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1.
Curr Urol Rep ; 22(4): 19, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554283

RESUMO

PURPOSE OF THE REVIEW: The goal of this paper was to evaluate the impact on erectile and ejaculatory function after anterior and posterior urethroplasty. RECENT FINDINGS: With a rise in the use of urethroplasty, its impact on sexual function has come into question. For anterior urethroplasties, some degree of erectile dysfunction is common, but this tends to be transient, with most patients having a resolution of any de novo dysfunction by 12 months. Patients with posterior urethral strictures have a very high rate of erectile dysfunction prior to surgery and may show improvement after urethroplasty. Ejaculatory function tends to improve in patients due to alleviation of obstruction while some patients notice degradation in force of ejaculation. While urethroplasty has a minimal permanent effect on sexual function for most patients, there are some patients who notice improvement and others worsening. Patients should be counseled on these risks prior to urethroplasty.


Assuntos
Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Ejaculação/fisiologia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Humanos , Masculino , Pênis/irrigação sanguínea , Pênis/inervação , Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Risco , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Uretra/inervação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
2.
Rev. int. androl. (Internet) ; 18(2): 79-83, abr.-jun. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-193764

RESUMO

Situational anejaculation means that a man can ejaculate in some situations but not in others. Intercourse type of anejaculation means existence of ejaculation by masturbation, but not during sexual intercourse. In some cases, men may be able to ejaculate and attain orgasm with one partner but not with another. Performance anxiety, hostility toward the partner, dysfunctional psychosexual development, and unconscious desire to avoid pregnancy are the possible underlying conditions. We herein reported a case of wife-specific intercourse anejaculation succesfully treated with sexual therapy. According to our best knowledge, this is an important case study in literature about intercourse type of situational anejaculation specific to the patient's wife that was treated with psychosexual counseling. The authors conclude that this clinical course of situational intercourse anejaculation suggests a psychological problem in these patients and sexual therapy is effective


La aneyaculación situacional significa que un varón puede eyacular en algunas situaciones, pero en otras no. El tipo de aneyaculación sexual implica la existencia de eyaculación mediante la masturbación, pero no durante las relaciones sexuales. En algunos casos, los varones pueden ser capaces de eyacular y alcanzar el orgasmo con un compañero, pero no con otro. La ansiedad subyacente, la hostilidad hacia la pareja, el desarrollo psicosexual disfuncional y el deseo inconsciente de evitar el embarazo son las posibles situaciones de fondo. En este documento, informamos de un caso de aneyaculación sexual específica de la esposa tratada con éxito con terapia sexual. Según nuestro mejor conocimiento, este es el primer estudio de caso en la bibliografía sobre el tipo de relación sexual de la aneyaculación situacional específica de la esposa del paciente que fue tratado con asesoramiento psicosexual. Los autores concluyen que este curso clínico de aneyaculación del coito situacional sugiere un problema psicológico en estos pacientes y la terapia sexual es efectiva


Assuntos
Humanos , Masculino , Feminino , Adulto , Disfunções Sexuais Psicogênicas/psicologia , Ejaculação/fisiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Coito/psicologia , Disfunções Sexuais Psicogênicas/etiologia
3.
Fertil Steril ; 113(2): 426-434, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32106994

RESUMO

OBJECTIVE: To document the prevalence of female sexual dysfunctions (FSDs) and factors associated with FSDs and sexually related personal distress in premenopausal women. DESIGN: Community-based cross-sectional study. SETTING: Eastern states of Australia. PARTICIPANTS: Women aged 18-39 years. INTERVENTIONS(S): Not applicable. MAIN OUTCOME MEASURE(S): Women were classified as having sexually related personal distress if they had a Female Sexual Distress Scale-Revised score of ≥11, and as having an FSD if they had a low Profile of Female Sexual Function desire, arousal, orgasmic function, responsiveness, or sexual self-image domain score plus sexually related personal distress. Sociodemographic factors associated with an FSD were examined by means of multivariable logistic regression. RESULT(S): The prevalence of sexually related personal distress was 50.2%. Sexually related personal distress without dysfunction affected 29.6%, and 20.6% had at least one FSD. The proportions of women with self-image, arousal, desire, orgasm, and responsiveness dysfunction were 11.1%, 9%, 8%, 7.9%, and 3.4% respectively. Sexual self-image dysfunction was associated with being overweight, obese, living together, not married, married, breastfeeding, and taking a psychotropic medication. Psychotropic medication was significantly associated with all FSDs. Independent risk factors for nonspecific sexually related personal distress included psychotropic medication., sexual inactivity, and infertility treatment. CONCLUSION(S): That one-half of young Australian women have sexually related personal distress and one in five women have at least an FSD, with sexual self-image predominating, is concerning. The high prevalence of distress signals the importance of health professionals being adequately prepared to discuss sexual health concerns.


