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Biomedical subjects

A Graziottin

Publications and source records attributed to A Graziottin.

At least 19 recordsLinked to original sources
PubMed2004

Are subjects with erectile dysfunction aware of their condition? Results from a retrospective study based on an Italian free-call information service.

The aim of the study was to analyse the socio-demographic and epidemiological characteristics of the Italian male population affected by sexual disturbances. Men complaining of erectile dysfunction (ED) who called the Pfizer program "Man and Woman in Health" between April 18th 2001 and May 27th 2002 and asked for information about their medical condition, were interviewed by trained doctors using a computer-assisted questionnaire. 16007 out of 25018 calls were considered for statistical analysis. Mean age of callers was 48.8+/-14.2 yr, reporting ED in 83% of cases. In the majority of men ED was severe (58%) and lasting more than 3 yr (25%). Multivariate analysis revealed that diabetes, depression, prostate surgery, heart disease, neurological disorders, liver and renal diseases were all significant and independent contributors to the degree of erectile impairment adjusted for age (p<0.001). The principal concomitant medications were anti-hypertensive (23%), antidiabetic (9%) and cardiovascular agents (6%). Cigarette smoking was present in 24%. On directed questioning of the caller, anxiety and distress were perceived as the most frequent causes of ED (42%) across all age groups, followed by the presence of concomitant disease/s (26%) especially in aging men. Also, a large number of men (41 %) with severe ED waited for more than 3 yr before looking for medical referral. Interestingly, only 19% had ever tried any specific medication for ED. These data indicate that 5 yr after worldwide approval and release of sildenafil, ED is still largely undiagnosed and under-treated, possibly because it is still perceived as a condition mainly due to distress or advancing age and therefore not deserving medical referral. Effective prevention of ED commences with better awareness of the pathological causes by the population and modification of risk factors by the doctors.

Adult↗
PubMed2003

Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision.

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's sexual response. It is apparent that fullfilment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Female↗
PubMed2003

Etiology and diagnosis of coital pain.

Coital pain is the leading symptom of two major sexual disorders, dyspareunia and vaginismus. According to the new International Classification on Female Sexual Disorders they are included under the category of "Sexual Pain Disorders". Dyspareunia has long been considered to be psychogenic. On the contrary, it has solid biological bases: location of pain and its characteristics are the strongest predictors of its organicity. Biological factors include hormonal, inflammatory, muscular, iatrogenic, neurologic, vascular, connective and immunitary causes. A specific pathology of pain is in play when the meaning of pain shifts from the "nociceptive" domain, when it signals an ongoing tissue damage, to the "neuropathic" dimension, when pain is generated within the pain system itself, with increased peripheral input and/or lowered central pain threshold, as happens in chronic vulvar vestibulitis. Vaginismus, with its associated defensive contraction of perivaginal muscles when intercourse is attempted, is credited to be the pelvic expression of a more general muscular defense posture, associated with a variable phobic attitude towards coital intimacy. Vaginismus may prevent intercourse in the most severe degrees, whilst in the milder ones it becomes a cause of dyspareunia. Psychosexual factors--loss of libido and arousal disorders, associated with, or secondary to, sexual pain related disorders--may contribute to the worsening of coital pain over time, alone or when associated to couple problems. The clinical approach should aim at diagnosing biological, psychosexual and context-dependent etiologies. The psychobiology of the experience of sexual pain needs to be addressed in a comprehensive, integrated and patient-centered perspective.

Coitus↗
PubMed2003

The challenge of sexual medicine for women: overcoming cultural and educational limits and gender biases.

