Efficacy of Hormonal and Nonhormonal Approaches to Vaginal Atrophy and Sexual Dysfunctions in Postmenopausal Women: A Systematic Review / Eficácia das abordagens hormonais e não hormonais para atrofia vaginal e disfunções sexuais em mulheres na pós-menopausa: Uma revisão sistemática

Abstract Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Resumo Objetivo Avaliar a eficácia das abordagens hormonais e não hormonais para os sintomas de disfunção sexual e atrofia vaginal em mulheres na pós-menopausa. Fontes de Dados Pesquisamos as bases de dados PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), e Cumulative Index to Nursing and Allied Health Literature (CINAHL), assim como bancos de dados de ensaios clínicos. Foram analisados estudos publicados entre 1996 e 30 de maio de 2020. Nenhuma restrição de idioma foi aplicada. Seleção dos Estudos Foram selecionados ensaios clínicos randomizados que avaliavam o tratamento das disfunções sexuais em mulheres na pós-menopausa. Coleta de Dados Três autores (ACAS, APFC e JL), revisaram cada artigo com base em seu título e resumo. Os dados relevantes foram posteriormente retirados do texto completo do artigo. Quaisquer discrepâncias durante a revisão foram resolvidas por consenso entre todos os autores listados. Síntese dos Dados Ao todo, 55 estudos foram incluídos na revisão sistemática. As abordagens testadas para tratar a disfunção sexual foram: lubrificantes e hidratantes (18 estudos); fitoestrogênios (14 estudos); deidroepiandrosterona (DHEA; 8 estudos); ospemifeno (5 estudos); testosterona vaginal (4 estudos); exercícios para os músculos do assoalho pélvico (2 estudos); oxitocina (2 estudos);laser de CO2 vaginal (2 estudos); lidocaína (1 estudo), e vitamina E vaginal (1 estudo). Conclusão Identificou-se falta de coerência na literatura quanto aos tratamentos propostos e medidas de resultados selecionadas. Apesar da grande diversidade de modalidades de tratamento e medidas de resultados, esta revisão sistemática pode lançar luz sobre alvos potenciais para o tratamento, que é considerado necessário para a disfunção sexual, assumindo que a maioria dos estudos randomizados foi avaliada com baixo risco de viés de acordo com a ferramenta de avaliação de risco de viés de Cochrane Collaboration. Esta revisão tem cadastro no International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Validation of the Orgasm Rating Scale in the Context of Masturbation / Validación de la Orgasm Rating Scale en el Contexto de la Masturbación

Background: The Orgasm Rating Scale (ORS) assesses the subjectiveexperience of orgasm. Its psychometric properties have only been examinedin the context of sexual intercourse. This study aims to validate the ORSin the context of solitary masturbation. Methods: A sample of 1,171 menand 1,424 women aged 18-83 years (M = 40.51, SD = 12.07) completedthe ORS in the solitary masturbation context along with other scales toassess sexual attitudes, solitary sexual desire, propensity for sexual arousal/inhibition, and sexual functioning. Results: A four-dimensional structurewas confirmed, similar to the homologous version for the context of sexualintercourse. Measures obtained from the ORS were sex and age invariant,exhibited adequate internal consistency, discriminated between peoplewith orgasmic difficulties, and were associated with related variables.Conclusions: The ORS is a multidimensional measure that providesreliable, valid measures of the subjective experience of orgasm in thecontext of solitary masturbation.

Antecedentes: la Orgasm Rating Scale (ORS) evalúa la experienciasubjetiva del orgasmo. Sus propiedades psicométricas únicamente seexaminaron en el contexto de las relaciones sexuales. El objetivo de esteestudio es validar la ORS en el contexto de la masturbación en solitario.Método: una muestra formada por 1.171 hombres y 1.424 mujeres de 18a 83 años (M = 40,51; DT = 12,07) completaron la ORS en el contexto dela masturbación en solitario junto con otras escalas para evaluar actitudessexuales, deseo sexual solitario, propensión a la excitación/inhibiciónsexual y funcionamiento sexual. Resultados: se confirma una estructurade cuatro dimensiones, al igual que su versión homóloga para el contextode las relaciones sexuales. Las medidas obtenidas mediante la ORS soninvariantes por sexo y edad, sus dimensiones muestran una adecuadaconsistencia interna, discriminan entre personas con y sin dificultadesorgásmicas y se relacionan con variables afines. Conclusiones: la ORSes una medida multidimensional que aporta medidas fiables y válidas dela experiencia subjetiva del orgasmo en el contexto de la masturbación ensolitario.

Una mejor comprensión de la sexualidad humana a través del estudio de la asexualidad / A better understanding of human sexuality through the study of asexuality

La asexualidad ha cobrado importancia con la entrada del presente siglo. Sin embargo, sigue siendo un fenómeno poco estudiado. Las investigaciones realizadas hasta la fecha confirman que la carencia de “atracción erótica” hacia uno u otro sexo es definitoria y se impone como el eje de todos los comportamientos asexuales englobados bajo idéntica denominación. Por ello, el estudio presente se centra en delimitar con precisión el concepto de “atracción sexual” que es distinto al cariño, a la admiración, a la mal llamada “atracción romántica” y a la excitación sexual. Por otra parte, en el asexual se observan frecuentes conductas masturbatorias y parafílicas, y es obvio que estas conductas responden a otros factores no dependientes de la “atracción erótica,” lo que conduce a mantener como evidencia la existencia de tres factores fundamentales constituyentes del núcleo de la sexualidad humana: atracción sexual, excitación y orgasmo. Factores no covariables entre sí, cuya presencia, conjunta o aislada, explica las diferentes conductas sexuales de hombres y mujeres. (AU)