Assuntos
Comportamento Sexual , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Fatores Etários , Austrália/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Prevalência , Medição de Risco , Fatores de Risco , Fatores Sexuais , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Adulto Jovem
4.
Am J Obstet Gynecol ; 222(6): 588.e1-588.e10, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31836546

RESUMO

BACKGROUND: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE: To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN: This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS: In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6-month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of Improvement-I. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02-2.81). CONCLUSION: Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.


Assuntos
Incontinência Fecal/fisiopatologia , Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida , Disfunções Sexuais Psicogênicas/fisiopatologia , Incontinência Urinária/fisiopatologia , Idoso , Estudos de Coortes , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Modelos Logísticos , Sintomas do Trato Urinário Inferior/fisiopatologia , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Razão de Chances , Satisfação do Paciente , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/fisiopatologia , Prolapso de Órgão Pélvico/psicologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos , Fumar/epidemiologia , Telas Cirúrgicas , Resultado do Tratamento
5.
J Sex Marital Ther ; 46(1): 18-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31216244

RESUMO

The limited body of research on sexuality in eating disorders supports the occurrence of considerable sexual concerns. The aim of the present study was to examine eating disorder symptoms in relation to sexual function, and sexual pain in particular. Female undergraduate students completed a series of online questionnaires. All domains of sexual function were predicted by aspects of disordered eating, with disordered eating generally being associated with more sexual difficulties. Psychological characteristics common to those with eating pathology were also associated with sexuality variables, such that psychological maladjustment was associated with poorer sexual function. Psychological maladjustment was found to mediate the association between eating disorder risk and sexual function. The results of this study suggest that sexual function should be addressed during eating disorder care.


Assuntos
Sintomas Comportamentais/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Comportamento Sexual/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Adolescente , Adulto , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Feminino , Humanos , Estudantes/psicologia , Inquéritos e Questionários , Adulto Jovem
6.
Int J Impot Res ; 32(2): 221-225, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31164728

RESUMO

The impact of abnormalities in the vascular bed of the external genitalia and vagina on female sexuality is not well defined because of some methodological difficulties in correctly assessing vascular changes of genitalia in women. Transmucosal oxygen tension (TmPO2) represents a precise measure of oxygen partial pressure at the clitoris surface and is expression of clitoral tissue perfusion. Aim of the study was to correlate TmPO2 with female sexual dysfunction (FSD) in healthy women in order to evaluate the impact of clitoral vascularization on female sexual health. Twenty-seven healthy, heterosexual, and sexually active women of reproductive age (mean age: 31.18 ± 4.71) were enrolled in the study. TmPO2 was assessed in every woman. In addition, all the women filled out the Female sexual function index (FSFI). After adjustment for some covariates (age, BMI, and smoking), TmPO2 significantly correlated with FSFI total score (r = 0.4261; p = 0.0379) and with arousal (r = 0.3239; p = 0.0390), lubrication (r = 0.4345; p = 0.0339), orgasm (r = 0.4092; p = 0.0471), and satisfaction (r = 0.4456; p = 0.0291) scores. In addition, TmPO2 was significantly lower in the FSD than in the NO FSD group (28.4 ± 14.5 versus 48.1 ± 25.1 mmHg; p = 0.0416). This study first shows that in healthy women of reproductive age clitoral tissue perfusion, as assessed by TmPO2, correlates very well with FSD and in particular with arousal, lubrication, orgasm, and satisfaction. Further studies should confirm our data and test TmPO2 as potential predictor for cardiovascular disease and metabolic conditions in women.


