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[Female sexual dysfunction].
OBJECTIVE: Comprehensive information about female sexual dysfunctions and possibilities of their treatment. DESIGN: Review article. SETTING: Institute for Postgraduate Medical Education, Prague. METHODS: Analysis of the literary data (texts in medical journals, monographies, textbooks, internet--"Medline") and author's clinical experience. CONCLUSIONS: Female sexual dysfunctions are highly prevalent but not well defined and understood. Existing definitions and classifications of female sexual dysfunctions are reevaluated and revised at present. Contemporary classification was expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. The female sexual response cycle is initiated by neurotransmitters which increase pelvic blood flow, vaginal lubrication, clitoral and vaginal reactivity. The effect of the therapy consists in the stabilization of the hormonal levels. New drugs with vasocongestive effect on genital are discussed.
Proceedings of the annual meeting of the Female Sexual Function Forum. October 2001, Boston, Massachusetts, USA.
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[PSYCHOSOMATIC ASPECTS OF VAGINISMUS].
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[Survey of the prevalence of chronic prostatitis in men with premature ejaculation].
OBJECTIVE: To investigate the prevalence of chronic prostatitis in men with premature ejaculation. METHODS: The segmented urine specimens before and after prostatic massage and the expressed prostatic secretion specimens from 106 patients with premature ejaculation and 38 controls were evaluated by microscopic and/or bacteriological studies. The prevalence of premature ejaculation was also investigated in 120 patients with chronic prostatitis. RESULTS: Prostatic inflammation was found in 46.2% and chronic bacterial prostatitis in 34.7% of the subjects with premature ejaculation, respectively. Compared with the controls, the findings were statistically significant (P < 0.05). The prevalence of premature ejaculation in the patients with chronic prostatitis was 47.5% (57/120). CONCLUSIONS: Chronic prostatic inflammation may play a role in the pathogenesis of some cases of premature ejaculation and it is important to give a careful examination of the prostate before initiating any therapy for premature ejaculation.
[In sex dysfunctions--not just a "male issue". Don't forget women].
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[Premature orgasm in the male].
To date, we have no uniform definition of ejaculatio praecox. In a qualitative approach, premature ejaculation is ascribed to a failure to control excitement. As causes, organic disorders and erectile dysfunction must be excluded. The majority of cases, however, are due to psychological or partnership problems. The history-taking should aim, in particular, to uncover possible anxiety in conjunction with premature orgasm, and also to establish the reactions of the partner. As therapy, medication (local anesthetics, antidepressive agents, PDE-5 inhibitors) and sexual-therapeutic measures are available. Since few sufferers take the initiative in seeking treatment, particular importance attaches to providing the public with information about the therapeutic options for treating this common disorder.
Sexuality following hematopoietic cell transplantation.
Hematopoietic cell transplantation (HCT) is a therapeutic modality used to treat a variety of malignant and nonmalignant disorders. Because HCT often involves the use of high-dose radiation and chemotherapy, it is associated with numerous toxicities and effects, including changes in sexuality and sexual functioning. These changes may include decreased libido, erectile and ejaculatory dysfunction, premature menopause, vaginal alterations, dyspareunia, and infertility. Psychosocial factors, such as anxiety, depression, and concurrent life stressors, also may affect sexuality and sexual functioning. Healthcare providers caring for patients undergoing HCT need to initiate discussions about the impact of HCT on sexuality pretransplant and continue those discussions throughout and following the treatment process.
Dimensions of sexual dysfunction in Parkinson disease.
OBJECTIVE: The authors sought to better understand the factors related to sexual dysfunction in Parkinson disease (PD). METHODS: Twenty-one PD patients and their partners received the Derogatis Interview for Sexual Functioning-Self Report (DISF-SR). Additional measures assessed disease severity, autonomic dysfunction, mood, and social circumstance. RESULTS: Data from 17 male patients demonstrated profound impairment in the dimensions of sexual arousal, behavior, orgasm, and drive, with most patients scoring below the 1st percentile on these Derogatis Interview subscales. All four dimensions showed significant intercorrelations. In contrast, 53% of patients scored above the 50th percentile in sexual fantasy. Sexual fantasy subscale scores were positively correlated with duration of PD. CONCLUSIONS: The usefulness of the DISF-SR in this PD population was limited by extremely low scores and strong correlations among the subscales. The increase in sexual fantasy with greater PD duration suggests that patients with advancing disease remain interested in sex and that sexual dysfunction in PD is clinically relevant in this group.
Male sexual problems and the general physician.
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The sexual difficulties of women.
Despite the fact that women are susceptible to experiencing a wide variety of sexual difficulties and complaints during their lifetime, it is also true that women are sexually resilient and are capable of satisfactory sexual response throughout their life cycle. Often, permission and reassurance, coupled with sensible suggestions are sufficient to overcome bothersome sexual difficulties. When this is not helpful, referral to a well-trained sexual or couples' therapist is indicated.