Asexuality has gained importance with the entrance of the present century. However, this phenomenon has been little studied. The investigations carried out to date confirm that the lack of “erotic attraction” towards one sex or the other is defining and imposes itself as the axis of all the asexual behaviors encompassed under the same name. Therefore, the present study focuses on defining precisely the concept of “sexual attraction”, which is different from affection, admiration, the so-called “romantic attraction”, and sexual excitement. On the other hand, there are frequent masturbatory and paraphilic behaviors in asexual people, and it is obvious that these behaviors respond to other factors not dependent on the “erotic attraction”, which leads us to maintain as evidence the existence of three fundamental constituent factors of the core of human sexuality: sexual attraction, excitement, and orgasm. Non-covariable factors, whose presence, joint or isolated, explains the different sexual behaviors of men and women. (AU)

Aspectos negligenciados na reabilitação sexual masculina após prostatectomia radical / Aspects neglected in the male sexual rehabilitation after radical prostatectomy

O câncer de próstata é uma das neoplasias mais frequentes na população masculina. A prostatectomia radical está entre os principais tratamentos para essa afecção, sendo a primeira escolha para casos de doenças localizadas e localmente avançadas. Contudo, essa modalidade de tratamento cirúrgico costuma trazer grande prejuízo à função sexual masculina como um todo. Sabe-se que a disfunção erétil é uma complicação frequente e temida do tratamento cirúrgico do câncer de próstata, de forma que há diversas estratégias para prevenir e tratar tal condição. Porém, uma adequada reabilitação sexual desses pacientes envolve um atendimento global às dificuldades encontradas no restabelecimento de uma vida sexual satisfatória, não apenas focado na qualidade das ereções. Infelizmente, há uma série de problemas sexuais frequentes que são desencadeados pela prostatectomia radical, mas que ainda são extremamente negligenciados no cuidado pós-operatório. Dentre eles podemos citar: queda do desejo sexual, perda de volume peniano, desenvolvimento de deformidades penianas e distúrbios do orgasmo e da ejaculação. Neste artigo são abordados os principais efeitos sexuais da prostatectomia radical que costumam ser negligenciados no seguimento

Terapia de reemplazo hormonal combinada con testosterona para el tratamiento del trastorno del deseo sexual hipoactivo en mujeres en climaterio* / Hormone replacement therapy combined with testosterone for the treatment of hypoactive sexual desire disorder in climacteric women

Objetivo: evaluar la eficacia y seguridad de dos terapias hormonales sustitutivas, combinadas con testosterona, en el tratamiento del trastorno del deseo sexual hipoactivo en mujeres en climaterio. Materiales y métodos: ensayo clínico, aleatorizado, controlado, no enmascarado. Se incluyeron mujeres mayores o igual a 40 años y menores de 60 años, con útero, con actividad sexual en las últimas seis semanas, aquejadas por síntomas vasomotores, cuyo motivo de co sulta consistió en bajo deseo sexual. Se utilizó como instrumento el cuestionario Índice de Función Sexual Femenina (IFSF). Se asignaron dos grupos aleatorizados: grupo «A¼ (51 recibieron estrógenos conjugados de equinos y edroxiprogesterona más testosterona) y grupo «B¼ (54 tibolona más testosterona). El estudio fue realizado entre julio de 2015 y diciembre de 2016, en Armenia, Quindío, Colombia. Resultados: se analizó una población de 105 mujeres. La media de edad fue de 55,8 (DS±9,38) años. En la población total, al inicio del estudio, la mediana fue de 3 encuentros sexuales por mes. Al final la mediana fue de 5 encuentros sexuales por mes, (grupo «A¼ 4 encuentros y grupo «B¼ 7 encuentros, p=0,0036). Al finalizar la investigación se observó que las mujeres del grupo «B¼, mostraron puntuaciones promedias significativamente más altas en el IFSF (28,56 DS±4,63 puntos), al compararlas con las mujeres del grupo «A¼ (27,57 DS±4,32) (p<0,0001). Conclusiones: la terapia con tibolona asociada a testosterona es una opción de tratamiento efectiva en el trastorno del deseo sexual hipoactivo en mujeres en climaterio..(AU)

Objective: to evaluate the efficacy and safety of two hormone replacement therapies, combined with testosterone, in the treatment of hypoactive sexual desire disorder in women in climacteric. Materials and methods: clinical trial, randomized, controlled, not masked. Women over 40 years old and under 60 years old, with a uterus, with sexual activity in the last six weeks, suffering from vasomotor symptoms, whose reason for consultation consisted of low sexual desire were included. The Female Sexual Function Index questionnaire was used as an instrument. Two randomized groups were assigned: group "A" (51 received conjugated estrogens from equines and medroxyprogesterone plus testosterone) and group "B" (54 tibolone plus testosterone). The study was conducted between July 2015 and December 2016, in Armenia, Quindío, Colombia. Results: a population of 105 women was analyzed. The average age was 55,8 (SD ± 9,38) years. In the total population, at the beginning of the study, the median was 3 sexual encounters per month. In the end, the median was 5 sexual encounters per month, (group «A¼ 4 meetings and group «B¼ 7 meetings, p = 0,0036). At the end of the investigation, it was observed that the women of the «B¼ group showed significantly higher average scores in the IFSF (28,56 SD ± 4,63 points), compared with values in the women of the «A¼ group (27,57 DS ± 4,32) (p<0,0001). Conclusions: testosterone-associated tibolone therapy is an effective treatment option in hypoactive sexual desire disorder in women in climacteric..(AU)

Dispositivo EROS en el manejo de la anorgasmia femenina: Estudio prospectivo de serie de casos en mujeres del Quindío / EROS device in the management of female anorgasmia: Prospective study of the series of cases in women in Quindío

