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PubMed1997

Effects of hormone replacement therapy on sexuality in postmenopausal women in a mideast country.

OBJECTIVE: During the postmenopausal period, sexual interest and activity seem to decline, as part of the menopausal effect of oestrogen deficiency. The aim of this study was to evaluate other factors that could contribute to sexual dysfunction and the effect of hormone replacement therapy among postmenopausal women in Kuwait. METHOD: Between June 1992, and June 1994, details of sexual history were compiled from 261 postmenopausal women that attended the Menopause Clinic at the Maternity Hospital, Kuwait. The effect of hormone replacement was analysed from the sexual history and the bacteriology of the lower genital tract. RESULTS: About 71% of the 261 postmenopausal women were still sexually active. Among those not sexually active, 38% had loss of interest, 22% because of divorce or death of husband, 20% from loss of interest by husband, and in 13% because the husbands had impotence from medical problems. Of the sexually active women, 41.1% had reduced libido. Contributing factors included vaginal symptoms like dyspareunia and vaginal dryness, vaginal infection, disturbances in the premenopausal menstrual pattern and disharmony with husbands. About 23 to 45% of the postmenopausal women with oestrogen replacement therapy, had significant relief of their symptoms of sexual dysfunction. Vasomotor symptoms had better response compared to sexual dysfunction (p < 0.01). Natural oestrogen gave slightly better relief of symptoms of sexual dysfunction than other forms of oestrogen therapy. Livial gave complete relief of dyspareunia and vaginal dryness in 9.1% and 3.9% respectively, but none of those with libido and vaginal discharge had any relief. CONCLUSION: There is a decline in sexual response and activity in postmenopausal women in Kuwait. This is however, multifactorial in origin. Although oestrogen replacement therapy gives significant relief in symptoms of sexual dysfunction, other contributory factors should always be evaluated.

Adult↗
PubMed2006

Quality of life and sexual function following surgery for rectal cancer.

The last 20 years have seen enormous strides forward in the treatment of rectal cancer with the development of improved surgical technique, tumour staging, histopathological audit and multidisciplinary team (MDT) management with emphasis on improving survival and reducing local recurrence rates. However, each rectal cancer discussed at the MDT meeting involves an individual patient. The quality of life for each patient must be taken into account when making treatment decisions, which sometimes may not fit with 'standard' treatment guidelines as the individual patient does not have a 'standard' tumour. For one patient with a tumour 5 cm above the anal verge, a low anterior resection may maintain quality of life with no incontinence and preservation of urinary and sexual function. For another with a tumour at the same level, preoperative chemo-radiotherapy may exacerbate mild incontinence and a low resection may result in a 'perineal stoma'. A decision to perform an abdomino-perineal excision (APE) must not be considered a failure of surgical treatment or be seen as a suboptimal centre by having a high APE rate. On the contrary, APE rates should represent sub-specialization and patient selection. Indeed, good function from a permanent stoma may be better than bad function from a poorly functioning coloanal pouch. Having improved tumour staging, surgical technique, oncological treatment and histopathological assessment, quality of life must not be forgotten. Both quality and quantity of life are important to all patients.

Colectomy↗
PubMed2004

Sexual healthcare needs of women aged 65 and older.

OBJECTIVES: To compare prevalence and type of sexual concerns and interest in and experience with discussing these concerns with physicians for women younger than 65 and 65 and older. DESIGN: Cross-sectional survey. SETTING: Departments of Family Practice and Obstetrics and Gynecology at Madigan Army Medical Center, Tacoma, Washington. PARTICIPANTS: Of 1,480 women seeking routine gynecological care, 964 (65%) responded; 163 (17%) were aged 65 and older. MEASUREMENTS: Self-reported sexual concerns and interest in and experience with discussing these concerns with their physicians. RESULTS: Older women had a similar number of sexual concerns as younger women and were more likely to be concerned about their partner's sexual difficulties. Older women were less likely to have ever had the topic of sexual health raised during healthcare visits. Even though these women were more likely to report youthful-appearing physicians as hindering the topic of sexual health, the majority indicated that they would have discussed their concerns had the physician raised the topic and were interested in a follow-up appointment to do so. CONCLUSION: Although the types of sexual concerns vary in frequency, women aged 65 and older have a similar number of sexual concerns as younger women. Older women want physicians to inquire about their sexual health. This discussion should include inquiries about their partner's sexual functioning. To overcome age as a barrier to this discussion, younger physicians should be particularly attentive to initiating the topic of sexual health.

Adolescent↗
PubMedDate not supplied

Sexual implications of gynecologic cancer treatments.

Gynecologic cancers affected 81,000 women in 1999. The disease and its associated treatment commonly pose a threat not only to the life of such patients, but also to their sexuality and fertility. These women and their partners require knowledgeable, compassionate care. Effective, holistic nursing care for women experiencing gynecologic cancers requires an understanding of basic concepts of female sexuality, the diagnosis and treatment of gynecologic malignancies, the impact of the disease and its treatment on a woman's sexuality, and ways the nurse can incorporate sexuality issues into practice.

