[Women's sexual function through sexual response models: From DSM-IV to DSM-5].

Until recently, DSM classifications regarding women's sexual dysfunctions were based on definitions that mainly derived from experts opinions, rather than clinical or epidemiological studies. Additionally, this classification was the same for men and women, taking for granted the existence of a single sexual response model for men and women. More specifically, the main models that were described and prevailed were the linear models of Master's & Johnson and Kaplan, as well as the circular model of Rosemary Basson that followed. The differences between linear and circular models have to do mainly with the fact that stages of sexual response overlap with each other in the circular model, while the initiation of sexual activity may not need the presence of spontaneous sexual desire. In linear models, the stages of sexual desire, arousal, orgasm and resolution follow each other in a stable manner, in contrary to circular models where sexual desire may not be neither the first stage nor the main reason for sexual activity. In this case, reasons for sexual activity may vary, focusing also on other aspects of human sexuality and personality and not only on innate sexual desire. DSM-5 based the classification of sexual dysfunctions on the circular model, although there is still not enough evidence to prove that all men and women can be represented by the same sexual response model throughout the lifespan. Apart from the aforementioned sexual response models, also other models have been described by several investigators, making an important effort to give a more accurate and complete description of human sexual function, as well as its disorders. The present article makes an attempt to review the sexual response models that have been described by the literature up to date, as well as to relate them to the DSM-IV and DSM-5 classifications.

Serum beta-endorphin levels in morbidly obese patients: the effect of vertical banded gastroplasty.

The associations between serum beta-endorphin levels and clinical and metabolic variables as well as beta-endorphin changes after surgically induced weight loss were investigated in 43 morbidly obese patients. A significant positive correlation between beta-endorphin and body weight, degree of body weight increase and ACTH was found preoperatively. Only body weight was independently associated with beta-endorphin levels. Twelve months following vertical banded gastroplasty, there was an extensive weight loss in all patients and improvement in their metabolic profile. A significant reduction in beta-endorphin levels which was proportional to the extent of weight loss was also observed.

The effect of vertical banded gastroplasty on glucose-induced beta-endorphin response.

BACKGROUND: beta-Endorphin is an endogenous opioid involved in the regulation of food intake and obesity as well as in insulin metabolism. In this study, we investigated glucose-induced beta-endorphin, insulin, and glucose responsiveness in morbidly obese patients and the effect of surgically induced weight loss. METHODS: Thirty-two healthy, nondiabetic, morbidly obese patients (body mass index over 40 kg/m2) and 32 normal-weight controls were studied. Serum levels of beta-endorphin, insulin, and glucose were measured under basal conditions and during an oral glucose tolerance test (OGTT) before and 12 months following vertical banded gastroplasty. RESULTS: Preoperative basal levels of beta-endorphin, insulin, and glucose and their responses during OGTT in obese patients were significantly higher compared with those of controls. After surgery, basal beta-endorphin, insulin, and glucose levels decreased significantly compared with preoperative values. Postoperative basal insulin and glucose levels were similar to those in controls, while beta-endorphin levels remained significantly higher than those of controls. A significant reduction in total responses of beta-endorphin, insulin, and glucose during OGTT was also observed; however, postoperative beta-endorphin and insulin responses remained significantly higher than in controls. CONCLUSION: Morbidly obese patients have an increased glucose-stimulated response of beta-endorphin, insulin, and glucose which is partially corrected with weight loss following vertical banded gastroplasty.

Impotence and its non-surgical management.

Impotence is a common symptom which can cause considerable distress to both the sufferer and his partner. The use of pharmacotherapy to improve erectile function will continue to increase as safe and effective drugs are developed. However, restoring erectile function should not be the only treatment objective. It is also essential to address personal and emotional factors in the sufferer, conflicts in his relationship with his partner, and sexual problems in his partner, all of which may be instrumental in causing or maintaining the presenting impotence. We advocate a combined approach with appropriate medical treatment and sex and couple therapy.