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PubMed2006

Aging and sexuality.

Sexuality, although only one aspect of one's being, plays an integral role during the aging process. This role has physical and psychologic ramifications. A healthy sexual attitude combined with addressing physical health needs provides a greater potential for enjoying a more fulfilled lifestyle as one ages. With aging come significant potential medical problems and associated psychologic disturbances. These issues present a challenge to those in the medical profession who treat this age group. It is important to those physicians accepting this responsibility to become extremely familiar with all the nuances affecting those in the golden years of their lives. This enormous responsibility requires knowledge, caring, compassion, understanding, and sensitivity. With luck, we will all reach those golden years and receive the freedom to experience and express sexuality that is most certainly deserved.

Aged↗
PubMed2004

General practitioner attitudes to discussing sexual health issues with older people.

How health professionals perceive and manage later life sexual problems remains relatively unexplored and, in particular, little is known about the attitudes of GPs, who represent the first point of contact for most older people in the UK who experience sexual health concerns. This paper draws on qualitative data generated from in-depth interviews with 22 GPs working in demographically diverse primary care practices in Sheffield, UK. Analysis identified that GPs do not address sexual health proactively with older people and that, within primary care, sexual health is equated with younger people and not seen as a 'legitimate' topic for discussion with this age group. However, it was apparent that many beliefs held about the sexual attitudes and behaviours of older people were based on stereotyped views of ageing and sexuality, rather than personal experience of individual patients. The discussion considers the implications of these findings for primary care, particularly in relation to education and training.

Aged↗
PubMed2005

Human sexuality, sex hormones, and epilepsy.

The function of the hypothalamic-pituitary axis (HPA), including the production of luteinizing hormone, follicle-stimulating hormone, gonadotropin-releasing hormone, and prolactin, and the concentrations and metabolism of its end products, such as estrogen, testosterone, and dehydroepiandrosterone, appear to be modified in many people with epilepsy. Effects of the disorder itself and effects of antiepileptic drugs (AEDs) both appear to contribute to these hormonal alterations, which may be associated with sexual dysfunction. Focal epileptic discharges from the temporal lobe may affect HPA function, as is suggested by the normalization of androgen levels seen in men with temporal lobe epilepsy who become seizure-free after surgery. Hepatic enzyme-inducing AEDs such as carbamazepine and phenytoin may be most clearly linked to altered metabolism of sex steroid hormones, but valproic acid, an enzyme inhibitor, has also been implicated in the causation of reproductive endocrine abnormalities. Polycystic ovaries and polycystic ovarian syndrome (PCOS) are widely believed to be common in women with epilepsy, but the actual prevalence and the pathogenesis of PCOS in this population are disputed. Hormonal changes and sexual dysfunction need to be addressed in any comprehensive approach to epilepsy management, as well as any comprehensive epilepsy research program. Avoidance of enzyme-inducing AEDs and achievement of freedom from seizures as the goal of treatment are strongly recommended.

Anticonvulsants↗
PubMed2006

Problems of sexual function after spinal cord injury.

Sex is a legitimate and fundamental need in humans. Substantial changes to both the autonomic and somatic nervous system occur after spinal cord injury, and result in altered sexual function and fertility potential. This chapter provides a clinical overview of the main sexual and reproductive concerns and priorities men and women face after spinal cord injury. Besides genital functioning, other autonomic functions affect sexuality, such as bladder and bowel function, cardiovascular control and temperature regulation. These interlinked autonomic functions are presented in their impact on sexuality. The mind-body interaction and spinal feedback loops are discussed. It is proposed that human sexuality after spinal cord injury can be a model for investigating integrated autonomic function. Recent research on the measurement of cardiovascular parameters during vibrostimulation and ejaculation demonstrates the discordance between objective and subjective signs of autonomic dysreflexia. It is hoped that health care professionals and researchers will become motivated to attend to the unmet sexual health care needs of this population.

Autonomic Dysreflexia↗
PubMed2006

Ascending spinal pathways from sexual organs: effects of chronic spinal lesions.

A recent survey of paraplegics indicates that regaining sexual function is of the highest priority for both males and females (Anderson, K.D. (2004) Targeting recovery: priorities of the spinal cord-injured population J. Newrotrauma, 21: 1371-1383). Our understanding of the neural pathways and mechanisms underlying sexual behavior and function is limited at the present time. More studies are obviously needed to direct experiments geared toward developing effective therapeutic interventions. In this chapter, a review of studies on the processing of sensory inputs from the male and female reproductive organs is presented with a review of what is known about the location of ascending spinal pathways conveying this information. The effect of spinal cord injury on sexual function and the problems that ensue are discussed.

Afferent Pathways↗
PubMed2006

Descending pathways modulating the spinal circuitry for ejaculation: effects of chronic spinal cord injury.