Assuntos
Clitóris/irrigação sanguínea , Orgasmo/fisiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Adulto , Monitorização Transcutânea dos Gases Sanguíneos , Clitóris/fisiopatologia , Feminino , Heterossexualidade , Humanos , Membrana Mucosa/química , Satisfação Pessoal , Projetos Piloto , Comportamento Sexual , Inquéritos e Questionários , Vagina/fisiopatologia
7.
Arthritis Care Res (Hoboken) ; 72(1): 41-62, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30941870

RESUMO

OBJECTIVE: To systematically review evidence of the impact of inflammatory arthritis on, or association of inflammatory arthritis with, intimate relationships and sexual function. METHODS: Ovid Medline, Ovid PsycINFO, Ovid Embase, and EBSCO CINAHL databases were searched. Two independent reviewers selected articles, extracted data, and conducted manual searches of reference lists from included studies and previous reviews. The quality of evidence was assessed using standard risk-of-bias tools. RESULTS: Fifty-five eligible studies were reviewed. Of these, 49 (89%) were quantitative, 5 (9.1%) were qualitative, and 1 (1.8%) used a mixed-method design. Few quantitative studies were rated as low risk of bias (n = 7 [14%]), many were rated as moderate (n = 37 [74%]) or high risk (n = 6 [12%]). Quantitative study sample sizes ranged from 10 to 1,272 participants, with a reported age range 32-63 years. Qualitative study sample sizes ranged from 8 to 57 participants, with a reported age range 20-69 years. In studies reporting the Female Sexual Function Index, all inflammatory arthritis groups demonstrated mean scores ≤26.55 (range of mean ± SD scores: 14.2 ± 7.8 to 25.7 ± 4.7), indicating sexual dysfunction. In studies reporting the International Index of Erectile Function, all inflammatory arthritis groups reported mean scores ≤25 (range of mean ± SD scores: 16.0 ± 5.3 to 23.8 ± 7.0), indicating erectile dysfunction. Key qualitative themes were impaired sexual function and compromised intimate relationships; prominent subthemes included inflammatory arthritis-related pain and fatigue, erectile dysfunction, diminished sexual desire, and sexual function fluctuations according to disease activity. CONCLUSION: Sexual dysfunction appears highly prevalent among men and women with inflammatory arthritis, and increased clinician awareness of this impairment may guide provision of tailored education and support.


Assuntos
Artrite/psicologia , Relações Interpessoais , Comportamento Sexual , Disfunções Sexuais Psicogênicas/etiologia , Sexualidade , Artrite/complicações , Artrite/fisiopatologia , Humanos , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia
8.
Epilepsy Behav ; 100(Pt A): 106495, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31577987

RESUMO

Sexual dysfunction is a common comorbidity in people with epilepsy (PWE) that adversely affects their quality of life. Nearly one-half of men and women with epilepsy have sexual dysfunction, but in the majority, this often goes unnoticed. The wide variation in the reported prevalence of sexual dysfunction in PWE is due to the significant heterogeneity among the studies with regard to patient population, type and severity of epilepsy, number and type of antiseizure drugs (ASDs) used, and the tools used for assessing sexual dysfunction. Generally, patients with uncontrolled epilepsy, longer duration of epilepsy, focal epilepsy, higher seizure frequency, and those receiving enzyme-inducing and multiple ASDs are more likely to have sexual dysfunction. Women generally have dysfunction in the domains of desire, while males usually have arousal disorders such as erectile dysfunction and premature ejaculation. There is limited evidence to indicate that sexual function improves in patients rendered seizure-free following epilepsy surgery. Multiple mechanisms including direct effects of epilepsy, effects of ASDs, and psychosocial factors contribute to sexual dysfunction in epilepsy. Circumstantial evidence indicates that seizures and interictal epileptiform discharges can directly affect the hypothalamic-pituitary axis as well as production of gonadal steroids. Enzyme-inducing ASDs cause sexual dysfunction by affecting the metabolism of gonadal steroids. Limited data suggest that newer ASDs including oxcarbazepine, lamotrigine, and levetiracetam cause no or minimal sexual dysfunction. Depression and anxiety significantly contribute to sexual dysfunction in PWE. A multipronged and multidisciplinary approach is essential for optimizing the sexual functions. Every effort should be made to identify and treat reversible causes including changing to nonenzyme-inducing ASDs and to provide symptomatic relief. Large, prospective studies are required to improve our understanding on prevalence and mechanisms of sexual dysfunction in PWE.