Resumen Introducción: La anorgasmia es el retraso persistente, o recurrente o ausencia de orgasmo después de una fase de excitación sexual normal, resultando en dificultades personales o interpersonales. El tratamiento se aborda desde diferentes perspectivas. Objetivo: Presentar los resultados de la efectividad y seguridad del uso del dispositivo EROS-CTD en el manejo de la anorgasmia femenina, en un grupo de mujeres del Quindío. Materiales y métodos: Estudio de reporte de casos, de tipo observacional, descriptivo, prospectivo, de mujeres intervenidas por trastorno del orgasmo, en Armenia, Quindío, Colombia, en el periodo de 2012 a 2017. Resultados: Se intervino 39 mujeres; edad media de 35,1 (DS ± 3,7) años. La anorgasmia primaria fue del 61,53% y la secundaria del 38,36%. El promedio de seguimiento del uso del dispositivo EROS-CTD, fue de 23,7 (DS ± 4,5) meses por paciente. Al finalizar el estudio, la satisfacción global con el uso del dispositivo es del 89,74%, ninguna de las mujeres presentó complicaciones relacionadas con el uso del aparato. Conclusiones: La efectividad del tratamiento de la anorgasmia femenina con el dispositivo EROS-CTD, ha beneficiado favorablemente a las mujeres del estudio.

Abstract Introduction: Anorgasmia is the persistent, or recurrent, or absence of orgasm after a normal phase of sexual arousal, resulting in personal or interpersonal difficulties. Treatment is approached from different perspectives. Objective: To present the results of the effectiveness and safety of the use of the EROS-CTD in the management of female anorgasmia in a group of women from Quindío. Materials and methods: A descriptive, prospective observational study of case reports was carried out with women intervened by orgasm disorder in Armenia, Quindío, Colombia, from 2012 to 2017. Results: 39 women were intervened whose average age was 35.1 (DS ± 3.7). Primary anorgasmia was 61.53% and the secondary was 38.36%. The average follow-up of the use of EROS-CTD was 23.7 (DS ± 4.5) months per patient. At the end of the study, overall satisfaction with the use of the device is 89.74%, none of the women presented complications related to the use of the appliance. Conclusions: The effectiveness of the treatment of female anorgasmia with EROS-CTD has benefited the women of the study.

Una mirada a la masturbación femenina: estudio descriptivo transversal en mujeres universitarias del área metropolitana de Bucaramanga, Colombia / A look at female masturbation: descriptive cross-sectional study in university women of the metropolitan area of Bucaramanga, Colombia

Resumen Introducción. La masturbación es un tema que encierra múltiples mensajes, tanto culturales negativos como sexológicos positivos. Esta diversidad es una ventana para explorar la sexualidad femenina. Objetivo. Establecer la prevalencia de masturbación en estudiantes universitarias del área metropolitana de Bucaramanga, Colombia. Materiales y métodos. Estudio descriptivo transversal con cuestionario de autorreporte. Se realizó análisis descriptivo e inferencial con nivel de significancia de p<0.05. Resultados. Se encuestaron 1 039 mujeres (edad mediana: 20, RIC: 4). La prevalencia de masturbación fue del 32.2%; de ellas, solo el 73.1% llegaba al orgasmo por esta estimulación. 1 de cada 3 mujeres que se no se masturba reportó incapacidad para alcanzar el orgasmo. La masturbación fue más frecuente en mujeres >35, de estratos socioeconómicos altos, no religiosas o católicas con poco o nulo nivel de religiosidad, que estudian, trabajan como independiente y se autoidentifican como bisexuales. Conclusiones. 1 de cada 3 mujeres que no refiere masturbarse reporta disfunción orgásmica; de esta forma, las actividades masturbatorias son un factor protector de la disfunción. Es importante realizar educación desde la autoexploración para que la mujer pueda conocerse y disfrutar plenamente de su sexualidad.

Abstract Introduction: Masturbation is a topic that contains multiple messages, both culturally negative and positive for sexology. This diversity becomes a window to explore female sexuality. Objective: To establish the prevalence of female masturbation among university students from the metropolitan area ofBucaramanga, Colombia. Materials and methods: Descriptive cross-sectional study using a self-report questionnaire. Descriptive and inferential analysis was performed finding a significance level of p<0.05. Results: 1 039 women were surveyed (median age: 20, IQR: 4). The prevalence ofmasturbation was 32.2%, of which only 73.1% reached orgasm through this stimulation. 1 in 3 women who do not masturbate reported anorgasmia. Masturbation was more frequent in women >35 years of age, from high socioeconomic status, non-religious or Catholic with little or no religiousness, who study, work independently and self-identify as bisexual. Conclusions: 1 in 3 women who claim that they do not masturbate reported orgasmic dysfunction; therefore, masturbatory activities are a protective factor for the dysfunction. Providing self-exploration education is important so that women can get to know their body and fully enjoy their sexuality.

Prevalencia y caracterización de la eyaculación femenina. estudio de corte transversal. en mujeres colombianas del Quindío. 2012 a 2016 / Prevalence and characterization of female ejaculation. cross section study. in colombian women of Quindío. 2012 to 2016

Introducción:La eyaculación femenina es un fenómeno caracterizado por la salida de un líquido, diferente a la orina, a través de la uretra, en el momento del orgasmo.Objetivos: Determinar la prevalencia de la eyaculación femenina, en un grupo de trabajadoras sexuales, y evaluar las características físicoquímicasdel fluido uretral expulsado.Materiales y métodos: Estudio descriptivo de corte transversal y prospectivo. Se enrolaron mujeres entre 18 y 39 años, atendidas en la consulta del investigador entre enero del 2012 y junio del 2016, en la consulta externa de una clínica privada de Armenia. Se incluyeron trabajadoras sexuales, sin incontinencia urinaria, sin infecciones de transmisión sexual o vaginosis, y no gestantes ni en puerperio. Se midió la prevalencia de la eyaculación femenina (expulsión de fluido a través de la uretra, durante la excitación y el orgasmo), y se evaluaron las características físicoquímicasde dicha secreción (ácido cítrico, fosfatasa ácida, fructosa, PSA, densidad, osmolaridad, pH, viscosidad y volumen).Resultados: Se evaluaron un total de 78 mujeres. La edad promedio fue de 32,6±8,2 años. La prevalencia de la eyaculación femenina fue del 69,23%. El volumen promedio deleyaculado fue de29,73±7,08 ml(rango entre 0 y 57 ml). En el análisis físico químico del líquido uretral se encontró que el color varió entre nacarado y gris opalescente, con una osmolaridad de 269,3±3,57 mOsm/Kg, pH de 5,4, densidad de 1.032 g/L, la viscosidad fue de 12,75 mm para el filamento y un volumen promedio de 29,73 cc; las sustancias más comunes fueron PSA 0,75 ng/ml con una concentración promedio de fructosa de 12 mmol/L y de ácido cítrico de 729 mg/L.Conclusión: La eyaculación femenina es una realidad en nuestra población, alrededor de dos de cada tres mujeres la presentan.

