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A population survey of sexual activity, sexual dysfunction and associated help-seeking behavior in middle-aged and older adults in Germany.

The Global Study of Sexual Attitudes and Behaviors was a survey of 27,500 men and women aged 40 to 80 years in 29 countries. Here we report the sexual activity, the prevalence of sexual problems and related help-seeking behaviour among subjects in Germany. A telephone survey was conducted in 2001 and 2002, using a standardised questionnaire covering demographics, general health, relationships, and sexual behaviours, attitudes and beliefs. A total of 1,500 individuals in Germany (750 men and 750 women) completed the survey. Eighty-six percent of men and 66% of women had engaged in sexual intercourse during the year preceding the interview. The most common male sexual problems were early ejaculation (15%), a lack of sexual interest, erectile dysfunction and non-pleasurable sex (each 8%). The most common female sexual problems were a lack of sexual interest (18%), non-pleasurable sex (14%) and lubrication difficulties (13%). Most sexual problems were less common among men and women in Germany than in other European regions. Increasing age was a significant predictor of a lack of sexual interest and erectile difficulties in men. Only 18% of men and 15% of women had talked to a doctor about their sexual problem(s). In conclusion, many middle-aged and older German adults reported continued sexual interest and activity. Overall, sexual problems were less prevalent in Germany compared with other European regions. Of those who experienced sexual problems, however, few had sought medical help. This was often due to a lack of perception of a problem.

Adult↗

Sexual dysfunction after curative radical resection of rectal cancer in men: the role of extended systematic lymph-node dissection.

BACKGROUND: This study was designed to determine the incidence and patterns of sexual dysfunction after curative radical resections (CRR) with or without extended systematic lymph-node dissection (ESLND) for rectal cancer Material/Methods: A total of 91 patients with rectal cancer were reviewed with respect to surgical procedures and postoperative sexual functions using the International Index of Erectile Function (IIEF), a 15-item self-administered questionnaire. CCR (abdomino-perineal resections or sphincter-saving anterior resections) was performed in 78 patients (Group I) and ESLND plus CRR in 13 patients (Group II), and sexual functions were also evaluated in the colostomy and non-colostomy subgroups. RESULTS: In the postoperative period, the five domains of IIEF scoring decreased significantly from the preoperative scores in both groups (p<0.05), but the postoperative decreases were not significant between groups I and II (p>0.05). Having a permanent colostomy decreases IIEF scores in all colostomized patients. CONCLUSIONS: CRR and CRR+ESLND both decrease sexual function and lymph-node dissection is not considered to have any additive effect on this decrease. In addition to standard surgery, anxiety about having a malignant disease and permanent colostomy may play an important role in male sexual dysfunction.

Adult↗

[Women's sexual life quality assessment with use of questionnaires in clinical trials--review of accessible tools, their characteristics and comparison of their properties].

AIM: Aim of the study is a review of women's sexual life quality assessment questionnaires available in literature, analysis of their construction, special properties and usability in clinical trials. MATERIAL AND METHODS: Medline database and accessible literature has been reviewed. Seven questionnaires have been chosen for analysis. Analysis in scope of potential and usability of those questionnaires in clinical tests has been performed. CONCLUSIONS: Suitability of The Female Sexual Function Index (FSFI) and The Brief Index of Sexual Functioning for Women (BISF-W) have been shown as universal tools for sexual function assessment in clinical trials. They meet current model of women's sexual reaction and criteria of sexual disfunction classification.

Clinical Trials as Topic↗

[Anorgasmy prevalence in women attended at Familiar Medicine Unit no. 1 in Obregon, Sonora, Mexico].