Assuntos
Epilepsia/complicações , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Adulto , Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/fisiopatologia , Epilepsia/psicologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia
10.
Obstet Gynecol ; 134(5): 899-908, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31599840

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of bremelanotide for the treatment of premenopausal women with hypoactive sexual desire disorder. METHODS: Two identical phase 3, randomized, double-blind, placebo-controlled, multicenter clinical trials (RECONNECT) evaluated the safety and efficacy of bremelanotide 1.75 mg administered subcutaneously as needed in premenopausal women with hypoactive sexual desire disorder. Patients were randomized 1:1 to 24 weeks of treatment with bremelanotide or placebo. Sample size was estimated based on simulations from key endpoints in patients with hypoactive sexual desire disorder from a prior trial. Coprimary efficacy endpoints were change from baseline to end-of-study in the Female Sexual Function Index-desire domain score and Female Sexual Distress Scale-Desire/Arousal/Orgasm item 13. RESULTS: Study 301 began on January 7, 2015, and concluded on July 26, 2016. Study 302 began on January 28, 2015, and concluded on August 4, 2016. Of the 1,267 women randomized, 1,247 and 1,202 were in the safety and efficacy (modified intent-to-treat) populations, respectively. Most participants were white (85.6%), from U.S. sites (96.6%), and had a mean age of 39 years. From baseline to end-of-study, women taking bremelanotide had statistically significant increases in sexual desire (study 301: 0.30, P<.001; study 302: 0.42, P<.001; integrated studies 0.35, P<.001) and statistically significant reductions in distress related to low sexual desire (study 301: -0.37, P<.001; study 302: -0.29, P=.005; integrated studies -0.33, P<.001) compared with placebo. Patients taking bremelanotide experienced more nausea, flushing, and headache (10% or more in both studies) compared with placebo. CONCLUSIONS: Both studies demonstrated that bremelanotide significantly improved sexual desire and related distress in premenopausal women with hypoactive sexual desire disorder. The safety profile was favorable. Most treatment-emergent adverse events were related to tolerability and the majority were mild or moderate in intensity. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02333071 (study 301) and NCT02338960 (study 302). FUNDING SOURCE: Palatin Technologies, Inc., and AMAG Pharmaceuticals, Inc.


Assuntos
Libido/efeitos dos fármacos , Peptídeos Cíclicos , Receptor Tipo 3 de Melanocortina/agonistas , Receptor Tipo 4 de Melanocortina/agonistas , Disfunções Sexuais Psicogênicas , alfa-MSH/análogos & derivados , Adulto , Fármacos do Sistema Nervoso Central/administração & dosagem , Fármacos do Sistema Nervoso Central/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Injeções Subcutâneas , Peptídeos Cíclicos/administração & dosagem , Peptídeos Cíclicos/efeitos adversos , Pré-Menopausa/fisiologia , Pré-Menopausa/psicologia , Angústia Psicológica , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Resultado do Tratamento , alfa-MSH/administração & dosagem , alfa-MSH/efeitos adversos
11.
Obstet Gynecol ; 134(5): 909-917, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31599847

RESUMO

OBJECTIVE: To evaluate the long-term safety and efficacy of bremelanotide as treatment for hypoactive sexual desire disorder in premenopausal women. METHODS: Women who completed the 24-week double-blind core phase of RECONNECT, composed of two parallel phase 3 trials (301 and 302) examining the safety and efficacy of bremelanotide compared with placebo in premenopausal women with hypoactive sexual desire disorder, could enroll in the 52-week open-label extension, provided they had not experienced serious adverse events during the core phase. Efficacy was assessed using the coprimary endpoints from the core phase, and all adverse events were collected during the open-label extension. All statistical analyses were descriptive. RESULTS: The study 301 open-label extension began on July 17, 2015, and concluded on July 13, 2017; the study 302 open-label extension began on October 5, 2015, and concluded on June 29, 2017. Of the 856 eligible patients who completed the core phase, 684 elected to participate in the open-label extension, and 272 completed it. The most common treatment-emergent adverse events considered related to study drug were nausea (40.4%), flushing (20.6%), and headache (12.0%), and the only severe treatment-emergent adverse event experienced by more than one participant in both studies was nausea during the open-label extension. The change in Female Sexual Function Index-desire domain score and Female Sexual Distress Scale-Desire/Arousal/Orgasm item 13 from baseline to end of the open-label extension ranged from 1.25 to 1.30 and -1.4 to -1.7, respectively, for patients who received bremelanotide during the core phase, and 0.70-0.77 and -0.9, respectively, for patients who received placebo during the core phase. CONCLUSION: During the 52-week open-label extension of RECONNECT, no new safety signals were observed, and premenopausal women treated with bremelanotide exhibited sustained improvements in hypoactive sexual desire disorder symptoms. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02333071 (study 301) and NCT02338960 (study 302). FUNDING SOURCE: Palatin Technologies, Inc., and AMAG Pharmaceuticals, Inc.