Sexual dysfunction is a common complication in men with chronic spinal cord injury. In particular, ejaculation is severely compromised or absent and the resulting infertility issues are important to this group of predominantly young men. To investigate the neural circuits and descending spinal pathways involved in ejaculation, animal models have been developed in normal and spinal cord-injured preparations. Primarily through studies in rats, spinal ejaculatory circuits have been described including (i) autonomic circuits at the thoracolumbar and lumbosacral levels mediating the emission phase of ejaculation, (ii) somatic circuits at the lumbosacral level controlling the expulsion phase of ejaculation through sequential and rhythmic contraction of perineal striated muscles (e.g. bulbospongiosus), and (iii) a proposed ejaculatory pattern generator in the lumbar cord. Midthoracic incomplete chronic spinal cord injury has revealed the dependency of spinal ejaculatory circuits on bilateral spinal pathways from the brainstem via modulation of pudendal motor neuron reflexes and pudendal nerve autonomic fibers. Accordingly, sensory input from the dorsal nerve of the penis, required to trigger the ejaculatory response in animals and humans, is no longer inhibited from the lateral paragigantocellularis nucleus in the ventrolateral medulla. This inhibitory effect, likely presynaptic through a serotonergic pathway, is thought to be necessary to provide the rhythmic, bursting, and sequential contractions of the perineal muscles during ejaculation. Chronic lateral hemisection injury, which severs half of the descending lateral funiculus-located pathways, results in new functional connections of the pudendal reflex inhibitory and pudendal sympathetic activation pathways across the midline, above and below the lesion, respectively. Clinical correlations in spinal cord-injured men have demonstrated the validity of the rodent animal for the study of ejaculatory dysfunction after chronic injury.

Animals↗
PubMed2006

Female sexual function after spinal cord injury.

Over the past 10 years, studies of the impact of spinal cord injuries on female sexuality have expanded from questionnaire studies in small populations with unknown levels and degrees of injury to laboratory-based analyses of women with known injury patterns. These studies have provided detailed information on how specific injury patterns affect specific aspects of the female sexual response. Research findings have supported the hypothesis that the sympathetic nervous system is regulatory for psychogenic genital vasocongestion and that orgasm is a reflex response of the autonomic nervous system. Based on these results, a new system for the classification of sexual function in women with spinal cord injury (SCI) is proposed. Moreover, studies related to the treatment of sexual dysfunction in women with cord injury are reviewed.

Autonomic Nervous System↗
PubMed2003

Sexuality and disease.

Disease is commonly associated with sexual dysfunction in both men and women. In many cases, effective treatments are available that can improve libido, erectile dysfunction, and vaginal dryness. Sexual problems in older persons with disease often lead to anxiety, marital discord, and withdrawal. It is the responsibility of all health care professionals to inquire about sexuality in all patients, no matter what the patient's age, and to be aware that frailty [79-81] is not, in itself, a barrier to sexuality. Health professionals need to give education, support, and counseling on sexuality for patients with disease.

Arthritis↗
PubMed1999

Sexuality of patients with advanced heart failure and their spouses or partners.

BACKGROUND: Sexuality is an important aspect of quality of life for patients with advanced heart failure and their spouses or partners. Therefore, we conducted a study to determine the types of sexual problems and concerns of patients and their spouses/partners, their level of interest in receiving information on this topic, and the relationship between their need for information and the degree of sexual problems. METHODS: Sixty-three couples were recruited from a university-affiliated, outpatient, heart failure program during their initial visit. RESULTS: The most important sexual relationship issue of both patients and spouses/partners was related to decreased frequency in sexual relations. They reported the need to receive specific information about sexual activity as moderate to very high, but it was unrelated to the level of need for education and counseling. CONCLUSIONS: Nurses and physicians need to assume interest and provide instruction related to the sexual activity needs of patients and their spouses/partners.

Adolescent↗
PubMedDate not supplied

[Sexuality in acute myocardial infarction patients].

We as nurses in the Coronary Unit we do not see the sexuality of the patients sufficiently addressed neither by us nor by the patients themselves. In this article we are trying to analize the reasons and to emphasize the need to include this subject in our Nursing Problem List. In it we explaine the fears and the wrong ideas that we have identified in our patients. The sexual function is not affected by a myocardial infarction but psychological factors, age, drugs and other associated diseases might be a reason. A quiet enviroment, a fit training plan and looking for personalise proper alternatives may help the patient to start a satisfactory sexual life again.

Humans↗
PubMed2006

Canadian Consensus Conference on menopause, 2006 update.