OBJECTIVE: To estimate the prevalence of anorgasmy in women. PATIENTS AND METHODS: An observational, descriptive and transversal study was done from August 2002 to January 2003 surveying women with sexual activity in a clinic of the Mexican Institute of Social Security in Obregon, Sonora. The questionnaire was validated by the UNAM. The analyzed variables were: age, scholar degree, the age in which women started sexual activity, number of children, marital status, the number of sexual partners, pleasure to sex for the women, satisfaction and feeling like doing sex, who decides and begins to do sex, frequency of sexual intercourse, knowledge about orgasm and one's own experience, as well as psychosomatic symptoms. Data were analyzed by descriptive statistics, chi square test and Likert's scale. RESULTS: Seventy-three women were surveyed, with ages between 16 and 46 years. Anorgasmy frequency was of 6.8%; 53.4% of the women had secondary education and 37% superior education. Time of active sexual life varied between 1 and 30 years; the knowledge about orgasm was of 74%. CONCLUSIONS: The orgasmic dysfunction is lower in this region than that reported in the bibliography, this could be due to the greater scholar degree of women, social and cultural issues, and the women's independence. Nevertheless, the health team must be qualified to detect and treat it, in order to avoid complications.

Adolescent↗

[Sexual problems after allogenic stem cell transplantation].

Allogenic stem cell transplantation is an effective procedure for malignant haematological diseases, for these reasons the number of long-term survivors has increased as well as the concern for their quality of life. The late effects of transplantation can highly influence the patient's sexuality and relationships through psychological and physical factors. Psychological factors: regression due to sickness, staff-dependency, emotional and physical partner-dependence, distress related to sterility. Physical factors: hypo-oestrogenism, genital mucosae dryness and sometimes vulval or vaginal chronic graft-versus-host disease. Addressing the topic of intimacy may cause anxiety and embarrassment among nurses, haematological staff and practitioners with the risk of leaving patients in a sort of "conspiracy of silences".

Adult↗

[Investigation of sexual disorders].

It is not easy for physicians to investigate genuinely sexual problems because of our personal conceptions about sex related to our familial and religious upbringing. Lack of medical education or information and bad personal experiences inhibit us from speaking freely with our patients. And they, before daring to talk to us about a sexual problem, must already be suffering from severely handicapped relations. Being able to explore in details what causes them problem, to investigate if there is a real sexual dysfunction and how it occurs, will help patients a great deal by providing them a precise diagnosis. We must therefore determine whether the sexual problem is the symptom of a somatic or a psychiatric disease, or a secondary effect of a medication or a drug, before identifying it as a psychosomatic or emotional dysfunction.

Humans↗

Sexual health issues in men with cancer.

While the cancer patient may be affected by sexual dysfunction throughout the entire course of the disease, sexual health is largely underevaluated and undertreated. Sexual problems should be anticipated and patients should be actively screened as they are unlikely to initiate discussion on sexual issues. Cancer-related sexual dysfunction may involve several components, and an understanding of the underlying etiologies is essential to tailoring the appropriate treatment to the individual patient. This article reviews the numerous factors potentially involved in male sexual dysfunction associated with a variety of cancers.

Genital Neoplasms, Male↗

[Assessment of sexual function from a psychopharmacological viewpoint].

The aim of this paper is to discuss aspects linked to the assessment of sexual activity in mental health patients. Traditionally, and to this day, this assessment has received insufficient consideration by intervening professionals. Emphasis is made on determining the onset of sexual dysfunction with respect to the disorder prompting the visit. Schizophrenia is taken as the paradigm of the pathology least considered as regards assessment of the sexual activity of those suffering from this disorder.

Female↗

[Bladder, bowel and sexual dysfunction in patient with mulitple sclerosis].