Introduction:Female ejaculation is a phenomenon characterized by the exit of a liquid, different fromurine, through the urethra, at the moment of orgasm.Objetives:To determine the prevalence of female ejaculation, in a group of sex workers, and to evaluate the physical and chemical characteristics of the ejected urethral fluid.Materials and methods: Descriptive study of cross section and prospective. Women between 18 and 39 years of age were enrolled, assisted in the researcher's consultation between January 2012 and June 2016, in the outpatient clinic of a private clinic in Armenia. Sex workers were included, without urinary incontinence, without sexually transmitted infections or vaginosis, and not pregnant or in puerperium. The prevalence of female ejaculation (expulsion of fluid through the urethra during excitement and orgasm) was measured and thephysical and chemical characteristics of this secretion were evaluated (citric acid, acid phosphatase, fructose, PSA, density, osmolarity, pH, viscosity and volume).Results: A total of 78 women were evaluated. The average age was 32.6 ± 8.2 years. The prevalence of female ejaculation was 69.23%. The average volume of the ejaculate was 29.73 ml. In the physical-chemical analysis of the urethral fluid it was found that the color varied between pearly and opalescent gray, with an osmolarity of 269.3 ± 3.57 mOsm / Kg, pH of 5.4, density of 1.032 g / L, viscosity it was 12.75 mm for the filament and an average volume of 29.73 cc; the most common substances were PSA 0.75 ng / ml with an average fructose concentration of 12 mmol / L and citric acid of 729 mg / L.Conclusión: Female ejaculation is a reality in our population, about two out of three women present it.

Significado de la sexualidad y el orgasmo en un grupo de mujeres profesionales / Meaning of Sexuality and Orgasm in Professional Women

Introducción La salud sexual se considera uno de los elementos de bienestar y salud general en el ser humano. Múltiples estudios asocian calidad de vida y salud corporal con la actividad sexual. Objetivo Comprender el significado de la sexualidad y el orgasmo en un grupo de mujeres profesionales. Materiales y Métodos Se realizó una investigación cualitativa con enfoque etnográfico, en la que participaron 15 mujeres profesionales con vínculo a la vida universitaria. La edad del grupo fue entre 26­58 años. Se utilizó una entrevista estructurada que permitió conocer y describir sus prácticas de sexualidad. La investigación está inscrita y aprobada en el Sistema Universitario de la Universidad de Antioquia. Resultados Las 15 entrevistadas manifestaron tener vida sexual activa y expresaron los siguientes ejes temáticos: La sexualidad significó la construcción y el reconocimiento del sí mismo para refinar el encuentro con el otro; es un espacio de relacionamiento que requiere del entendimiento mutuo, no limitado a lo coital; compartir las creencias, valores y rituales con sus parejas da una estabilidad que se traduce en una sexualidad sana. El sexo en pareja es un ejercicio de relación que genera alegría, placer y ganas de vivir. La sexualidad significa un encuentro permanente con el otro, donde la convivencia, la armonía, la posibilidad de crecer, es lo que se prodiga, como deseo y pasión; ese vínculo de pareja es un tipo de conexión que no se equipara con otras relaciones. La sexualidad es parte de la salud, es algo natural e indispensable en la vida de las personas. El orgasmo es definido como un momento de supremo placer liberador de energía, que produce éxtasis, un momento culmen donde parece juntarse la vida y la muerte. No es el fin último, ni es tan satisfactorio como el vínculo que se genera en los encuentros; el orgasmo no lo es todo y no siempre se vive con la misma intensidad. Conclusión Para las mujeres entrevistadas sexualidad implica salud, bienestar y encuentro con el otro. El orgasmo no es una condición indispensable para gozar la actividad sexual.

Introduction Sexual health is considered one of the elements of wellbeing and general health in the human being. Multiple studies associate quality of life and bodily health with sexual activity. Objective Understand the meaning of sexuality and orgasm in professional women. Materials and Methods A qualitative research with ethnographic approach was designed, in which 15 professional women with links to university life participated. The age of the group was between 26­58 years. A structured interview was used which enabled them to know and describe their sexuality practices.. The research is registered and approved in the University System of the University of Antioquia. Results The 15 interviewees had active sex life and expressed the following thematic axes: Sexuality meant the construction and recognition of the self to refine the encounter with the other; is a space of relationship that requires mutual understanding, which is not limited to the coital; sharing beliefs, values and rituals with their partners gives stability that translates into a healthy sexuality. Sex as a couple is an exercise in relationship that generates joy, pleasure, energy and the desire to live. Sexuality means a permanent encounter with the other, where coexistence, harmony, the possibility of growing, is what is lavished, as desire and passion; this link is a type of connection that is not equated with other relationships. Sexuality is part of health, is something natural and indispensable in the lives of people, which is altered by desires and concerns. Eroticism has an emotional and emotional component that makes pleasure possible. The orgasm is defined by the participants as a moment of supreme energy-releasing pleasure, which produces ecstasy, a culminating moment where life and death seem to gather together, a sensation of maximum fullness, of climax. Orgasm is not the ultimate goal, nor is it as satisfying as the bond generated in encounters; orgasm is not everything and not always lived with the same intensity. Conclusion For women interviewed sexuality implies health, well-being and encounter with the other. Orgasm is not an indispensable condition to enjoy sexual activity.