OBJECTIVE: To provide guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor symptoms, urogenital, sexual, and mood and memory concerns and on specific medical considerations, and cardiovascular and cancer issues. OUTCOMES: Prescription medications, complementary and alternative medicine (CAM), and lifestyle interventions are presented according to their efficacy in treating menopausal symptoms. EVIDENCE: MEDLINE and the Cochrane database were searched for articles from March 2001 to April 2005 in English on subjects related to menopause, menopausal symptoms, urogenital and sexual health, mood and memory, hormone therapy, CAM, and on specific medical considerations that affect the decision of which intervention to choose. VALUES: The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this report (see Table 1). SPONSORS: The development of this consensus guideline was supported by unrestricted educational grants from Berlex Canada Inc, Lilly Canada, Merck Frosst, Novartis, Novogen, Novo Nordisk, Proctor and Gamble, Schering Canada, and Wyeth Canada.

Affect↗
PubMed1998

Sex and the quality of life in Denmark.

From a representative sample of 2460 Danish citizens, ages 18 to 88, anonymous answers were obtained to a 317-item quality-of-life (QL) questionnaire, which included five questions on sexuality. Among the respondents in the sample, 1.2% reported they were bisexual and 0.9% homosexual. Although sexual problems were found in all age groups, lack of a suitable sex partner and inability to achieve orgasm were more common among the young and erectile dysfunction more common among the old. Most frequent problems among the women were reduced sexual desire (11.2%) and the lack of a suitable sex partner (4.9%), and among the men, the lack of a suitable sex partner (7.3%) and erectile dysfunction (5.4%). The QL of persons with sexual problems was from 1.2 to 19.1% lower than the population mean (as expressed in terms of this mean). The intermediate sized covariation between sexual problems and the QL suggests that such problems can be symptoms of a reduced QL rather than medical problems to be tackled through medical intervention or sex therapy proper. Implications for a quality-of-life-sensitive clinical practice are discussed.

Adult↗
PubMed2003

Perceptions of sexuality as related to sexual functioning and sexual risk in women with different types of childhood abuse histories.

Perceptions of one's sexuality, self-reported sexual functioning, and sexual risk were examined in a community sample of 148 women with histories of either childhood sexual abuse (n = 26), both childhood sexual and physical abuse (n = 44), and neither form of abuse (n = 78). Controlling for depression and anxiety, the groups did not differ on sexual desire, arousal/orgasm, sexual pain, or masturbation. Women with abuse histories reported more negative affect during sexual arousal and reported more lifetime vaginal intercourse partners than nonabused women. In addition, the abuse samples reported more negative perceptions of their sexuality in their worst psychological states using the Structural Analysis of Social Behavior (SASB) method than did women with no abuse history. An interpersonal focus and more precise abuse labeling are recommended, potentially revising our assumptions about symptom clusters and treatment.

Adult↗
PubMed2004

Sex on the internet: furthering our understanding of men with online sexual problems.

A survey on the MSNBC Web site identified 384 men as having online sexual problems (OSP). Respondents' reasons for online sexual activity (OSA) and their preferred Internet medium were associated with several online and offline consequences and behaviors, including important aspects of real-time relationships and sexual experimentation. Two broad behavior patterns manifested by men with OSP were identified: Men who use the Internet (a) to further their real-time sex lives and (b) as a substitute for their real-time sex lives. Men who facilitate their offline sex lives with the Internet might do so for any number of reasons, many of which are adaptive (e.g., sex education, to purchase sexual materials). Future research should use samples from a variety of affinity Web portals to further examine the factors that differentiate individuals who show no negative effects of OSA from those who do.

Adolescent↗
PubMed1995

Factors associated with sexual functioning in women following spinal cord injury.

Research into sexuality following spinal cord injury (SCI) has tended to concentrate on male experiences and the physical capabilities for sexual intercourse. The sexuality of women following SCI has only recently been addressed and studies are limited to small numbers and the use of non-standardised measures. The present investigation utilised standard measures of affective state and body satisfaction together with pre and post-injury questionnaire information of sexual dysfunction, feelings about sex and importance of sexual activity in a group of 85 women with SCI. Sexual dysfunction increased significantly post-injury, whilst feelings about sex and it's importance were unaffected. Sexual dysfunction and the importance of sex were inversely correlated. General and Head satisfaction estimates were not significantly different to control samples, whilst Body Satisfaction was increased for women with disabilities. None of the body satisfaction measures were related to the sexual functioning measure. General dissatisfaction was associated depression. Both anxiety and depression were experienced by the same individuals, and anxiety related to current sexual dysfunction. Qualitative data supported previous findings concerning the effects of social and attitudinal barriers on sexual functioning.

Adolescent↗
PubMed2000

Impact of erectile dysfunction on quality of life: patient and partner perspectives.

Quality of life (QoL) has become one of the important parameters in the evaluation of treatment and assessment of medical conditions, and it may be an important tool in determining the urgency of the need for therapeutic intervention for erectile dysfunction (ED). It is important to evaluate QoL of the couple, because men and women alike will suffer because of male erectile disability. Future drug trials, as well as studies of sexological intervention programs, should involve both partners. International Journal of Impotence Research (2000) 12, Suppl 4, S144-S146.

Erectile Dysfunction↗