METHODS: Sixty postmenopausal women in a stable relationship with a partner capable of intercourse, and presenting sexual complaints that appeared after menopause, were randomly divided into two groups: EP (n = 29) received one tablet of equine estrogens (CEE) 0.625 mg plus medroxyprogesterone acetate (MPA) 2.5 mg and one capsule of placebo; EP + A (n = 31) received one tablet of CEE 0.625 mg plus MPA 2.5 mg and one capsule of methyltestosterone 2.0 mg; The treatment period was 12 months. The effects of treatment on sexual energy were assessed using the Sexual Energy Change Scale. The ability to reach orgasm in sexual relations with the partner was verified through monthly calendars and by calculating the ratio between monthly frequency of orgasms in sexual relations and monthly sexual frequency. RESULTS: There was a significant relationship between improvement in level of sexual energy and the addition of methyltestosterone to CEE/MPA treatment (p = 0.021). No significant effect on orgasmic capacity was noted after the treatment period. CONCLUSION: Addition of methyltestosterone to CEE/MPA therapy may increase sexual energy, but might not affect the ability to obtain orgasm in sexual relations.

Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women--results of the Brazilian study on sexual behavior (BSSB).

The objective of this study was to assess the prevalence and risk factors of female sexual dysfunctions across a selection of social groups. In all, 1219 women in the community, aged 18 y or older, answered a 38-question self-applicable questionnaire. Statistical analysis was performed using multivariate logistic regression. The average age was 35.6 y (s.d.=12.31) and the average number of sexual intercourses was 2.8 (s.d.=1.94) a week. At least one sexual dysfunction was reported by 49% of the women; lack of sexual desire (LSD) by 26.7%; pain during sexual intercourse (PSI) by 23.1% and orgasmic dysfunction (OD) by 21%. Women aged over 40 y represented an LSD and OD risk factor, whereas women aged over 25 y showed less likelihood of presenting PSI. The educational level was inversely correlated with the risk of LSD, OD and PSI. Depression and cardiopathies increased PSI occurrences and women with diabetes mellitus showed a higher probability of developing LSD and OD. In conclusion, almost half the women had at least one sexual dysfunction, and prevalence increased with age and lower educational levels. Preventive medical care for the female population, mainly for patients with chronic and/or degenerative diseases, considerably reduced the chances of sexual dysfunction.

Perfil sexual da populaçäo brasileira: resultado do Estudo do Comportamento Sexual (ECOS) do Brasileiro / Sexual profile of brazilian population: results from Brazilian Study of Sexual Behavior(BSSB)

Objetivo: Apresentar os principais hábitos e disfunçöes sexuais da polpulaçäo brasileira. Materiais e métodos: Amostrta de 2.835 indivíduos (47 porcento homens e 53 porcento mulheres), maiores de 18 anos, foi pesquisada no ano de 2000. testes de qui-quadrado foram realizados. Resultados: Para homens, as principais disfunçöes foram: disfunçäo erétil (DE)- 46,2 porcento, ejaculaçäo precoce (EP)- 15,8 porcento, falta de desejo sexual (FDS)- 12,3 porcento e disfunçäo orgásmica (DO)- 10 porcento. Para mulheres: disfunçäo orgásmica (DO)- 29,3 porcento, dor à relaçäo sexual (DRS)- 21,1 porcento e falta de desejo sexual - 34,6 porcento. $,9 porcento dos homens e 16,4 porcento das mulheres näo têm vida sexual ativa.Mulheres iniciam vida sexual 5,6 anos mais cedo que há 40 anos. O número médio de relaçöes sexuais por semana foi de 3,1 para homens e 2,8 para mulheres. A maioria dos homens (72,4 porcento) e das mulheres (57,7 porcento) se disseram à vontade para falar de sexo, sendo os indivíduos mais velhos os mais insatisfeitos com a vida sexual. Afeto e carinho foram os elementos considerados mais importantes num relacionamento sexual, para homens (63,3 porcento) e para mulheres (71,3 porcento). O maior medo masculino numa relaçäo sexual foi näo satisfazer a parceira (62,6 porcento) e em segundo lugar contaminar-se com DST (58,3 porcento). Para mulheres, oresultado foi inverso: contaminar-se com DST (54,1 porcento) e näo satisfazer o parceiro (45 porcento). Conclusöes: DE é a disfunçäo mais referida entre os homens. DO e FDS säo muito mais comum em mulheres. Para homens, o maior medo é de mau desempenho sexual e para mulheres, contaminaçäo com DST. Insatisfaçäo sexual aumenta com a idade, para ambos os sexos. Nas últimas quatro décadas, o onício da vida sexual tem ocorrido mais cedo para mulheres, enquanto para homens näo se observou muita diferença.(au)

Prevalence and correlates of erectile dysfunction: results of the Brazilian study of sexual behavior.

