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1.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
Obes Surg ; 29(5): 1571-1575, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30706310

RESUMO

INTRODUCTION: Female sexual dysfunction (FSD) among the obese women is often under diagnosed and ignored especially in Malaysia, a nation of conservative multiethnic society. There are only a few studies on FSD resolution post-bariatric surgery. The objective was to identify the rate and resolution or improvement of FSD, among obese multiethnic Malaysian women post-bariatric surgery. MATERIAL AND METHODS: This is a prospective study of women undergoing bariatric surgery, between May 2017 and April 2018. FSD was diagnosed using the Malay version of Female Sexual Function Index (MVFSFI) questionnaire. Patients filled up the questionnaire before and 6 months after surgery. Association between BMI reduction and FSFI score improvement was measured using Fisher's exact test. Outcomes between types of surgery (sleeve gastrectomy and gastric bypass) was compared. RESULTS: Fifty-two women completed the study. The mean age was 38.77 ± 6.7. There were 44 (84.6%) Malay patients, 7 (13.5%) Indian patients, and 1 (1.9%) Chinese patient. There was a significant reduction in mean BMI, 39.89 ± 6.9 pre-surgery to 30.32 ± 5.4 post-surgery (p value < 0.001). The rate of FSD among the obese is 75.0% pre-surgery compared to 36.0% post-surgery. There was a significant improvement in mean FSFI score pre- and post-surgery: 18.73 and 25.93 respectively and in each of all 6 domains (p value < 0.001). There was a significant association between BMI reduction and improvement in FSFI score (p = 0.019). There was no difference in outcomes between types of surgery. CONCLUSION: FSD is highly prevalent among the obese multiethnic Malaysian women. Bariatric surgery has proven benefit in resolving FSD across all sexual domains and should be considered as a management option in this group of women.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Disfunções Sexuais Fisiológicas/cirurgia , Disfunções Sexuais Psicogênicas/cirurgia , Adulto , Comorbidade , Feminino , Humanos , Malásia , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Obesidade Mórbida/psicologia , Projetos Piloto , Estudos Prospectivos , Comportamento Sexual/fisiologia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/complicações , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Inquéritos e Questionários
11.
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
12.
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
13.
Sex Med Rev ; 7(1): 2-12, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30301706

RESUMO

INTRODUCTION: Persistent genital arousal disorder (PGAD) is a highly distressing and poorly understood condition characterized by unwanted sensations of genital arousal in the absence of subjective sexual desire. Research has shown that some individuals with PGAD also report orgasm, urinary, and pain symptoms, with 1 recent study specifically comparing a "painful persistent genital arousal symptom" group to a "non-painful persistent genital arousal symptom" group on various indicators given the highly frequent report of comorbid genitopelvic pain in their sample. AIM: To review literature on PGAD focusing on the presence of pain symptoms. METHODS: A literature review through May 2018 was undertaken to identify articles that discuss pain characteristics in individuals with persistent sexual arousal syndrome, persistent genital arousal disorder, symptoms of persistent genital arousal, and restless genital syndrome. MAIN OUTCOME MEASURE: A review of pain/discomfort associated with persistent genital arousal, and the proposal of a new theoretical framework of genitopelvic dysesthesias. RESULTS: PGAD is a distressing condition that is associated with a significant, negative impacts on psychosocial and daily functioning. Although it is clear that unwanted and persistent genital arousal is the hallmark symptom of PGAD, symptoms of pain and discomfort are also frequently reported. Based on the results of this review, a model of genitopelvic dysesthesias is proposed, with subcategories of unpleasant sensations that are based on patients' primary complaint: arousal, arousal and pain, or pain (and other sensations). CONCLUSION: The proposed model can provide an important framework for conceptualizing conditions characterized by unpleasant genitopelvic sensations. A model such as this one can benefit highly misunderstood conditions that are questioned in terms of their legitimacy and severity-such as PGAD-by conceptualizing them as sensory disorders, which in turn can reduce stigma, unify research efforts, and potentially improve access to care. Pukall CF, Jackowich R, Mooney K, et al. Genital Sensations in Persistent Genital Arousal Disorder: A Case for an Overarching Nosology of Genitopelvic Dysesthesias? Sex Med Rev 2019;7:2-12.