Women's sexuality is multifactorial, rooted in biological, psychosexual and context-related factors, correlated not only to the couple concerned, but also to family and socio-cultural issues. Female sexual identity, sexual function and sexual relationship interact to give female sexual health its full meaning or, on the contrary, its problematic profile. Women's sexuality is discontinuous throughout the life cycle and is dependent on personal, current contextual and relationship variables as well as historical factors. Female sexual dysfunctions (FSD) occur along a continuum from dissatisfaction (with or without significant distress) to complete dysfunction (with or without significant distress). Sexual problems reported by women are not discrete and often co-occur, co-morbidity being one of the leading characteristics of female sexual dysfunctions. Socio-cultural factors may modulate the expression and complaining modality, i.e. wording of a sexual disorder. The meaning of sexual intimacy is to be understood, as it is indeed a strong modulator of the sexual response and of the quality of satisfaction the woman experiences, besides being the simple adequacy of the sexual function. Quality of feelings for the partner and the partner's health and sexual problems may further contribute to FSD. To improve women's sexual health, physicians should receive a formal training in sexual medicine both in the general medical training and in the speciality course; should become competent in the first level medical diagnosis of FSD; have an interdisciplinary approach and acknowledge the socio-cultural and context-dependent differences in FSD etiology and wording.

Cultural Characteristics↗
PubMed2000

Cardioprotective effects of ovarian hormones and the HERS in perspective.

The increased population of women in menopause living in the industrialized countries is associated with an increase of diseases which are dependent or facilitated by a state of estrogen deficiency such as cardiovascular and cerebrovascular diseases. Several studies have shown that estrogen replacement therapy reduces the occurrence of coronary and may be of cerebrovascular disease by nearly 50% in treated women compared to non-users. These findings are supported by the evidence that estrogens have a beneficial effect on cholesterol metabolism and deposition, contributing to the inhibition of atherosclerotic plaque formation in arterial walls as well as a direct effect on the vessel wall. Progestins may, in some cases, counteract the beneficial effect of estrogens upon cardiovascular functions. More androgenic progestins may have a detrimental effect upon vascular reactivity while less androgenic progestins seem not to reduce the beneficial effect of estrogens. Of interest, continuous combined administration of hormone replacement therapy seem to be preferable for women with coronary artery disease or for those with increased cardiovascular risk. Case-control and cohort studies have shown that estrogen progestin therapy is associated with a significant reduction of cardiovascular mortality and morbidity. The HERS study has added critical data regarding the cardioprotective effect of hormone replacement therapy in elderly women with proven coronary artery disease. Because of the several methodological and statistical flaws of the HERS study, further studies are warranted to evaluate the effect of hormone replacement therapy on cardiovascular prognosis. Large scale randomized studies will evaluate the effect of estrogen and estrogen-progestin replacement therapy upon cardiovascular events in menopausal women. Until completion of these studies hormone replacement therapy in women with increased cardiovascular risk should be seen with no enthusiasm but also with no fear.

Cardiovascular Diseases↗
PubMed2000

Libido: the biologic scenario.

Libido is a comprehensive and yet elusive word that indicates basic human mental states--and their biological counterparts--involved in the beginning of sexual behavior. It has three main roots: biological, motivational-affective and cognitive. All these dimensions may be variably affected in the post menopause, contributing to a progressive decrease of sexual drive that parallels the process of aging. Loss of estrogens and, specifically, of androgens deprives female libido of major biological fuel. The effect of this loss is pervading, affecting the central nervous system, the sensory organs that are the major windows to environmental sexual stimuli and the quality of sexual response, central, peripheral non-genital and genital. Prolactin increase may further inhibit libido. Arousal disorders, dyspareunia, orgasmic difficulties, dissatisfaction, both physical and emotional, may contribute to a secondary loss of libido. Depression, anxiety and chronic stress, may interfere with central and peripheral pathways of the sexual response, reducing the quality of sexual function mostly in its motivational root. Relational conflicts and/or marital delusions and partner-specific problems, erectile deficit first, may contribute to the fading of sexual drive in the post-menopausal years. Well tailored HRT, including androgens in selected cases, may reduce the biological causes of loss of libido. A comprehensive treatment requires a balanced evaluation between biological and psychodynamic factors.

Androgens↗
PubMed2000

AMS three-piece inflatable implants for erectile dysfunction: a long-term multi-institutional study in 200 consecutive patients.

