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2.
Am J Clin Dermatol ; 20(5): 639-646, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313079

RESUMO

Psoriasis involving the genital skin occurs in up to two-thirds of psoriasis patients but is often overlooked by physicians. Furthermore, psoriasis objective and subjective severity indexes for common plaque psoriasis often neglect the impact this small area of psoriasis can have on a patient. It can have a significant impact on patients' psychosocial function due to intrusive physical symptoms such as genital itch and pain, and a detrimental impact on sexual health and impaired relationships. The mainstay of treatment is topical therapy. In patients with genital psoriasis refractory to traditional topical treatment, biologic treatments may greatly improve patient outcomes.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/terapia , Fototerapia/métodos , Psoríase/terapia , Fatores Biológicos/uso terapêutico , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Genitália Feminina/patologia , Genitália Masculina/patologia , Humanos , Masculino , Psoríase/diagnóstico , Psoríase/psicologia , Angústia Psicológica , Qualidade de Vida , Índice de Gravidade de Doença , Saúde Sexual , Pele/patologia , Resultado do Tratamento
3.
Ann Dermatol Venereol ; 146(4): 273-278, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30928124

RESUMO

Since sexual satisfaction is a key factor in quality-of-life scores, the aim of this review article is to examine current knowledge concerning the impact on male sexuality of psoriasis, particularly genital psoriasis. Risk factors for sexual dysfunction, and more specifically erectile dysfunction, demonstrated to date include severity of psoriasis, genital psoriasis, psoriatic arthritis, smoking, psychological disorders (anxiety-depression), cardiovascular comorbidities and side effects of psoriasis treatments. Studies evaluating the burden of genital psoriasis on male sexuality are contradictory: while the link between genital psoriasis and global sexual functioning has been clearly established in relation to question 9 of the DLQI, discrepancies exist between the scoring systems used concerning sexual satisfaction. Finally, psoriasis patients have expressed a wish to receive more care from their dermatologist in terms of their genital psoriasis and its impact on their sexual activity.


Assuntos
Orgasmo , Psoríase/psicologia , Qualidade de Vida/psicologia , Comportamento Sexual/psicologia , Transtornos de Ansiedade/psicologia , Artrite Psoriásica/psicologia , Comorbidade , Transtorno Depressivo/psicologia , Disfunção Erétil/psicologia , Doenças dos Genitais Masculinos/psicologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Fumar/psicologia
4.
Br J Dermatol ; 180(3): 647-656, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30188572

RESUMO

BACKGROUND: Genital psoriasis is often under-recognized. OBJECTIVES: To assess the instantaneous prevalence of genital psoriasis and describe its clinical features, association with a particular subtype of psoriasis and its impact on general and sexual quality of life (QoL). METHODS: GENIPSO is a prospective study conducted by private and hospital-based dermatologists. This study featured the consecutive inclusion of patients consulting for extragenital psoriasis. The clinical features of psoriasis and genital psoriasis were recorded and QoL and sexual health questionnaires were distributed to patients. RESULTS: Overall, 335 of 776 patients (43·2%) included in the study had genital involvement. All were aware that they had genital lesions but only 135 patients (40%) declared that they had been previously examined. Genital lesions were associated with male sex, severity of psoriasis, age of onset > 20 years, inverse psoriasis and involvement of scalp, nail and external auditory canal, but were not associated with obesity, psoriatic arthritis and active sex life. Itching was the main symptom. Genital psoriasis was associated with impairment of QoL and sexual health according to the Dermatology Life Quality Index and the Female Sexual Function Index. CONCLUSIONS: Genital psoriasis has a high prevalence in patients consulting for extragenital psoriasis, which affects QoL, and should be taken into account by dermatologists in order to optimize global care.


Assuntos
Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Psoríase/epidemiologia , Qualidade de Vida , Saúde Sexual , Adulto , Idoso , Estudos Transversais , Feminino , França/epidemiologia , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/complicações , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Psoríase/complicações , Psoríase/diagnóstico , Psoríase/psicologia , Encaminhamento e Consulta/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos
5.
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
6.
BMJ Open ; 8(6): e018213, 2018 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-29960999