Assuntos
Libido/efeitos dos fármacos , Efeitos Adversos de Longa Duração , Peptídeos Cíclicos , Disfunções Sexuais Psicogênicas , alfa-MSH/análogos & derivados , Adulto , Fármacos do Sistema Nervoso Central/administração & dosagem , Fármacos do Sistema Nervoso Central/efeitos adversos , Feminino , Humanos , Injeções Subcutâneas , Efeitos Adversos de Longa Duração/induzido quimicamente , Efeitos Adversos de Longa Duração/diagnóstico , Peptídeos Cíclicos/administração & dosagem , Peptídeos Cíclicos/efeitos adversos , Angústia Psicológica , Receptor Tipo 3 de Melanocortina/agonistas , Receptor Tipo 4 de Melanocortina/agonistas , Estudos Retrospectivos , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Tempo , Resultado do Tratamento , alfa-MSH/administração & dosagem , alfa-MSH/efeitos adversos
12.
Psychiatr Danub ; 31(Suppl 3): 561-567, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488791

RESUMO

INTRODUCTION: Female sexuality may be affected by many somatic and psychological factors. Somatic conditions have impact on psychological well-being. We assumed that chronic disease like Irritable Bowel Syndrome (IBS), when producing the long-term distress, may greatly influence sexual functioning. AIM: The aim of this study was to determine whether the severity of IBS influences sexual functions of women and take into consideration other factors like Small Intestinal Bacterial Overgrowth (SIBO) comorbidity and duration of IBS. SUBJECTS AND METHODS: Study patients were recruited by contacting IBS patients at Gastroenterology Ward of Clinical University Centre in Katowice. The survey consisted of 3 parts. The first part were socio-demographic questions. The second part was polish translation of Female Sexuality Functions Index (FSFI) questionnaire. The third part consisted of questions about the patient condition, pharmacotherapy and Irritable Bowel Syndrome Severity Score (IBSSS) questionnaire. 307 women were included in the study and completed the questionnaire. 143 participants were diagnosed with IBS. The mean age of participants was 27 (IQR=23-33). 29% of the patients (n=41) had severe, 47% (n=68) moderate and 24% (n=34) mild IBS. RESULTS: The prevalence of sexual dysfunctions was greater in women with IBS (48%) than in healthy control group (23%) (p<0.001). The median of FSFI was: 30.1 (26.3-32.8) for healthy control group, 30 (23.5-32.6) for mild IBS, 26.2 (22.2-31.6) for moderate and 24.4 (20.1-28.9) for severe. CONCLUSION: IBS decreases all domains of women sexual activity. Severity of sexual dysfunctions relate to intensity of IBS symptoms. All physicians treating IBS-patients should take sexual dysfunctions into their clinical consideration.


Assuntos
Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/psicologia , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Psicogênicas/complicações , Sexualidade/psicologia , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Infecções Bacterianas/fisiopatologia , Feminino , Humanos , Intestinos/microbiologia , Intestinos/fisiopatologia , Síndrome do Intestino Irritável/microbiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia
13.
J Sex Med ; 16(9): 1324-1327, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31488287