Assuntos
Doenças dos Genitais Femininos/fisiopatologia , Doenças dos Genitais Masculinos/fisiopatologia , Genitália/inervação , Parestesia/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Ansiedade , Nível de Alerta/fisiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Parestesia/complicações , Parestesia/psicologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/psicologia
14.
Menopause ; 26(4): 365-372, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30363011

RESUMO

OBJECTIVE: Although menopause is a natural event in a woman's life, some of its symptoms can be severe enough to adversely affect her health. There is some evidence to suggest that diet has an influence on menopausal symptoms, but less attention has been paid to dietary patterns. The purpose of this study is to determine the association of dietary patterns with physical, mental, and genitourinary menopausal symptoms. METHODS: A cross-sectional study design was applied using a sample of 400 postmenopausal women who attended health centers in the south of Tehran, Iran. The menopausal symptoms were assessed by a Menopause Rating Scale (MRS) questionnaire; a 147-item, semi-quantitative food-frequency questionnaire was used to collect dietary information, and major dietary patterns were identified by principal component analysis. Linear regression was used to evaluate the relationship between menopausal symptoms and dietary patterns. RESULTS: Three major dietary patterns were identified: vegetables and fruits (VF); mayonnaise, liquid oils, sweets, and desserts (MLSD); and solid fats and snacks (SFS). It has been found that the VF dietary pattern is inversely associated with general (ß = -1.37; SE = 1.08; P for trend <0.001), physical (ß = -1.54; SE = 1.09; P for trend <0.001), and mental (ß = -1.58; SE = 1.11; P for trend <0.001) symptoms. A stronger adherence to the MLSD dietary pattern was directly associated with general (ß = 1.15; SE = 1.08; P for trend <0.001) and genitourinary symptoms (ß = 1.54; SE = 1.1; P for trend <0.001). Moreover, the SFS dietary pattern was directly related to the general (ß = 1.23; SE = 1.09; P for trend = 0.01), physical (ß = 1.24; SE = 1.09; P for trend = 0.04), and mental (ß = 1.29; SE = 1.12; P for trend < 0.001) symptoms. CONCLUSION: The present study demonstrated that there is an inverse association between VF dietary pattern and menopausal symptoms. In contrast, the MLSD and SFS dietary patterns were correlated to an increased risk of these symptoms.


Assuntos
Dieta , Menopausa , Ansiedade/fisiopatologia , Artralgia/fisiopatologia , Atrofia , Atenção/fisiologia , Estudos Transversais , Depressão/fisiopatologia , Gorduras na Dieta/administração & dosagem , Gorduras na Dieta/efeitos adversos , Ingestão de Energia , Exercício Físico , Feminino , Frutas , Fogachos/fisiopatologia , Humanos , Transtornos da Memória/fisiopatologia , Menopausa/fisiologia , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Inquéritos e Questionários , Sudorese/fisiologia , Vagina/patologia , Verduras
15.
BJOG ; 126(3): 402-411, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30222235

RESUMO

OBJECTIVE: To assess the short- and long-term effects of mindfulness-based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk-reducing salpingo-oophorectomy (RRSO). DESIGN: Randomised controlled trial. SETTING: A specialised family cancer clinic of the university medical center Groningen. POPULATION: Sixty-six women carriers of the BRCA1/2 mutation who developed at least two moderate-to-severe menopausal symptoms after RRSO. METHODS: Women were randomised to an 8-week MBSR training programme or to care as usual (CAU). MAIN OUTCOME MEASURES: Change in the Menopause-Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time. RESULTS: At 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0-3.9) and 3.8 (95% CI 3.3-4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1-4.0) and 3.9 (95% CI 3.5-4.4). No significant differences were found between the MBSR and CAU groups in the other scores. CONCLUSION: Mindfulness-based stress reduction was effective at improving quality of life in the short- and long-term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress. TWEETABLE ABSTRACT: Mindfulness improves menopause-related quality of life in women after risk-reducing salpingo-oophorectomy.