RESUMO

INTRODUCTION: Non-specific genital infection (NSGI; non-Chlamydia trachomatis, non-Neisseria gonorrhoeae-associated urethritis) is a common diagnosis in symptomatic heterosexual men attending UK sexual health clinics (SHCs). but little is known about the psychosocial impact of this diagnosis. METHODS: We conducted an observational study among symptomatic heterosexual men attending SHCs to evaluate the psychosocial impact of an NSGI diagnosis compared with a diagnosis of Chlamydia trachomatis (CT), Neisseria gonorrhoeae or no abnormalities detected focusing on the feasibility of our study methodology. Participants completed a computer-assisted self-interviewing (CASI) including two validated measures of psychosocial impact: the EQ-5D-5L health-related quality of life and Rosenberg Self-Esteem Scale, before diagnostic testing and 2 weeks after receiving test results (follow-up 1 (FU-1)) and a qualitative interview. We compared scores between diagnostic groups using paired t-tests, qualitative data were analysed thematically and feasibility was assessed by process analysis. RESULTS: 60 men completed the baseline CASI (75% response rate). 46 (76.6%) were eligible for follow-up; 11/46 (23.9%) completed the follow-up CASI, and 3/11 (27.3%) completed the qualitative interview. 81.7% of all participants left CASI feedback at baseline: 73.5% reported the questionnaire as 'fine' or 'very good'. Qualitative interview participants reported the study was acceptable. Compared with baseline, among patients completing FU-1, only patients with a diagnosis of NSGI (p<0.05) or CT (p<0.05) showed increased EQ-5D-5L Index, whereas patients with a diagnosis of NSGI (p=0.05) showed decreased mean Rosenberg Self-Esteem Scale score. CONCLUSIONS: Although most participants indicated study acceptability at baseline, and we employed measures to increase retention (CASI questionnaires, reminder messages and a focus on men's health), we experienced high loss to follow-up. We found that heterosexual men attending SHCs with symptoms of urethritis experience both positive and negative psychosocial impacts following their clinic attendance, which warrants further investigation.


Assuntos
Doenças dos Genitais Masculinos/psicologia , Qualidade de Vida , Adulto , Instituições de Assistência Ambulatorial , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Estudos de Viabilidade , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/microbiologia , Gonorreia/diagnóstico , Gonorreia/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Reino Unido , Adulto Jovem
7.
Curr Urol Rep ; 19(8): 59, 2018 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-29855742

RESUMO

PURPOSE OF REVIEW: Chronic scrotal pain (CSP) is a common yet poorly understood condition, with significant impacts on overall quality of life. Many patients will have sought evaluation and management from multiple providers in an attempt to find a solution for their pain. RECENT FINDINGS: Despite many emerging treatments for CSP and further understanding of the potential etiologies and pathophysiological basis of the condition, its natural history is poorly understood. It is also important to recognize the psychosocial impact of CSP and consider formal referral for psychological evaluation and treatment if the patient endorses significant psychiatric responses to pain. It is important to also recognize the neuropathic component of pain that may arise in patients with CSP. Neuropathic medications show promise as a narcotic-sparing pharmacological intervention. There are promising surgical options for CSP including microsurgical denervation of the spermatic cord. This article highlights the current best practice recommendations on the evaluation and management of chronic scrotal pain.


Assuntos
Dor Crônica/terapia , Doenças dos Genitais Masculinos/terapia , Escroto , Dor Crônica/etiologia , Dor Crônica/psicologia , Denervação , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Qualidade de Vida , Cordão Espermático/inervação
8.
Salud Publica Mex ; 60(6): 624-632, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30699267

RESUMO

OBJECTIVE: To estimate the burden of genital warts (GW)in Mexico. MATERIALS AND METHODS: We estimated the annual incidence of GW based on data reported by specialist physicians. We also assessed GW treatment practices, the average cost of treatment, and the psychosocial burden of GW among patients. RESULTS: The annual incidence of GW in Mexico was estimated to be 547 200 cases. Treatment procedures vary by specialist and patient gender. The estimated annual cost was $195 million USD. The psychosocial impact of GW was slightly greater in males than females. CONCLUSIONS: This is the first evaluation of the burden of GW in Mexico. Our data suggest that GW are common, with significant health-related costs and psychosocial impact.