[Systematic review of the subjective experience of orgasm]. / Revisión sistemática sobre la experiencia subjetiva del orgasmo.

Orgasm is an essential component of the sexual response. Its study has generated results that point out its importance in human sexuality. The aim of the present study was to review the subjective orgasm experience, its evaluation and its association with personal, interpersonal and psychosocial variables. After conducting a literature search in major databases, we provide a total of 121 scientific articles published between 2000 and 2016, in which the subjective orgasm experience was the main variable. The analysis of the related variables shows that personal variables (for example, health and demographic factors) and interpersonal variables (for example, sexual functioning) are the most considered. To conclude, we observe the need to develop standardized instruments to evaluate specifically the subjective orgasm experience and the need to study jointly the associated variables in order to propose explanatory models of orgasm that are useful for clinical practice.

Prevalence and characterisation of sexual dysfunctions in women, in 12 colombian cities, 2009-2016 / Prevalencia y caracterización de las disfunciones sexuales en mujeres, en 12 ciudades colombianas, 2009-2016

ABSTRACT Objective: To determine the prevalence and characterisation of sexual dysfunctions in a population of sexually active women with ages ranging between 18 and 72 years, in 12 Colombian cities. Materials and methods: Descriptive cross-sectional study that included women 18 years of age and older, sexually active within the past six weeks, living in Colombia. Excluded were illiterate and pregnant women, women in the first 6 months postpartum, women with a psychiatric disease or neurological deficit, and women with a history of cancer. The study was conducted in healthcare centres in twelve cities (Bogotá, Medellín, Cali, Barranquilla, Cartagena, Cúcuta, Ibagué, Bucaramanga, Villavicencio, Pereira, Manizales and Armenia) between June 2009 and December 2016. A consecutive sampling method was used. The "Female Sexual Function Index" validated in Spanish was applied. Sociodemographic variables, a history of sexual and reproductive health, sexual behaviour, and frequency of overall sexual dysfunction and by type of dysfunction assessed were measured. A descriptive analysis of the data was performed using absolute and relative measurements. A stratified description was made by age under or over 40 years. Results: Of a total of 72,894 candidates for enrolment, 50,991 (69,95%) were ultimate analysed. Mean age was 30.9±10.8 years. The prevalence of sexual dysfunction in the study group was 32.97% (16,812 women). The score on the FSFI in the affected women was 24.07±6.18 points. Issues were found with libido in 32.97%, orgasm in 21.93%, arousal in 16,86%, lubrication in 14,79%, and pain in 7.56%. Median sexual dysfunction per woman was 2, found in 64.16%. Conclusion: Among Colombian women, a prevalence of sexual dysfunction is found in close to one-third of the population, characterised mainly by issues with libido and orgasm. Interventions are required in order to establish an immediate diagnostic and therapeutic plan.

RESUMEN Objetivo: Establecer la prevalencia y caracterizar la disfunción sexual en una población de mujeres sexualmente activas, con edades entre 18 y 72 años, en doce ciudades colombianas. Materiales y métodos: Estudio de corte transversal descriptivo. Se incluyeron mujeres mayores de 18 años con actividad sexual en las últimas 6 semanas, y residentes en Colombia. Se excluyeron las mujeres analfabetas, embarazadas o en primeros 6 meses posparto, pacientes psiquiátricas, con deficit neurológico o historial de cáncer. El estudio se llevó a cabo en la consulta externa ginecológica de instituciones hospitalarias privadas en 12 ciudades del país (Bogotá, Medellín, Cali, Barranquilla, Cartagena, Cúcuta, Ibagué, Bucaramanga, Villavicencio, Pereira, Manizales y Armenia) entre junio de 2009 y diciembre de 2016. Se realizó muestreo consecutivo. Se aplicó el Índice de Función Sexual Femenina validado en español. Se midieron variables sociodemográficas, antecedentes de salud sexual y reproductiva, comportamiento sexual, frecuencia de disfunción sexual global y por tipo de disfunción evaluada. Se realizó un análisis descriptivo de la información utilizando medidas de frecuencia absoluta y relativa para los datos. Se hace descripción estratificada por edad (40 años o menos y mayor de 40 años). Resultados: De un total de 72.894 mujeres candidatas a ingresar se analizaron finalmente 50.991 (69,95 %). La edad promedio fue de 30,9 ± 10,8 años. La prevalencia de disfunción sexual en el grupo estudiado fue del 32,97 % (16.812 mujeres). La puntuación del Índice de Función Sexual Femenina (IFSF) en las mujeres afectadas fue de 24,07 ± 6,18 puntos. Se presentaron dificultades con el deseo (32,97 %), el orgasmo (21,93 %), la excitación (16,86 %), la lubricación (14,79 %) y dolor (7,56 %). La mediana de disfunciones sexuales por mujer fue de 2, que se hizo presente en el 64,16 %. Conclusión: En las mujeres colombianas existe una prevalencia de disfunciones sexuales cercana a la tercera parte de la población, caracterizadas principalmente por trastornos del deseo y del orgasmo. Se requieren intervenciones para establecer un plan diagnóstico y terapéutico inmediato.