OBJECTIVES: The aim of this study was to assess the longterm mechanical reliability of AMS (American Medical Systems) three-piece inflatable implants and their impact on patient-partner satisfaction in 200 consecutive patients with erectile dysfunction who underwent surgery in five different institutions. METHODS: Patient charts included in the study were collected and extensively assessed to record pre- and intraoperative data and postoperative complications. All patients and 120 partners were then seen often in the office at a mean follow-up of 59 months (range 6-130) and they were extensively questioned about function of the device and its impact on the couple's sexual life. RESULTS: At the long-term follow-up, 185 patients (92.5%) were still engaging in sexual intercourse with a mean frequency of 1.7/week. Patients and partners reported prosthetic erections as excellent, satisfactory or poor in 96 (48%), 100 (50%) and 4 (2%) cases, and in 20 (17%), 80 (66%) and 20 (17%) cases, respectively. Postoperative sexual activity was considered excellent, satisfactory or poor by 140 (70%), 44 (22%) and 16 (8%) patients and by 34 (28%), 81 (68%) and 5 (4%) partners, respectively. Reasons for patients' complaints included postoperative penile shortening in 60 (30%) cases and poor glandular engorgement in 40 (20%) cases. Partners' main complaint was unnaturalness of the prosthetic erection, a factor reported by 30 (25%) subjects. Complications requiring surgical exploration included infection in 12 patients (6%) and mechanical failure in 8 patients (4%). Kaplan-Meier estimates demonstrated significantly decreased mechanical survival for the Ultrex type of cylinders compared to the CX type of cylinders. CONCLUSIONS: AMS three-piece inflatable implants provide an overall patient and partner satisfaction rate of 92 and 96%, respectively. However, postoperative penile shortening and poor glandular engorgement were the causes of some complaints among the patient population as well as the unnaturalness of prosthetic erection among female partners. In the long-term, mechanically speaking, CX cylinders seem to be more reliable than the Ultrex ones.

Adult↗
PubMed2000

Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.

PURPOSE: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. MATERIALS AND METHODS: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. RESULTS: Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. CONCLUSIONS: We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

Female↗
PubMed1999

Strategies for effectively addressing women's concerns about the menopause and HRT.

HRT has many benefits for postmenopausal women yet acceptance and compliance with therapy is low. This paper sets out some of the main concerns women have regarding HRT and highlights ways that physicians can effectively deal with these concerns. Physicians dealing with women concerned about starting or continuing HRT should conduct patient-centered consultations employing good counseling skills. Dealing effectively with women's concerns means addressing their attitude to HRT, listening to the patients' fears in an understanding and non-dismissive way, and focusing on good communication. Common concerns relating to unwanted effects such as bleeding, fear of cancer, weight gain, thrombosis, general systemic effects, and the use of medical intervention generally, can be dealt with if the physician follows the principles for conducting a patient-centered interview. When it comes to decisions about starting and continuing on HRT, it is important that women are treated with understanding, their concerns are taken seriously, and they are given time to air their views and ask questions. Tailoring treatments to individual patients can overcome many of the problems women have with HRT, however it is important that the decision to start HRT, and the most suitable regimen and delivery system to use, be decided in partnership with the patient. This should result in the patient having a better understanding of HRT, and may improve compliance.

Attitude of Health Personnel↗
PubMed1998

The biological basis of female sexuality.

Human sexuality has three main roots: biological, motivational-affective-relational, and cognitive. Unfortunately, in women, the biological dimension is usually disregarded. Hormones are necessary, but not sufficient, factors to maintain a satisfying human libido. In women, oestrogens prime the central nervous system, acting as neurotrophic and psychotrophic factors throughout life. They also prime the sensory organs, including the skin with its sebaceous and sweat glands, which are the key receptors for external sexual stimuli. Oestrogens are also the 'permitting factors' for the action of vaso-intestinal peptide, the key neurotransmitter involved in the endothelial and vascular changes leading to vaginal lubrication. Other factors, such as medication, alcohol and other health problems, can modify the biological impact of hormones on libido. Depression may cause a progressive decline in interest in sexual behaviour leading to low libido, difficulty in sexual arousal, secondary anorgasmia and/or frank sexual aversion. Increasing attention of doctors towards the sexual problems of women will dramatically improve female quality of life, especially during difficult periods of transition.