Bladder, bowel and sexual dysfunction are not rare in multiple sclerosis (MS). The most frequent bladder disorders are in urgency, frequency as well as retention. In this study we analyzed bladder dysfunction (urgency, frequency and retention), defecation (constipation and incontinence) as well as sexual problems (libido, erection and vaginal lubrication) in patients with relapsing-remitting form of multiple sclerosis (MS) depending on disability status. Concerning Expanded Diasability Status Score (EDSS), patients have been divided in two groups: EDSS 0-4.5. (Group A), and EDSS 5.0-10.0 (group B). We analyzed 60 patients: 35 (58.3%) women, and 25 (41.7%) men. In both group A and B, with no bladder disorder was 18 patients (30%). In group A: 15 (25%); in group B: 3 (5%). With urgent incontinence were 36 (60%) patients - group A: 19 (31%); group B: 17 (28%). With retention were 6 (10%) patients - group A: 4 (6.6%); group B: 2 (3.3%). There is no statistical significant difference in number of patients with and with no urinary problems in both groups (p>0.05). Of all analyzed patients in group A and B with no urinary disorders were 9 men (15%) and 9 women (15%). With urinary problems were 16 men (26.7%) and 26 women (43.3%). Statistically it is significant higher number of women than men (p<0.05). With no defecation problems were 54 (90%) patients - in group A: 36 (60%); in group B: 18 (30%). With constipation were 5 (8.3%) - in group A: 2 (3.3%); in group B 3 (5%). In group B one patient (1.6%) had incontinence. There is no statistical significant difference in number of patients with and with no bowel elimination dysfunction in both groups p>0.05). 12 (20%) men had no bowel elimination problems and 24 women (40%), but 10 (16.6%) men and 8 (13.3%) women had the bowel elimination dysfunction. There is no statistical significance (p>0.05). No libido disturbance had 44 (73.3%) patients. In the group A: 35 (58.3%); in group B: 9 (15%). 16 (26.7%) patients had the libido disturbances. In group A: 3 (5%); in group B 13 (21.6%). Statistically there is significant lower number of patients with libido problems in group A (p<0.05). No vaginal lubrication had 21 (35%) women. In group A: 18 (30%); in group B 3 (5%). Vaginal lubrication disturbance had 14 (23.3%). In group A: 7 (11.6%); in group B 7 (11.6%). Statistically it is significant lower number of women with no lubrication in group B (p<0.05). No erection problems had 11 (18.3%) men. In group A: 9 (15%); in group B 2 (3.3%). Erection disturbance had 14 (23.3%). In group A: 4 (6.6%); in group B: 10 (16.6%). There is statistical significant lower number of men with erection problems in group A. (p<0.05). Of all analyzed patients in both groups A and B 18 men (30%) and 26 (43%) women had no problems with libido and 7 (11.6%) men and 9 (15%) women had the problems. There is no statistical significance in sex distribution (p>0.05). 11 (18.3%) men had no erection problems, 14 (23.3%) had the problems. 21 (35%) women had no vaginal lubrication problems, 14 (23.3%) women had the problems. Erection disturbances are not statistically significant to vaginal lubrication problems (p>0.05).

Adult↗

[Therapeutic aspects in coronary cardiac patients who suffer from sexual dysfunction in a cardiac rehabilitation program].

Sexual dysfunction is one of the severe consequences of acute coronary events. Rehabilitation programs should address this aspect of functioning that has important implications for the patient's quality of life. In order to improve patients' sexual functioning and improve their quality of life we developed a comprehensive model of sexual therapy designed specifically for cardiac patients undergoing rehabilitation program. This model integrates educational, supportive and cognitive-behavioral therapy with appropriate medication (such as viagra). The model is implemented in co-therapy by two sexologists, a social worker and a physician. An empirical study has shown the positive outcomes of this model. This article describes the model and reports case vignettes that exemplify its effects on cardiac patients in rehabilitation and their spouses.

Behavior Therapy↗

[We are sexual beings. Sexuality/reproduction pattern. An evaluation and the implications for nurses in the mental health field].

The author pretends to integrate the double-sided aspects of nursing care in the mental health field with the specific attention each individual needs as a sexual being, since this is an intrinsic factor of human beings. The World Health Organization defines sexual health as "the integration of physical, affective, intellectual and social aspects of a sexual being, in such a manner that from those aspects comes the enrichment and development of human personality, communication and love".

Female↗

[Sexual dysfunctions in selected endocrinopathies].

According to the socio-sexological reports approximately 40-45% of women and up to 30% of males may suffer from different sexual dysfunctions. The prevalence of those disorders is gradually increasing with age. Multiply numbers of endocrinopathies may influence the human sexual life. In diabetic patients all phases of the sexual responses cycle, especially orgasm, might be affected. Women diagnosed with PCOS have decreased adaptation to the sexual life, low self-esteem and perception of self sexual attractiveness. The intimacy of infertile couples has not been well described and the characteristic of particular dysfunction in sex life has not been established yet. Interdisciplinary approach, understood as treatment of the endocrinopathy accompanied with psychological and sexological counseling, seems to be the fundamental issue in the therapy of sexual dysfunctions in patients with endocrinological disorders.