RESUMO

INTRODUCTION: Ejaculation and orgasm are important components of sexual response in men. Our understanding of both phenomena is limited. Anejaculation can be a source of substantial distress, even when procreation (ostensibly the only purpose of ejaculation itself) is not a priority. AIM: To present an opinion on male perceptions of ejaculation disorders (specifically anejaculation) based on a variety of data sources, including peer-reviewed literature. METHODS: A non-systematic review of literature on anejaculation and other impairments of ejaculatory and orgasmic response was conducted. Relevant articles were critically analyzed and reported MAIN OUTCOME MEASURE: An opinion is presented, based on existing data sources, on how and why ejaculation is deemed important to men and their sexual partners. RESULTS: The peer-reviewed literature on disorders of ejaculation is scant; existing reports oftentimes do not adequately distinguish between orgasm and ejaculation in assessment. Men's perceptions of ejaculation quality appear to be positively associated with satisfaction with sexual response, particularly regarding orgasm. Based on very limited data, female sexual partners of men appear to often (but not always) value the orgasmic experience of their partner; only a minority prioritize actual ejaculation. There is evidence that disorders of ejaculation may be particularly troublesome for men who have sex with men. CLINICAL IMPLICATIONS: The influence of medical conditions and treatments on ejaculation should be considered in the clinical context. Psychological adaptations and interventions may be of value in some cases. STRENGTHS & LIMITATIONS: Data on the clinical relevance of anejaculation outside the context of concomitant orgasmic dysfunction are sparse. Men's experience of orgasm is at least partially associated with ejaculation-specific variables; whether this association is mediated by psychological, physical, or a combination of factors remains unclear. CONCLUSIONS: Ejaculation, orgasm, and sexual satisfaction are closely intertwined but distinct phenomena. Shindel AW. Anejaculation: Relevance to Sexual Enjoyment in Men and Women. J Sex Med 2019;16:1324-1327.


Assuntos
Coito/psicologia , Ejaculação/fisiologia , Orgasmo/fisiologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/psicologia , Parceiros Sexuais/psicologia , Adulto , Coito/fisiologia , Feminino , Humanos , Masculino , Satisfação Pessoal , Aconselhamento Sexual , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia
14.
PLoS One ; 14(8): e0221063, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415608

RESUMO

Data from clinical trials investigating on-demand medication often consist of an intentionally varying number of measurements per patient. These measurements are often observations of discrete events of when the medication was taken, including for example data on symptom severity. In addition to the varying number of observations between patients, the data have another important feature: they are characterized by a hierarchical structure in which the events are nested within patients. Traditionally, the observed events of patients are aggregated into means and subsequently analyzed using, for example, a repeated measures ANOVA. This procedure has drawbacks. One drawback is that these patient means have different standard errors, first, because the variance of the underlying events differs between patients and second, because the number of events per patient differs. In this paper, we argue that such data should be analyzed by applying a multilevel analysis using the individual observed events as separate nested observations. Such a multilevel approach handles this drawback and it also enables the examination of varying drug effects across patients by estimating random effects. We show how multilevel analyses can be applied to on-demand medication data from a clinical trial investigating the efficacy of a drug for women with low sexual desire. We also explore linear and quadratic time effects that can only be performed when the individual events are considered as separate observations and we discuss several important statistical topics relevant for multilevel modeling. Taken together, the use of a multilevel approach considering events as nested observations in these types of data is advocated as it is more valid and provides more information than other (traditional) methods.


Assuntos
Nível de Alerta , Libido , Disfunções Sexuais Psicogênicas , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Disfunções Sexuais Psicogênicas/fisiopatologia
15.
Neurocase ; 25(1-2): 66-74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30990123

RESUMO

Changes in higher-order cognitive behaviors such as reward recognition, salience processing, novelty perception, decision-making, emotional contagion, motivation, and empathy may contribute to intimacy dysfunction. Network circuitry underlying these cognitive functions is often activated in sexually intimate behavior. We propose that sexual dysfunction in AD and bvFTD is more nuanced than is commonly believed, and propose how AD and bvFTD atrophy may correlate neuroanatomically to brain regions and networks that contribute to the higher-order cognitive aspects of intimacy. The characterization of sexual intimacy in dementias must be expanded to meet the needs of our dementia patients and their romantic partners.