[A psychotherapy center for sex problems at the University of Minnesota].
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Utility of selective serotonin reuptake inhibitors in premature ejaculation.
The introduction of selective serotonin reuptake inhibitors (SSRIs) has revolutionized our understanding of the treatment of premature ejaculation. Lifelong premature ejaculation may be a neurobiological phenomenon, namely part of a biological variability of the intravaginal ejaculation latency time in men. Animal studies support this view, and an animal model for premature and delayed ejaculation has recently been developed. It is proposed that drug treatment of premature ejaculation should consist of 5-hydroxytryptamine (5-HT)2c receptor stimulation and/or 5-HT1A receptor inhibition. A meta-analysis of 35 daily treatment studies with selective serotonin reuptake inhibitors (SSRIs) and clomipramine demonstrated comparable efficacy of clomipramine with the SSRIs sertraline and fluoxetine in delaying ejaculation, whereas the efficacy of the SSRI paroxetine was greater than all other SSRIs and clomipramine. It is postulated that acute treatment with SSRIs, including those with short half-lives, will not produce an ejaculation delay equivalent to that induced by daily treatment of SSRIs.
Sexual dysfunction, Part I: Classification, etiology, and pathogenesis.
BACKGROUND: The sexual dysfunctions are extremely common but are rarely recognized by primary care physicians. They represent inhibitions in the appetitive or psychophysiologic changes that characterize the complete adult sexual response and are classified into four major categories: (1) sexual desire disorders (hypoactive sexual desire, sexual aversion disorder), (2) sexual arousal disorders (female sexual arousal disorder, male erectile dysfunction), (3) orgasmic disorders (inhibited male or female orgasm, premature ejaculation), and (4) sexual pain disorders (dyspareunia, vaginismus). METHODS: Articles about the sexual dysfunctions were obtained from a search of MEDLINE files from 1966 to the present using the categories as key words, along with the general key word "sexual dysfunction." Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: Cause and pathogenesis span a continuum from organic to psychogenic and most often include a mosaic of factors. Organic factors include chronic illness, pregnancy, pharmacologic agents, endocrine alterations, and a host of other medical, surgical, and traumatic factors. Psychogenic factors include an array of individual factors (e.g., depression, anxiety, fear, frustration, guilt hypochondria, intrapsychic conflict), interpersonal and relationship factors (e.g., poor communication, relationship conflict, diminished trust, fear of intimacy, poor relationship models, family system conflict), psychosexual factors (e.g., negative learning and attitudes, performance anxiety, prior sexual trauma, restrictive religiosity, intellectual defenses), and sexual enactment factors (e.g., skill and knowledge deficits, unrealistic performance expectations). Understanding the cause and pathophysiology of sexual disorders will help primary care physicians diagnose these problems accurately and manage them effectively.
[Sexual problems in women after surgical interventions].
Sexual disorders following operative interventions have a variety of causes. Apart from functional disturbances (e.g. as a result of the formation of scar tissue, hormone deficiencies, etc.), problems arising from the psychological problem of coping with the intervention itself also play an important role. A major course of conflict lies in communication problems between the partners involved. Potential sexual disorders should be discussed in the preoperative period, with the aim of enabling the patient to come to terms with the postoperative situation. However, it remains a task of the physician after the operation to actively support the patient in dealing with the traumatization she has experienced.
[Treatment of vaginismus with the Paula Garburg sphincter muscle exercises].
OBJECTIVE: To prospectively assess and compare a novel approach to the treatment of vaginismus based on Paula Garburg's sphincter muscle exercises to the traditional approach based on Masters & Johnson. PATIENTS AND METHODS: The study population included 60 consecutive patients with vaginismus who were referred to our sex therapy clinic. The patients were randomly assigned into two groups. The study group (30 patients) underwent a step-by-step program consisting of the performance of the Paula Garburg sphincter muscle exercises to achieve pelvic muscle relaxation combined with the active introduction of Young vaginal dilators of graduated size. A control group (30 patients) underwent a behavioral treatment based on Masters and Johnson's desensitization approach that was combined with the active introduction of Young vaginal dilators of graduated size. RESULTS: All patients completed the program, all with a successful outcome, as defined by the achievement of full intercourse or the introduction of a number 6 Young vaginal dilator. The mean number of treatment sessions required for successful outcome was shorter in the study as compared to the control group (4.9 +/- 1.4 vs. 7.4 +/- 3.5, respectively. P < 0.001). Furthermore, while the percentage of patients undergoing up to 5 sessions until successful outcome was significantly higher in the study as compared to the control group (p < 0.05), the percentage of patients undergoing > 10 sessions was significantly lower. CONCLUSION: Paula Garburg's sphincter muscle exercises together with the use of Young vaginal dilators is a simple, easy and very effective treatment for vaginismus. The outcome matched or even surpassed that of the traditional behavioral approaches.