Evaluación de la calidad de vida en mujeres climatéricas con prolapso genital luego del uso del pesario / Evaluation of the quality of life in climacteric women with genital prolapse after the use of the pessary

Resumen Objetivo. Evaluar la efectividad del pesario sobre la calidad de vida y la función sexual en mujeres climatéricas con prolapso genital grado II o mayor. Material y método. Estudio analítico, observacional, de corte transversal. Se eligieron mujeres en climaterio que asistieron a consulta por prolapso genital, en la Clínica la Sagrada Familia, Armenia, Quindío, entre enero de 2009 y diciembre de 2016. Se les aplicó dos escalas para medir el grado de satisfacción con el uso del pesario: la escala Menopause Rating Scale, y el Índice de Función Sexual Femenina. Ambos cuestionarios fueron realizados antes de la inserción del pesario y luego de tres meses de uso. Resultados. La muestra la constituyeron 57 mujeres con prolapso genital de 33.177 que consultaron en ginecología, para un 0,17% de mujeres tratadas con pesario. El 36,84% presentaron prolapso grado II; 47,36%, grado III, y 15,78%, grado IV. La edad media fue 52,8±5,4 años (rango entre 48 y 78 años); la edad media de la menopausia fue 48,3±4,2 años (rango entre 45 y 51 años), destacándose la menopausia natural en la mayoría (89%). El mayor porcentaje de mujeres usuarias del pesario pertenece al grupo de edad de más de 65 años (84,21%). La puntuación media global de la escala Menopause Rating Scale, antes de la inserción del pesario fue de 18,8±4,3 puntos (rango entre 6,9±3,3 y 19,5±9,6), y 10,2±5,4 puntos (rango entre 2,7±1,2 y 7,5±4,2) después de tres meses de uso. La puntuación media total del Índice de Función Sexual Femenina, antes de la inserción del pesario, fue 16,3 ± 8,3 puntos (rango entre 8,7 y 27,9); después de tres meses de uso del pesario la puntuación media total fue 21,7± 8 puntos (rango entre 9,9 y 29,7). Los trastornos sexuales más frecuentes fueron disminución del deseo (85,2%), anorgasmia (74,7%) y dolor (65,7%), con una prevalencia global de dificultades sexuales del 81,3%. Conclusión. El uso de pesarios en mujeres con prolapso genital grado II o mayor es una terapia eficaz en la disminución de los síntomas vaginales con mejoría en la calidad de vida y la sexualidad.

Abstract Objective. To evaluate the effectiveness of the pessary on quality of life and sexual function in climacteric women with genital prolapse grade II or higher. Material and methods. Analytical, observational, cross-sectional study. Women in climacteric who attended consultation for genital prolapse were elected at the Sagrada Familia Clinic, Armenia, Quindío, between January 2009 and December 2016. Two scales were applied to measure the degree of satisfaction with the use of the pessary: the «Menopause Rating Scale¼ Scale, and the Female Sexual Function Index. Both questionnaires were carried out, before the insertion of the pessary and after three months of use. Results. The sample consisted of 57 women with genital prolapse of 33,177 who consulted in gynecology, for a 0.17% of women treated with pessary. 36.84% had prolapse grade II, 47.36% grade III and 15.78% grade IV. The mean age was 52.8 ± 5.4 years (range between 48 and 78 years); The mean age of the menopause was 48.3 ± 4.2 years (range between 45 and 51 years), with natural menopause standing out in the majority (89%). The highest percentage of women using the pessary belongs to the age group over 65 years old (84.21%). The overall average score of the «Menopause Rating Scale¼ before the insertion of the pessary was 18.8 ± 4.3 points (range between 6.9 ± 3.3 and 19.5 ± 9.6), and 10.2 ± 5.4 points (range between 2.7 ± 1.2 and 7.5 ± 4.2) after three months of use. The total mean score of the Feminine Sexual Function Index, before the insertion of the pessary was 16.3 ± 8.3 points (range between 8.7 and 27.9), after three months of use of the pessary the total average score it was 21.7 ± 8 points (range between 9.9 and 29.7). The most frequent sexual disorders were desire decrease (85.2%), anorgasmia (74.7%) and pain (65.7%), with an overall prevalence of sexual difficulties of 81.3%. Conclusion. The use of pessaries in women with genital prolapse grade II or greater is an effective therapy in the reduction of vaginal symptoms with improvement in quality of life and sexuality.

No es hora de abandonar el uso de terapias locales de hormonas vaginales / It is not time to abandon the use of local therapies of vaginal hormones

Los médicos que atienden a mujeres menopáusicas están familiarizados con el sín- drome genitourinario de la menopausia (SGM), anteriormente conocido como atrofia vulvova- ginal, una afección progresiva que afecta la función sexual y la calidad de vida. Aunque la SGM afecta hasta al 45% de las mujeres de mediana edad y mayores, la mayoría de las personas con esta afección no se diagnostican ni se tratan.1

Un réquiem al mítico punto "G" / A requiem to the mythical point "G"

Objetivo: revisar la literatura presente, respecto a la evidencia científica existente, en relación al punto "G". Materiales y métodos:Se realizó una búsqueda bibliográfica en diferentes bases de datos electrónicas para identificar literatura relevante EBSCO, Elsevier, Interscience, Medline, Ovid, Pubmed, SciELO, Scopus (1950 al 2016), Cochrane Group (julio 31 del 2016) y libros de texto impresos, así como de revistas de sexología científica indexadas y sociedades sexológicas reconocidas como: Advances in Sexual Medicine, American Journal of Sexuality Education, British Journal of Sexual Medicine (BJSM), European Journal of Sexual Health, Sexology and The Journal of Sexual Medicine; tratando de encontrar la mejor evidencia científica existente en relación al punto "G".Resultados:Se revisaron 75 títulos, de los cuales 65 cumplían con nuestros criterios de selección, correspondientes a artículos de revisión, diseños de tipo transversal, casos y controles. El termino Punto "G", no es un término usado en la anatomía humana; y no existen imágenes anatómicas ni ecográficas de dicho punto, por lo tanto, el punto "G" no existe; y a pesar de ser ampliamente aceptado entre las mujeres, los estudios anatómicos, bioquímicos e histológicos no han demostrado su existencia. Conclusiones: La literatura muestra que la vagina no tiene ninguna estructura anatómica que pueda desencadenar un orgasmo; y así como las teorías que afirmaban la existencia del punto "G", por más de treinta años tuvieron su auge, hoy por hoy, la evidencia de su no existencia, también está cogiendo eco.