Assuntos
Doença de Alzheimer/fisiopatologia , Demência Frontotemporal/fisiopatologia , Comportamento Sexual/fisiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Doença de Alzheimer/complicações , Demência Frontotemporal/complicações , Humanos , Disfunções Sexuais Psicogênicas/etiologia
16.
PLoS One ; 14(2): e0213059, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817770

RESUMO

BACKGROUND: The generation or persistence of sexual arousal may be compromised when inhibitory processes such as negative emotions, outweigh sexual excitation. Disgust particularly, has been proposed as one of the emotions that may counteract sexual arousal. In support of this view, previous research has shown that disgust priming can reduce subsequent sexual arousal. As a crucial next step, this experimental study tested whether disgust (by means of odor) can also diminish sexual arousal in individuals who are already in a state of heightened sexual excitation. METHODOLOGY: In this study, participants were all men (N = 78). To elicit sexual arousal, participants watched a pornographic video. Following 4.30 minutes from the start of the video clip, they were exposed to either a highly aversive/disgusting odor (n = 42), or an odorless diluent/solvent (n = 36), that was delivered via an olfactometer, while the pornographic video continued. In both conditions the presentation of the odor lasted 1 second and was repeated 11 times with intervals of 26 seconds. Sexual arousal was indexed by both self-reports and penile circumference. PRINCIPAL FINDINGS: The disgusting odor (released when the participants were already sexually aroused) resulted in a significant decrease of both subjective and genital sexual arousal compared to the control (odorless) condition. SIGNIFICANCE: The finding that the inhibitory effect of disgust was not only expressed in self-report but also expressed on the penile response further strengthens the idea that disgust might hamper behavioral actions motivated by sexual arousal (e.g., poor judgment, coercive sexual behavior). Thus, the current findings indicate that exposure to an aversive odor is sufficiently potent to reduce already present (subjective and) genital sexual arousal. This finding may also have practical relevance for disgust to be used as a tool for self-defence (e.g., Invi Bracelet).


Assuntos
Nível de Alerta/fisiologia , Asco , Odorantes , Comportamento Sexual/fisiologia , Comportamento Sexual/psicologia , Literatura Erótica/psicologia , Feminino , Humanos , Masculino , Ereção Peniana/fisiologia , Ereção Peniana/psicologia , Autorrelato , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Olfato/fisiologia , Adulto Jovem
17.
Psychoneuroendocrinology ; 104: 259-268, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30909007

RESUMO

Previous research has found lower serum levels of dehydroepiandrosterone (DHEA) or its sulfated form, DHEA-S, in women diagnosed with Hypoactive Sexual Desire Disorder (HSDD). Given that DHEA and DHEA-S have multiple direct actions on the brain as well as anti-glucocorticoid properties, it is possible that lower levels of DHEA directly impact women's sexual functioning. To date, the significance of the lower DHEA levels remains unclear. To our knowledge, there has been no empirical study of stress hormones as markers of HPA dysregulation in women with HSDD. To attend to this gap, the present study utilized several measures of HPA axis function - morning and evening cortisol and DHEA, the cortisol awakening response (CAR), diurnal cortisol slope, and cortisol:DHEA ratio - and examined their relationship with sexual functioning in N = 275 women with (n = 137) and without (n = 138) HSDD. Results demonstrated multiple hormonal markers of HPA dysregulation in women diagnosed with HSDD compared to control participants, specifically, lower AM cortisol and AM DHEA levels, a flatter diurnal cortisol slope, and a lower CAR. Overall, results of the present study indicate that persistently low sexual desire in women is associated with HPA axis dysregulation, with both cortisol and DHEA alterations potentially detrimental to sexual desire.


Assuntos
Libido/fisiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Adulto , Biomarcadores , Ritmo Circadiano/fisiologia , Desidroepiandrosterona/análise , Feminino , Humanos , Hidrocortisona/análise , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipotálamo-Hipofisário/fisiopatologia , Pessoa de Meia-Idade , Sistema Hipófise-Suprarrenal/metabolismo , Sistema Hipófise-Suprarrenal/fisiopatologia , Saliva/química , Caracteres Sexuais , Disfunções Sexuais Fisiológicas/fisiopatologia
18.
Sex Med Rev ; 7(3): 380-392, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30803922