Counseling↗

[Androgen deficiency in women].

Androgens are defined as the steroids having a binding affinity of the androgen receptor. In the reproduction age a daily production of testosterone is equally divided between the ovaries and adrenal and local tissue conversion of androstenedione and DHEA. After menopause the 80% of testosterone is produced in ovaries, but majority of precursors for peripheral conversion is adrenal origin. Androgen receptors are present throughout in the body; over 200 cellular actions of androgens have been described. Androgenic action is determined by quantitative level of the androgen present in the circulation, its degree of binding to proteins, the degree of interconversion to other androgens and estrogens, and the biological potency and androgen receptor binding affinity of the androgen. The most common clinical symptoms of androgen deficiency are the reduction of sex motivation, sex fantasy, sex enjoyment, sex arousal, vaginal vasocongestion, but also reduction of pubic hair, bone mass, muscle mass, worsening of quality of life (mood, affect, energy), more frequent vasomotors symptoms, insomnia, depression, headache. All these signs and symptoms can be multifactorial. Most common conditions associated with hypoandrogenism in women are hypothalamic-pituitary abnormalities, lack or insufficiency of ovaries, adrenal insufficiency, glucocorticoid therapy, exogenous estrogen administration. Besides the clinical picture the free testosterone measuring is important for diagnosis. The method of choice of this measure is equilibrium dialysis assay. Despite of clinical importance of androgen insufficiency in women, none of methods of androgen substitution is approved by FDA.

Adrenal Insufficiency↗

A systematic review of the literature on female sexual dysfunction prevalence and predictors.

Interest in human sexuality began in the 18th century, but formal and more rigorous studies focused on sexual satisfaction and sexual practices were published in the early 1900s. Alfred Kinsey's pioneering work on sexuality, in which he surveyed over 10,000 men and women age 16 and older, began in the late 1930s. In the mid-1960s, Masters and Johnson published their seminal work characterizing the sexual response cycle. Since then, numerous researchers have attempted to understand and to quantify "normal" sexual behaviors using survey techniques. We conducted a systematic review of the published literature on the prevalence of female sexual dysfunction overall and, more specifically, on sexual desire disorder, arousal difficulties, anorgasmia, and dyspareunia. The review also encompassed dysfunction related to the reproductive factors, such as pregnancy, hysterectomy, and menopause. We included sexual dysfunction comorbid with diabetes, depression, and antidepressant therapies. In total, 85 studies are summarized in this review, which spans literature from the early 1900s to the present. We performed a quality assessment of each study, defining quality based on the representativeness of the population studied and the rigor of the instruments used for assessing sexual dysfunction. Although none of the 85 studies included in the review met both standards of quality, some met one criterion and not the other. Definitions of female sexual dysfunction have been developed and refined recently, but there is an urgent need to determine measurable outcomes that can be used for future work.

Depression↗

Women's orgasm.

An orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Women's orgasms can be induced by erotic stimulation of a variety of genital and nongenital sites. As of yet, no definitive explanations for what triggers orgasm have emerged. Studies of brain imaging indicate increased activation at orgasm, compared to pre-orgasm, in the paraventricular nucleus of the hypothalamus, periaqueductal gray of the midbrain, hippocampus, and the cerebellum. Psychosocial factors commonly discussed in relation to female orgasmic ability include age, education, social class, religion, personality, and relationship issues. Findings from surveys and clinical reports suggest that orgasm problems are the second most frequently reported sexual problems in women. Cognitive-behavioral therapy for anorgasmia focuses on promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. To date there are no pharmacological agents proven to be beneficial beyond placebo in enhancing orgasmic function in women.

Arousal↗

Premature ejaculation.

Premature ejaculation is a common entity that can have a significant impact on an individual's sexual satisfaction and quality of life. Both behavioral and pharmacological options are available and effective for men presenting with this condition.

Adrenergic alpha-Antagonists↗