Female↗
PubMed1996

HRT: the woman's perspective.

Questionnaire studies in Europe show that women's concerns at the menopause are more related to their self-image and sexual identity than to medical consequences such as osteoporosis or coronary heart disease. Women long for help with menopausal problems, yet are concerned about the potential side effects of HRT and often perceive the information they receive from their doctors to be inadequate. Adverse effects of menopausal estrogen deprivation on sexual and psychological function occur via two main mechanisms. Firstly, the physical changes that occur at the menopause affect body image, sexual function and women's relationships with their partners. Lack of estrogens worsens the effects of ageing on the female body and psyche. Secondly, there are changes in neuroendocrine and psychological function (e.g. effects on mood, memory and sleep patterns), affecting ego and self-perception. Estrogen replacement in hormone replacement therapy (HRT) improves both sexual and psychological self-image and function.

Attitude to Health↗
PubMed1996

AMS 700 CX inflatable penile implants for Peyronie's disease: functional results, morbidity and patient-partner satisfaction.

This study was designed to clarify the functional results, morbidity and the patient-partner satisfaction observed with, the American Medical System 700 CX three-piece inflatable prosthesis in the treatment of impotence associated with Peyronie's disease. Thirty-three patients were treated and additional plaque surgery was performed in 13 cases (40%). Within 10 days of surgery, four patients (12%) developed a wound infection which was treated conservatively and one patient (3%) experienced glandular ischemia. At the 6-week follow-up, complete penile straightening was achieved in 23 patients (70%), while penile rigidity was considered optimal by all patients. On the contrary, the penis was considered short by 10 patients (30%). Five diabetic patients (15%) complained of severe scrotal and penile pain during full activation of the implant and in one of these patients (3%) the implant had to be removed. Due to spontaneous erections occurring after implant activation one patient (3%) required replacement of the reservoir from the Retzius space into the peritoneum. At the long-term follow-up (mean +/- SE: 17 +/- 2.2 months), 23 patients were evaluated and all found to be engaging in intercourse with the prosthesis. However, five patients (21%) and three of the 13 partners (25%) assessed were not yet completely satisfied. The American Medical System CX700 inflatable penile prosthesis obtains complete penile straightening in 70% and rigidity in 100% of impotent patients with Peyronie's disease. Patients should be fully informed about possible surgical morbidity and actual post-operative penile length.

Coitus↗
PubMed1995

[Sex therapy of erectile dysfunction: when, how].

Role, indications and limits of the sexologic therapy in the diagnosis and treatment of the erectile deficit are discussed. Emphasis is given to the sexologist's role in the treatments of youngest patients, where psychosexual vulnerability and precipitating factors may be critical in conditioning the final outcome of local (pharmacoinjection) and oral drug therapies.

Erectile Dysfunction↗
PubMed1994

[Andrological diagnosis from the viewpoint of the sexologist].

The importance of a medical sexological diagnosis, carried on with methodological and clinical rigour by specialists competent in the andrological as well as in the sexological field and the need of a close collaboration with the uro-andrologist is analyzed. From the diagnostic point of view, the priority role of the medical sexologist in the diagnosis of andrological problems with a functional etiology, in the evaluation of negative NPT, VSS and pharmaco-injection tests, secondary advantages of the symptom and of the partner's role in the genesis and in the maintenance of the problem is finally discussed.

Diagnosis, Differential↗
PubMed1993

[Andrologic therapy in the elderly--therapy seeking, acceptance, risks, satisfaction].

The paper discusses over questions and hidden requests of andrological and sexological help in the general medical consultation of the elderly; the most frequent specific andrological symptoms and the pertinent sexological implication; the conscious and unconscious ambivalence present in the acceptance of therapy; ongoing risks, in case of inappropriate or inadequate evaluation of the therapeutic request.

Aged↗