RESUMO

INTRODUCTION: Flibanserin, a multifunctional serotonin agonist and antagonist, is approved by the U.S. Food and Drug Administration (FDA) for treatment of acquired, generalized hypoactive sexual desire disorder in premenopausal women. During the FDA's review of flibanserin, concerns were raised about the risks of hypotension, syncope, and sedation-related adverse events, which increase with alcohol use. Based on the results of an alcohol challenge study, the FDA required a boxed warning and alcohol contraindication in the flibanserin prescribing information, as part of a risk evaluation and mitigation strategy program. AIM: To evaluate the adverse event profile of flibanserin in the context of that seen with other medications that affect serotonin in the brain and are commonly prescribed for women. METHODS: This was a review of data provided in the product prescribing information for flibanserin, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, other serotonergic antidepressants, and triptans. MAIN OUTCOME MEASURES: The incidence of adverse events was assessed. RESULTS: The incidences of hypotension, syncope, and sedation-related adverse events (eg, dizziness, somnolence, fatigue) in studies of flibanserin were within the ranges observed for serotonergic antidepressants; the rates of these adverse events were generally lower with triptan medications. Other flibanserin-associated adverse events (eg, nausea, insomnia, dry mouth) occurred more commonly in patients taking antidepressant medications. CONCLUSION: Although medications that affect the serotonin system have varying adverse event profiles (likely mediated by differences in serotonin-related mechanisms of action, specific brain structures affected, and effects on other neurotransmitter systems), the occurrence of central nervous system-related adverse events was not dissimilar between flibanserin and serotonergic antidepressants. Kingsberg SA, McElroy SL, Clayton AH. Evaluation of Flibanserin Safety: Comparison with Other Serotonergic Medications. Sex Med Rev 2019;7:380-392.


Assuntos
Benzimidazóis/uso terapêutico , Libido/efeitos dos fármacos , Pré-Menopausa , Serotoninérgicos/uso terapêutico , Disfunções Sexuais Psicogênicas/tratamento farmacológico , Feminino , Humanos , Disfunções Sexuais Psicogênicas/fisiopatologia
19.
Curr Urol Rep ; 20(4): 16, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30806828

RESUMO

Radical prostatectomy, the preferred treatment option for organ-confined prostate cancer, is associated with a wide variety of sexual dysfunctions including erectile and orgasmic dysfunctions. Climacturia is a type of orgasmic dysfunction that has been reported to occur in 20-60% of men after radical prostatectomy. Several treatment strategies for climacturia have been evaluated and recommended including behavioral changes, use of special devices, medications, specialized therapies, and surgeries. Inflatable penile prosthesis implantation might be the treatment of choice when conservative management approaches fail to treat erectile dysfunction. In this review article, the different options and approaches for the management of climacturia during inflatable penile prosthesis surgery will be discussed.


Assuntos
Implante Peniano , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Disfunções Sexuais Fisiológicas/cirurgia , Disfunções Sexuais Psicogênicas/cirurgia , Incontinência Urinária/cirurgia , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/cirurgia , Humanos , Masculino , Ereção Peniana/fisiologia , Ereção Peniana/psicologia , Prótese de Pênis , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Incontinência Urinária/etiologia
20.
J Hum Hypertens ; 33(5): 378-384, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30804462

RESUMO

This study examined the relationship between sexual dysfunction and marital adjustment in women with hypertension and the effect of the cultures on the sexual problems of women. Mixed method was used in this study. The study was conducted as quantitative (in descriptive type) to examine sexual dysfunction and marital adjustment in women with hypertension and as qualitative to examine the effect of culture on the views of individuals on sexual problems. The study included 102 women who met inclusion criteria (who were on medication and had active sexual life for 1 year). Patient information form, Arizona Sexual Experience Scale (Female), and Marital Adjustment Test (MAT) were used to collect the data. The mean age of the subjects was found to be 55.10 ± 9.13, the mean duration of hypertension diagnosis was 8.66 ± 6.43, and the mean time to start was 7.87 ± 6.30. The mean duration of marriage for the women with hypertension was 34.08 ± 12.507. There was a negative correlation between sexual orientation, orgasm and sexual satisfaction from the subscales of ASEX and the overall scale (p < 0.05). Accordingly, as the adaptation in marriage diminished, sexual problems increased in women. As a result of the study, it was determined that HT had a negative effect on sexual functioning problems and marital adjustment, but women accepted this situation because of their culture, "women do not have the right to sexuality" and naturally accept the absence of sexuality after a certain age.


Assuntos
Pressão Sanguínea , Hipertensão/etnologia , Estado Civil/etnologia , Comportamento Sexual/etnologia , Disfunções Sexuais Fisiológicas/etnologia , Disfunções Sexuais Psicogênicas/etnologia , Determinantes Sociais da Saúde/etnologia , Saúde da Mulher , Características Culturais , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertensão/psicologia , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Risco , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Fatores de Tempo , Turquia/epidemiologia
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