Assuntos
Doenças do Ânus/epidemiologia , Condiloma Acuminado/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Adulto , Doenças do Ânus/economia , Doenças do Ânus/psicologia , Doenças do Ânus/terapia , Terapia Combinada , Condiloma Acuminado/economia , Condiloma Acuminado/psicologia , Condiloma Acuminado/terapia , Efeitos Psicossociais da Doença , Feminino , Doenças dos Genitais Femininos/economia , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/economia , Doenças dos Genitais Masculinos/psicologia , Doenças dos Genitais Masculinos/terapia , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Medicina/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Vacinas contra Papillomavirus , Prevalência , Qualidade de Vida
9.
Sex Transm Dis ; 44(7): 390-392, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28608787
10.
Sex Transm Dis ; 44(7): 417-422, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28608791

RESUMO

BACKGROUND: Repeat chlamydia detection after treatment is common, and there is concern that treatment failure may be a cause. METHODS: Within a randomized trial, we established a prospective cohort of 600 participants with anogenital chlamydia diagnoses (200 each of women, heterosexual men, and men who have sex with men [MSM]). Participants were invited for repeat testing at 3 months and to complete a behavioral survey at 4 months. Positive samples were analyzed for organism DNA load and genovar. We estimated repeat chlamydia positivity, reinfection and treatment failure rates, and investigated the biological and behavioral factors associated with a repeat positive test. RESULTS: A total of 290 participants (100 women, 89 heterosexual men, 101 MSM) were retested at 1 to 4 months, with 43 repeat positives, including 26 classed as reinfection and 9 as treatment failures. Comparing MSM with heterosexual men and women combined, repeat positivity was higher (20.8% vs 11.6%, P = 0.04), and treatment failure was higher (6.9% vs 1.1%, P = 0.01), but there was no difference in reinfection rates (11.9% vs 7.4%, P = 0.21). Among MSM, the odds of repeat positivity increased by 90% with each additional log organism load in the original specimen (baseline) (adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Among heterosexuals, the odds of repeat positivity decreased by 10% with each additional week delay in being retested for chlamydia (adjusted odds ratio, 0.9; 95% confidence interval, 0.8-0.9). CONCLUSIONS: Positive retests were more common among MSM than heterosexuals. Treatment failure was more common in MSM with rectal chlamydia, reinforcing concerns about azithromycin treatment failure.


Assuntos
Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/psicologia , Chlamydia trachomatis/efeitos dos fármacos , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Cooperação do Paciente , Adulto , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Feminino , Seguimentos , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/tratamento farmacológico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Estudos Prospectivos , Doenças Retais/diagnóstico , Doenças Retais/tratamento farmacológico , Doenças Retais/psicologia , Recidiva , Falha de Tratamento , Adulto Jovem
11.
Skinmed ; 14(3): 237-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27502268

RESUMO

Case 1 A 35-year-old married man presented with diffuse burning of the scrotum for 6 months' duration that was aggravated by sitting and wearing tight-fitting undergarments. He reported a history of sexual exposure 6 months prior, after which the complaint started. Clinical examination of the scrotal skin, testis, epididymis, penis, and perianal area did not reveal any abnormality. Rectal examination was performed to rule out chronic proctitis. Investigations were performed to exclude sexually transmitted infections. Ultrasonography of the abdomen and pelvis was ordered to rule out organic cause. The patient experienced guilt from the exposure because he was married, and therefore was referred to the psychiatrist to rule out psychological problems. A diagnosis of major depressive disorder was made. He was started on amitriptyline 25 mg and was gradually increased to 50 mg. The patient showed gradual improvement in symptoms after 3 weeks of follow-up.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Relações Extramatrimoniais/psicologia , Doenças dos Genitais Masculinos/psicologia , Escroto , Adulto , Amitriptilina/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Culpa , Humanos , Masculino , Escroto/diagnóstico por imagem , Ultrassonografia
12.
Clin Exp Dermatol ; 41(5): 474-9, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26932754

RESUMO

BACKGROUND: Dysaesthetic penoscrotodynia (DPSD) is a poorly understood disorder, in which men experience distressing symptoms such as burning pain in their genital skin. Drugs for neuropathic pain are often used, but with little success. AIM: To review a series of patients with DPSD to highlight common themes and response to treatment. METHODS: Ten consecutive patients with DPSD were identified from specialist male genital dermatology and psychodermatology clinics at two centres. Clinical details, including psychiatric history, were reviewed retrospectively. Patients with no previously diagnosed psychiatric illness completed either the Generalized Anxiety Disorder (GAD)-7 scale and the Patient Health Questionnaire (PHQ)-9 depression scale, or the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI). RESULTS: Of the 10 patients, 9 had known or newly diagnosed psychopathology. All patients were offered psychodermatological treatment, of which 7 of 10 accepted. All of those who accepted psychodermatological treatment experienced an improvement in their genital symptoms. When post-treatment scores were collected, improvement in psychiatric symptoms accompanied improvement in genital symptoms. CONCLUSIONS: Psychopathology is almost invariably present in individuals with DPSD, yet these patients rarely volunteer such information. DPSD is most likely to constitute a functional somatic symptom disorder, hence psychodermatological treatment is indicated for its management. This concept reflects a significant change in the approach to this condition.