Objective: to review the present literature, in relation to point "G". EBSCO, Elsevier, Interscience, Medline, Ovid, Pubmed, SciELO, Scopus (1950 to 2016), Cochrane Group (July 31, 2016) and books Advances in Sexual Medicine, American Journal of Sexual Education, British Journal of Sexual Medicine (BJSM) ), European Journal of Sexual Health, Sexology and The Journal of Sexual Medicine; .results: 75 titles were reviewed, of which 65 met our selection criteria, corresponding to review articles, cross-sectional designs, cases and controls. The term "G" is not a term used in human anatomy; and there are no anatomical or ultrasound images of this point, therefore, point "G" does not exist; Anatomical, biochemical and histological studies have not proved their existence. Conclusions: The literature shows that the vagina does not have any anatomical structure that can trigger an orgasm; and as well as the theories that affirmed the existence of point "G", for more than thirty years took place its today, today, the evidence of its existence, is also catching echo.

Prevalence of Sexual Dysfunction among Expectant Women / Prevalência de disfunção sexual entre mulheres grávidas

Abstract Purpose To identify pregnancy as a causative factor of sexual dysfunction among expectant women. Methods A prospective study with 225 expectant mothers seen in the prenatal clinic of a federal university. Sexual function was evaluated by means of the Female Sexual Function Index (FSFI), and all domains were analyzed (desire, arousal, lubrication, orgasm, satisfaction, and pain). Initially, a univariate analysis of the sample was done. The averages for each domain according to the risk of sexual dysfunction (FSFI ≤ 26.5) were compared using the Student’s t-test for independent samples. The strength of the correlation between sexual dysfunction and all sociodemographic, clinical and behavioral variables was measured by the Chi-Square (X2) test. Then, odds ratios (ORs) and their confidence intervals were assigned to perform a bivariate analysis. Any p values less than 0.05 were considered significant. Results Approximately two-thirds of the women (66.7%) showed signs of risk of sexual dysfunction (FSFI ≤ 26.5). Within these cases, all sexual dysfunction domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) were found to be statistically significant (p < 0.001). The domains most affected were desire (2.67), satisfaction (2.71) and arousal (2.78). Conclusions Pregnancy appears to be an important causative factor of sexual dysfunction among pregnant women.

Resumo Objetivo Identificar a gravidez como fator causador de disfunção sexual entre mulheres gestantes. Métodos Estudo prospectivo com 225 gestantes atendidas no ambulatório de prénatal de uma universidade federal. A função sexual foi avaliada por meio do Female Sexual Function Index (FSFI), e todos os domínios foram analisados (desejo, excitação, lubrificação, orgasmo, satisfação e dor). Inicialmente, uma análise univariada da amostra foi feita. As médias para cada domínio de acordo com o risco de disfunção sexual (FSFI ≤ 26,5) foram comparadas pelo teste t de Student para amostras independentes. A força da correlação entre a disfunção sexual e todas as variáveis sociodemográficas, clínicas e comportamentais foi medida pelo teste do qui-quadrado (X2). A partir desta perspectiva, foram aferidos os odds ratios (ORs) e seus respectivos intervalos de confiança para a análise bivariada. Quaisquer valores de p inferiores a 0,05 foram considerados significativos. Resultados Cerca de dois terços das mulheres (66,7%) mostraram sinais de risco de disfunção sexual (FSFI ≤ 26,5). Dentro destes casos, todos os domínios de disfunção sexual (desejo, excitação, lubrificação, orgasmo, satisfação e dor) foram estatisticamente significativos (p < 0,001). Os domínios mais afetados foram o desejo (2,67), a satisfação (2,71) e a excitação (2,78). Conclusões A gravidez parece ser um importante fator causador de disfunção sexual entre mulheres gestantes.

O gozo da insatisfação na relação sexual

O gozo feminino é considerado por Lacan como Outro em relação ao do homem. Em todo caso, este gozo é difícil de ser discernido, ainda mais que ele pode, como nos mostra a clínica, ser facilmente simulado por uma mulher. Mas por que uma mulher se coloca na posição de simular um orgasmo? O que está em jogo para ela nessa prática? Tentaremos mostrar que a simulação não é apenas sinônimo de frigidez. Não que ela não o possa ser, mas a simulação é também fonte de prazer para uma mulher e, de forma pardoxal, algo capaz de favorecer o "encontro" com o outro (AU)

The enjoyment of the dissatisfaction in the sexual relationship. The feminine enjoyment is considered by Lacan, as "Other", compared to the enjoyment of the man. Anyway, it is difficult to enclose, especially since enjoyment can be, as shown by the clinic, easily simulated by a woman. But why does a woman put herself in the position of simulating the orgasm? What are the stakes of this practice? We would try to show that faking orgasm is not only a synonymous of frigidity. It could be, of course, but it is also a spring of pleasure for a woman and, paradoxically, an expedient capable of making possible the "gathering" with the other (AU)

O gozo da insatisfação na relação sexual / The enjoyment of dissatisfaction with sexual intercourse

O gozo feminino é considerado por Lacan como Outro em relação ao do homem. Em todo caso, este gozo é difícil de ser discernido, ainda mais que ele pode, como nos mostra a clínica, ser facilmente simulado por uma mulher. Mas por que uma mulher se coloca na posição de simular um orgasmo? O que está em jogo para ela nessa prática? Tentaremos mostrar que a simulação não é apenas sinônimo de frigidez. Não que ela não o possa ser, mas a simulação é também fonte de prazer para uma mulher e, de forma pardoxal, algo capaz de favorecer o "encontro" com o outro.