Assuntos
Síndrome Hereditária de Câncer de Mama e Ovário/prevenção & controle , Menopausa , Atenção Plena/métodos , Salpingo-Ooforectomia , Estresse Psicológico/terapia , Adulto , Terapia de Reposição de Estrogênios , Feminino , Genes BRCA1 , Genes BRCA2 , Síndrome Hereditária de Câncer de Mama e Ovário/genética , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Profiláticos , Qualidade de Vida , Terapia de Relaxamento , Comportamento de Redução do Risco , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia , Estresse Psicológico/psicologia
16.
Behav Res Ther ; 115: 90-102, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30466714

RESUMO

Low resting heart rate variability (HRV) has been associated with poor sexual arousal function in women. In a recent study, a single session of autogenic training increased HRV and facilitated improvements in both sexual arousal and perceived genital sensations among women experiencing decreased arousal. The current study expands upon these findings by examining the efficacy of HRV biofeedback, with and without autogenic training, as a treatment for sexual arousal dysfunction in an at-home setting. Participants (N = 78) were randomized into one of three conditions: HRV biofeedback, HRV biofeedback + autogenic training, or waitlist control. Each condition included three laboratory sessions; participants in the two active conditions completed 4-6 biofeedback sessions at home, and participants in the HRVB + A condition listened to a 14-min autogenic training recording before completing the biofeedback. Across the three laboratory visits, participants in the three conditions singficnatly differed in their genital arousal, subjective sexual arousal, and their perceived genital sensations. Compared to women in the control group, women who engaged in HRV biofeedback at home, with and without additional autogenic training, experienced increases in genital arousal, subjective sexual arousal, and perceived genital sensations. These results provide preliminary support for the contribution of heart rate variability level to female sexual arousal function and for the use of either of these interventions in the treatment of sexual arousal concerns.


Assuntos
Biorretroalimentação Psicológica/métodos , Frequência Cardíaca/fisiologia , Libido/fisiologia , Disfunções Sexuais Psicogênicas/terapia , Adolescente , Adulto , Feminino , Humanos , Disfunções Sexuais Psicogênicas/fisiopatologia , Resultado do Tratamento , Adulto Jovem
17.
Acta Clin Croat ; 58(3): 508-515, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31969764

RESUMO

This study aimed to investigate whether infertility and its treatment affect couple sexuality. A systematic literature review was performed, focusing on female and male sexual dysfunctions due to infertility. The method was descriptive, using a meta-synthesis of scientific research published between 2012 and 2017 in the English language. The search for suitable studies was carried out with the research databases Medline, CINAHL, PubMed and ScienceDirect using the following keywords: infertility, sexual dysfunctions, couple. It can be concluded that infertility negatively affects the sexuality of an infertile couple, which is further proven by a high percentage of sexual dysfunctions (43%-90% among women and 48%-58% among men). Couples report less satisfaction with sexuality. Since lower satisfaction and dysfunctions are closely connected with infertility and its treatment, couples might benefit from sexual therapy and support during the process of infertility treatment. Further research should focus on the evaluation of different psychological interventions that would address sexuality in couples when diagnosed and treated for infertility.


Assuntos
Infertilidade/psicologia , Infertilidade/terapia , Comportamento Sexual/psicologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Fisiológicas/terapia , Disfunções Sexuais Psicogênicas/terapia , Sexualidade/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Infertilidade/fisiopatologia , Masculino , Pessoa de Meia-Idade , Disfunções Sexuais Psicogênicas/fisiopatologia
18.
Obstet Gynecol Clin North Am ; 45(4): 709-722, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30401552

RESUMO

Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking.