Assuntos
Doenças dos Genitais Masculinos/psicologia , Doenças dos Genitais Masculinos/terapia , Transtornos Somatoformes/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/uso terapêutico , Anti-Infecciosos/uso terapêutico , Antidepressivos/uso terapêutico , Ansiedade/complicações , Fármacos Dermatológicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia/métodos , Qualidade de Vida , Estudos Retrospectivos
13.
J Am Acad Dermatol ; 72(6): 978-83, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25824273

RESUMO

BACKGROUND: Genital involvement has significant psychosexual implications for psoriasis patients. OBJECTIVE: This study was designed to ascertain factors associated with the development of genital psoriasis and its impact on quality of life and sexual functioning. METHODS: This was an observational, multicenter study of 354 consecutive psoriasis patients. RESULTS: One hundred thirty-four patients (38%) had current genital involvement while 224 (63%) had a current and/or previous history of genital involvement. Eighty-seven percent reported itch, 39% pain, 42% dyspareunia, 32% a worsening of their genital psoriasis after intercourse, and 43% a decreased frequency of intercourse. Younger age of onset of psoriasis, male sex, more severe disease, and involvement of the scalp, flexures, and nails were associated with the presence of genital disease. There was no association with circumcision or obesity. Patients with genital psoriasis had more impairment in quality of life and sexual health as determined by the Dermatology Life Quality Index (P < .0001), the Center for Epidemiological Studies-Depression Scale (P = .01), and the Relationship and Sexuality Scale (P < .0001). LIMITATIONS: This was a descriptive study from 2 tertiary referral centers where patients were likely to have more severe psoriasis. CONCLUSION: This study highlights the high prevalence of genital psoriasis and its profound impact on quality of life and sexual health.


Assuntos
Psoríase/complicações , Qualidade de Vida , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Administração Tópica , Adolescente , Adulto , Fatores Etários , Idoso , Fármacos Dermatológicos/uso terapêutico , Feminino , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Perfil de Impacto da Doença , Adulto Jovem
14.
Acta Derm Venereol ; 95(2): 211-6, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24806592

RESUMO

Genital psoriasis is a neglected manifestation of psoriasis, although it affects numerous patients and has major effects on sexual quality of life (SQoL). We aimed to assess the value of specialised care for patients with genital psoriasis. Patients were treated for at least one year at a specialised research outpatient clinic with extensive attention for genital lesions and SQoL. The genital lesions were treated according to a stepwise algorithm. First follow-up was planned after 6 weeks; subsequent follow-up visits were scheduled every 3 months. At every visit, psoriasis severity and SQoL were measured with validated tools. Differences in scores between visits were analysed by a mixed model for repeated measures. Forty-two patients were included (M:F = 25:17). All objective and subjective genital psoriasis severity and QoL parameters improved significantly within the first follow-up period of approximately 6 weeks. In female patients, SQoL also significantly improved. In conclusion, genital psoriasis can relatively easy be treated within limited time exposure, resulting in significant improvement of QoL. Prompt and simple adjustments in the provided care are enough to accomplish this.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Masculinos/tratamento farmacológico , Psoríase/tratamento farmacológico , Corticosteroides/administração & dosagem , Algoritmos , Inibidores de Calcineurina/administração & dosagem , Estudos de Coortes , Procedimentos Clínicos , Esquema de Medicação , Quimioterapia Combinada , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Ambulatório Hospitalar , Psoríase/diagnóstico , Psoríase/psicologia , Qualidade de Vida , Índice de Gravidade de Doença , Comportamento Sexual , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Vitamina D/administração & dosagem , Vitamina D/análogos & derivados
15.
World J Urol ; 33(1): 137-43, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24682594