The enjoyment of the dissatisfaction in the sexual relationship. The feminine enjoyment is considered by Lacan, as "Other", compared to the enjoyment of the man. Anyway, it is difficult to enclose, especially since enjoyment can be, as shown by the clinic, easily simulated by a woman. But why does a woman put herself in the position of simulating the orgasm? What are the stakes of this practice? We would try to show that faking orgasm is not only a synonymous of frigidity. It could be, of course, but it is also a spring of pleasure for a woman and, paradoxically, an expedient capable of making possible the "gathering" with the other.

Comparação entre exercícios perineais e exercícios sexuais como método de tratamento fisioterapêutico na disfunção orgásmica feminina / Comparison of perineal exercises and sexual exercises as a method of physical therapy treatment for female orgasmisc dysfunction

Objetivos: Comparar os exercícios perineais e exercícios sexuais como método de tratamento fisioterapêutico na disfunção orgásmica feminina. Métodos: Comparou-se dois grupos: exercícios sexuais (ES) e exercícios sexuais e perineais (ESP). Após a anamnese, avaliou-se a função muscular do assoalho pélvico através das escalas AFA e Esquema PERFECT e foi preenchido o questionário "Quociente Sexual - Versão Feminina". As pacientes do grupo ES receberam um folheto explicativo com exercícios que deveriam seguir três vezes ao dia, retornando ao ambulatório para reavaliação. Já as pacientes do grupo ESP, além de receberem as mesmas orientações do grupo ES, passaram por protocolos de exercícios perineais. Passadas as semanas de exercícios perineais, a paciente retornou para responder ao "QS-F" e passou pela avaliação final do assoalho pélvico. Resultados: Foram incluídas 14 pacientes, sendo cinco no grupo ES e nove no grupo ESP. Nossos achados demonstraram que 80% das pacientes do grupo ES conseguiram alcançar o orgasmo através da masturbação, e 40% das pacientes do mesmo grupo conseguiram alcançar o orgasmo na masturbação na presença do companheiro, enquanto este número oscilou de 11,1 a 22,2% no grupo ESP. Com relação à avaliação da função muscular, os resultados mostraram que houve aumento. Conclusões: A educação sexual é de extrema importância no tratamento da anorgasmia. A masturbação e o estímulo à fantasia são imprescindíveis para o conhecimento dos pontos eróticos. O programa de reabilitação do assoalho pélvico melhora a força muscular perineal, a sensibilidade e consciência perineal, e o prazer genital durante a penetração, além da qualidade sexual, comprovado pelo QS-F.

Início da atividade sexual de mulheres jovens: questionando sua satisfação e preferências / Sexual activity initiation of young women: questioning their satisfaction and preferences

O objetivo desta pesquisa exploratória foi identificar o início da atividade sexual, a satisfação e as preferências sexuais de mulheres jovens da cidade de São Paulo. A amostra foi composta por 60 mulheres com idade entre 18 e 21 anos, sexualmente ativas, que responderam um questionário preparado pelas pesquisadoras. Os resultados indicaram um início precoce da atividade sexual, apontaram que a maioria das jovens desta amostra prefere a penetração vaginal e o sexo oral recebido do parceiro. A grande maioria dessas mulheres afirmou estar satisfeita sexualmente, porém creditam esta satisfação ao parceiro e ao estabelecimento de um relacionamento amoroso e não à qualidade da relação sexual, nem ao orgasmo em si. Outros estudos com foco na satisfação sexual feminina são necessários e importantes para que essas mulheres sejam compreendidas e para que possam ter mais prazer nas relações sexuais.(AU)

It is an exploratory research in order to identify the onset of sexual activity, satisfaction and sexual preferences of young women in São Paulo. A group of 60 women aged 18 to 21, with regular sexual activity, answered a questionnaire prepared by the researchers. The results indicate an early onset of sexual activity, they showed that most young women in the sample prefer vaginal penetration and oral sex received from the partner. The vast majority of these women claimed to be sexually satisfied, but credit this satisfaction to the partner and the establishment of a loving relationship and not to the quality of intercourse or to the orgasm itself. Other studies focusing on female sexual satisfaction are necessary and important for these women to be understood and to improve the pleasure in sexual intercourse.(AU)

Início da atividade sexual de mulheres jovens: questionando sua satisfação e preferências / Sexual activity initiation of young women: questioning their satisfaction and preferences

O objetivo desta pesquisa exploratória foi identificar o início da atividade sexual, a satisfação e as preferências sexuais de mulheres jovens da cidade de São Paulo. A amostra foi composta por 60 mulheres com idade entre 18 e 21 anos, sexualmente ativas, que responderam um questionário preparado pelas pesquisadoras. Os resultados indicaram um início precoce da atividade sexual, apontaram que a maioria das jovens desta amostra prefere a penetração vaginal e o sexo oral recebido do parceiro. A grande maioria dessas mulheres afirmou estar satisfeita sexualmente, porém creditam esta satisfação ao parceiro e ao estabelecimento de um relacionamento amoroso e não à qualidade da relação sexual, nem ao orgasmo em si. Outros estudos com foco na satisfação sexual feminina são necessários e importantes para que essas mulheres sejam compreendidas e para que possam ter mais prazer nas relações sexuais.

It is an exploratory research in order to identify the onset of sexual activity, satisfaction and sexual preferences of young women in São Paulo. A group of 60 women aged 18 to 21, with regular sexual activity, answered a questionnaire prepared by the researchers. The results indicate an early onset of sexual activity, they showed that most young women in the sample prefer vaginal penetration and oral sex received from the partner. The vast majority of these women claimed to be sexually satisfied, but credit this satisfaction to the partner and the establishment of a loving relationship and not to the quality of intercourse or to the orgasm itself. Other studies focusing on female sexual satisfaction are necessary and important for these women to be understood and to improve the pleasure in sexual intercourse.