Assuntos
Dispareunia/fisiopatologia , Hormônios Gonadais/metabolismo , Menopausa/fisiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Saúde da Mulher , Administração Intravaginal , Dispareunia/psicologia , Terapia de Reposição de Estrogênios , Feminino , Humanos , Lubrificantes , Menopausa/metabolismo , Pessoa de Meia-Idade , Pós-Menopausa/metabolismo , Pós-Menopausa/fisiologia , Qualidade de Vida , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/psicologia
19.
Int J Gynecol Cancer ; 28(9): 1737-1742, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30358703

RESUMO

OBJECTIVE: Sexual health is important to quality of life; however, the sexual health of gynecologic cancer patients is infrequently and inadequately addressed. We sought to understand patient experiences and preferences for sexual health care to help inform strategies for improvement. METHODS/MATERIALS: An anonymous, cross-sectional survey of outpatient gynecologic cancer patients at a large academic medical center was performed as part of a larger study examining patient and caregiver needs. The survey explored patient-provider discussions about sexuality across 3 domains (experiences, preferences, barriers) and 4 phases of cancer care (diagnosis, treatment, treatment completion, follow-up). Age, relationship status, sexual activity, and cancer type were recorded. RESULTS: Mean age was 63 years. Most patients had ovarian cancer (38%) or endometrial cancer (32%). Thirty-seven percent received treatment within the last month, 55% were in a relationship, and 35% were sexuality active. Thirty-four percent reported sexuality as somewhat or very important, whereas 27% felt that it was somewhat or very important to discuss. Importance of sexuality was associated with age, relationship status, and sexual activity but not cancer type. Fifty-seven percent reported never discussing sexuality. Age was associated with sexuality discussions, whereas relationship status, sexual activity, and cancer type were not. The most common barrier to discussion was patient discomfort. Follow-up was identified as the best time for discussion. Sexuality was most often discussed with a physician or advanced practice provider and usually brought up by the provider. CONCLUSIONS: Demographic predictors of importance of sexuality to the patient are age, relationship status, and sexual activity. Providers primarily use age as a proxy for importance of sexuality; however, relationship status and sexual activity may represent additional ways to screen for patients interested in discussing sexual health. Patient discomfort with discussing sexuality is the primary barrier to sexual health discussions, and awareness of this is key to developing effective approaches to providing sexual health care.


Assuntos
Neoplasias dos Genitais Femininos/terapia , Cuidados Paliativos/métodos , Disfunções Sexuais Psicogênicas/terapia , Saúde Sexual , Sexualidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/fisiopatologia , Neoplasias do Endométrio/psicologia , Neoplasias do Endométrio/terapia , Feminino , Neoplasias dos Genitais Femininos/fisiopatologia , Neoplasias dos Genitais Femininos/psicologia , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/fisiopatologia , Neoplasias Ovarianas/psicologia , Neoplasias Ovarianas/terapia , Preferência do Paciente , Qualidade de Vida , Disfunções Sexuais Psicogênicas/etiologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia
20.
BMJ Open ; 8(8): e022863, 2018 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-30166306

RESUMO

INTRODUCTION: Female sexual dysfunction is a public health problem. Evidence suggests that the population of nursing women is more vulnerable to the phenomenon due to breast feeding. Thus, this protocol was developed to explore the factors that contribute to the development of sexual dysfunction in breastfeeding women. METHODS AND ANALYSIS: The systematic scoping review will be conducted in six stages, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The databases used will be: PubMed, Excerpta Medica Database, Cumulative Index for Nursing and Allied Health Literature, PsycINFO, Science Direct, Web of Science and Google Scholar. The searches were made until 1 June 2018, and no retrospective time limit was used. For the organisation of the literature retrieved from the databases, the EndNote Basic manager will be used. The Cochrane model will be used for the data extraction. The analysis of the quantitative data will be carried out through descriptive statistics and the qualitative data will be submitted to thematic analysis. The methodological quality of the empirical studies will be evaluated using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION: As it will be a review study, without human involvement, there will be no need for ethical approval. The results will be disseminated in a scientific journal, as well as in various media, such as: conferences, seminars, congresses or symposia.


Assuntos
Aleitamento Materno/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Aleitamento Materno/efeitos adversos , Feminino , Humanos , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Psicogênicas/fisiopatologia
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