RESUMO

PURPOSE: Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term? METHODS: Sexual quality of life (QoL) was assessed in 10 men (aged 20-43 years) at least 1 year after phalloplasty in a single institution (80 % radial forearm flap and 20 % anterolateral thigh flap). In all but one, an erectile prosthesis was implanted on average 1 year after phallic reconstruction. Sexual QoL outcomes were compared to those of men with hypospadias repair (n = 73) and control men (n = 50). RESULTS: After phalloplasty (mean 36.9 months, 14-92 months), all men were sexually active (80 % intercourse and 100 % masturbation with orgasm and ejaculation). However, 75 % indicated to be inhibited in seeking sexual contacts, compared to 40 % of hypospadias patients (p < 0.05) and 11 % of controls (p < 0.01). Although 90 % were satisfied with the final surgical result, dissatisfaction with some aspects of genital appearance was present in 50 %. Erogenous neophallus sensitivity was said to be less than previously hoped for. Six men developed urinary complications (urethral stricture and/or fistula), and one man underwent revision of the erectile implant because of dysfunction. Nevertheless, all indicated they would choose again for phalloplasty if necessary. CONCLUSIONS: Total phalloplasty opens new horizons for the treatment of men with penile deficiency, but limitations of the technique should be emphasized prior to surgery. An exploration of patient expectations and continued follow-up including psychological support is important for optimizing psychosexual comfort.


Assuntos
Doenças dos Genitais Masculinos/psicologia , Doenças dos Genitais Masculinos/cirurgia , Pênis/anormalidades , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Comportamento Sexual , Adulto , Estudos de Casos e Controles , Estudos Transversais , Ejaculação , Humanos , Masculino , Pessoa de Meia-Idade , Orgasmo , Satisfação do Paciente , Pênis/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
16.
J Sex Med ; 11(12): 2882-9, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25266400

RESUMO

INTRODUCTION: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relationship. However, beyond genital psoriasis, the importance of the distribution pattern of the disease has not been considered. AIM: To investigate the role of the distribution pattern of psoriasis in sexual dysfunction. METHODS: A prospective case series study was carried out on 133 patients with moderate to severe psoriasis. MAIN OUTCOME MEASURES: The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Forty-four women (mean age 42.0 ± 14.1) and 79 men (mean age 47 ± 11.7) were included in the study. Psoriasis lesions on abdomen, genitals, lumbar region, and buttocks in women and chest, genitals, and buttocks in men were associated with an increase in sexual dysfunction. Multivariate logistic regression analysis showed that the involvement of these specific areas may be independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSIONS: This is the first study identifying body areas other than genitals as potentially related to sexual dysfunction in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when deciding on treatment for psoriasis patients.


Assuntos
Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Masculinos/psicologia , Psoríase/psicologia , Autoimagem , Índice de Gravidade de Doença , Disfunções Sexuais Psicogênicas/psicologia , Adulto , Idoso , Ansiedade/etiologia , Imagem Corporal , Depressão/etiologia , Feminino , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Masculinos/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/complicações , Disfunções Sexuais Psicogênicas/etiologia , Inquéritos e Questionários
18.
J Sex Med ; 11(3): 653-63, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24373463

RESUMO

INTRODUCTION: The suppressing effects of chronic stress on sexual desire have long been noted. Yet the biological mechanisms underlying such effects, especially at the level of cellular biology of testicular cells, have not been fully investigated. AIM: In the present study, we used a chronic unpredictable mild stress model to examine the association between chronic stress and structural alterations in the male reproductive system. MAIN OUTCOME MEASURES: The main outcome measures were the structural changes in sperm cells and Leydig cells of male rats. We used Agmo and Ellingsen's procedure to study partner preference behavior and observed the morphology of Leydig cells and germ cells in the control and stress groups. METHODS: Our methods included histology, electron microscopy, and animal behavior tests. RESULTS: The results showed that after 5 weeks of chronic stress exposure, partner preference behavior was impaired, the total surface area of Leydig cells and the number and diameter of seminiferous tubules decreased significantly, and the number and size of Leydig cells, as well as the number and the short-axis diameter of spermatogenic cells, also decreased. At the ultrastructural level, transmission electron microscopy revealed that the basement membranes of seminiferous tubules in stressed rats was far thinner, had a low density, and was uneven in thickness compared with the normal group, with enhanced apoptosis in germ cells. CONCLUSION: We conclude that chronic stress can trigger organic damage to testicular cells in male rats.


Assuntos
Doenças dos Genitais Masculinos/patologia , Células Intersticiais do Testículo/patologia , Motivação/fisiologia , Túbulos Seminíferos/patologia , Comportamento Sexual Animal/fisiologia , Estresse Psicológico/psicologia , Animais , Apoptose/efeitos dos fármacos , Estro/fisiologia , Feminino , Doenças dos Genitais Masculinos/psicologia , Humanos , Masculino , Microscopia Eletrônica de Transmissão , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Espermatozoides/patologia , Estresse Psicológico/patologia
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