OBJECTIVES: To determine the prevalence of erectile dysfunction (ED) and explore its potential sociodemographic, medical, and lifestyle correlates. METHODS: While attending the "Health Awareness Fair" in nine major cities in Brazil, 1286 men completed a questionnaire regarding ED, demographic data, and medical conditions. ED was assessed by a single global self-rating question, in which subjects were asked to describe themselves as able to achieve and maintain an erection good enough for sexual intercourse always, usually, sometimes, or never, and the responses were used to classify the subjects as having no, minimal, moderate, or complete ED, respectively. Age-adjusted bivariate and multivariate analyses were carried out to calculate the prevalence odds ratios and 95% confidence intervals for the potential covariates. RESULTS: Overall, 46.2% of men reported some degree of ED (minimal 31.5%, moderate 12.1%, complete 2.6%). The prevalence of complete ED increased 10 times from 1% to 11% between subjects younger than 40 and older than 70 years; moderate ED rose from 8% to 27%, and minimal ED remained constant at approximately 31%. In bivariate age-adjusted analyses, low educational attainment, black race/ethnicity, homo/bisexuality, and a history of diabetes, hypertension, or depression were significantly (P <0.05) associated with an increased prevalence of ED. In the multivariate logistic regression model, these variables remained significantly associated with ED. CONCLUSIONS: The results of our study show that ED is a major health problem in Brazil and both the severity and prevalence increase with age. The medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients who are at risk of ED, as well as offer clues to the etiology of ED.

OCD and transvestism: is there a relationship?

OBJECTIVE: There have been reports of obsessive-compulsive disorder (OCD) patients with comorbid paraphilias. In this paper, two cases of comorbidity between OCD and transvestism are reported with the aim of discussing possible explanations for this association. METHOD: Longitudinal case studies of two patients with OCD and tranvestism according to the DSM-IV were assessed using semi-structured interviews. RESULTS: Both patients presented with OCD and comorbid transvestism with different clinical features and treatment response. The case whose cross-dressing was more egodystonic responded better to treatment. CONCLUSION: It is possible that some cases of transvestism are OCD-related while others are more related to a gender identity disorder. A dimensional approach focusing on common phenomenological and neurobiological substrates is suggested as particularly useful for clinical management and future research of both disorders.

Pedofilia: uma Proposta Terapeutica / Pedophilia: a therapeutic purpose

Os autores fazem uma revisao bibliografica sobre pedofilia, um transtorno da preferncia sexual que ocorre principalmente em homens e que acarreta varios problemas sociais, legais e pessoais, dando enfase aos aspectos terapeuticos. Apresentam como ilustracao o relato de um paciente de 35 anos de idade com diagnostico de pedofilia, que realiza tratamento psicoterapico e medicamentoso

Diagnóstico em psiquiatria e relaçäo médico-paciente / Psychiatric diagnosis and physician-patient relationship

A autora salienta a importância do diagnóstico, como procedimento médico. Em seguida, apresenta um breve histórico do desenvolvimento da Psiquiatria e do diagnóstico psiquiátrico para, entao, caracterizá-lo como pluridimensional e comentar sua sistematizaçao, privilegiando a sistemática de Leme Lopes. Chama a atençao para a atual tendência de sistemas classificatórios ateóricos em relaçao à etiologia. E, paradoxalmente, de recursos cada vez mais sofisticados, no campo do diagnóstico causal. Alerta para o reconhecimento das tensoes geradas pelo curso médico, as quais podem contribuir para a complexidade dos procedimentos diagnósticos, com prejuízo do aperfeiçoamento da relaçao médico-paciente e da finalidade terapêutica da Medicina e da Psiquiatria.

[Psychiatric diagnosis and physician-patient relations]. / Diagnóstico em psiquiatria e relação médico-paciente.

The author emphasizes the importance of diagnosis as a medical procedure. A brief history of Psychiatry development and of the psychiatric diagnosis in order to characterize it as multiple and to comment its systematization paying special attention to Leme Lopes point of view. The current predominance of non-theoretical classifying systems concerning etiology and, paradoxically, of more and more advanced resources in the causal diagnostic is pointed out. The author also stands out the recognition of the tensions generated by the medical studies, which may contribute to the complexity of the diagnostic procedures and to the damage of the development of the doctor-patient relationship as well as the therapeutic purpose of Medicine and Psychiatry.

Sexual disorders: demographic and diagnostic profile during one year of a multidisciplinary project.

Taking into consideration a study published 10 years ago on sexual disturbances of students at the University of São Paulo, the importance of the subject is discussed, along with the creation in 1993 of the Sexuality Project at the university hospital of the University of São Paulo School of Medicine. In its first year, this multidisciplinary project attended 140 patients with sexual dysfunctions (associated or not to other clinical manifestations); the majority were younger than 60 years-old, and 80 percent were male.

The Sexuality Project (Pro-Sex) of the Institute of Psychiatry of the HCFMUSP: first year of activities.

The results of one year of activities of a multidisciplinary staff comprised of five psychiatrists, one urologist, one gynecologist, and seven psychologists, who integrate the Sexuality Project (PRO-SEX) of the institute of Psychiatric. Hospital das Clinícas, College of Medicine, University of São Paulo (FMUSP), are presented. Different sexual disorders were evaluated and treated in 140 patients (116 men and 24 women). In addition, a standard protocol was established for the medical assistance of patients; four research projects have been initiated; and courses were offered to residents in psychiatry, urology, and obstetrics-gynecology, as well as to undergraduate and postgraduate students of FMUSP. The PRO-SEX staff presented their research at one congress and two symposiums, and published four articles. Furthermore, an extensive program was established for 1995 in order to continue the advanced medical study of human sexuality.