Female↗
PubMed2005

Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors.

The Global Study of Sexual Attitudes and Behaviors (GSSAB) investigated various aspects of sex and relationships among 27,500 men and women aged 40-80 years. Here, we report help-seeking behaviours for sexual problems in this population. A questionnaire was administered using the accepted survey method in each country. Although almost half of all sexually active respondents had experienced at least one sexual problem, less than 19% of them (18.0% of men and 18.8% of women) had attempted to seek medical help for their problem(s). The most frequent action taken by men and women was to talk to their partner (39%). Only 9% of men and women had been asked about their sexual health by a doctor in a routine visit during the past 3 years. Although sexual problems are highly prevalent, few men and women seek medical help for these problems. Overall, men and women show similar help-seeking behaviours.

Adult↗
PubMed2005

Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study.

INTRODUCTION: Much research has explored the experience of erectile dysfunction (ED) among men with ED, but far less attention has been paid to the perceptions and sexual experiences of the female partners of men with ED. AIM: The objective of this study was to characterize the attitudes, beliefs, and sexual experience of female partners of men with erectile difficulties. METHODS: Female partners of men with ED who had participated in the Men's Attitudes to Life Events and Sexuality (MALES) study were recruited for this research via mail or Internet, after their male partners consented to this contact. Female partners of men with ED (N = 293) responded to questionnaire measures assessing their frequency of sexual activity and the nature of their sexual experience, both before and after the development of their partner's ED, and in relation to their partner's use of phosphodiesterase type 5 (PDE5) inhibitors. RESULTS: Women reported engaging in sexual activity significantly less frequently after their partner developed ED in comparison with before (P < 0.001). Moreover, significantly fewer women experienced sexual desire, arousal, or orgasm "almost always" or "most times," and significantly fewer women reported satisfaction with their sexual relationship after their partner developed ED, compared with before (P < 0.001). Decreases in female sexual satisfaction and frequency of orgasm were significantly related to the male partner's self-reported severity of ED (P < 0.01). The proportion of women who experienced sexual desire, arousal, and orgasm "almost always" or "most times" was significantly higher in the group whose partners were currently using a PDE5 inhibitor (P < 0.05). CONCLUSION: Erectile dysfunction has significant adverse effects on the female partner's sexual experience. Women with partners who were currently using PDE5 inhibitors had a more satisfying sexual experience than those whose partners did not use a PDE5 inhibitor.

Adult↗
PubMed2005

Sexual dysfunction in female partners of men who have undergone radical prostatectomy correlates with sexual dysfunction of the male partner.

INTRODUCTION: Preservation and restoration of erectile function after radical prostatectomy (RP) for prostate cancer has been extensively studied. However, the influence of RP on the sexual function of female partners is poorly understood. AIM: The purpose of this retrospective study is to assess sexuality in men who have undergone RP for prostate cancer and their female partners. METHODS: Men who underwent RP for localized prostate cancer at our institution from 1996 to 2000 were identified and invited to participate in this study with their female partners. Both partners completed a demographic survey. Men completed the International Index of Erectile Function (IIEF) and female partners completed the Female Sexual Function Index (FSFI) and supplemental questions. MAIN OUTCOME MEASURES: Correlation between IIEF and FSFI domain scores was determined in matched couples using Pearson correlation coefficient. Kappa statistics and Spearman correlation coefficient were calculated for supplemental questions and IIEF domain scores. RESULTS: Of 1,134 men contacted by letter, 90 (8%) couples completed demographic surveys and both the IIEF/FSFI. Pearson correlation coefficients of IIEF and FSFI domain scores in matched couples demonstrated significant correlation (P<0.05) of all IIEF domains with all FSFI domains with the exception of male erectile function and overall sexual function with female sexual desire. There was moderate agreement between partner supplemental questions and IIEF domain scores. CONCLUSIONS: Response rate was very low. FSFI domain scores correlate with IIEF domain scores, indicating an interrelationship between male and female sexual dysfunction in these couples. Evaluation and treatment of sexual dysfunction after RP should involve both partners.

Aged↗
PubMed2006

Development and validation of a new questionnaire to assess sexual satisfaction, control, and distress associated with premature ejaculation.

INTRODUCTION: No validated questionnaires to assess the subjective aspects of premature ejaculation (PE) are currently in use. Clinical trials have generally only considered time, measured by ejaculatory latency, as an indicator of efficacy, but ejaculatory control, sexual satisfaction, and distress are important aspects of PE, which impact both the patient and his partner. The objective of this study was to develop and validate a new questionnaire to measure the overall experience of PE. METHODS: The questionnaire was developed using four stages: item pool development, initial psychometric analyses, patient interviews, and final psychometric analyses. RESULTS: An item pool of 17 was generated and reduced to 10 items through the initial psychometric analyses. Patient interviews did not require addition of further items and resulted in only minor modifications to item wording for clarity. Final psychometric analyses of the 10-item measure confirmed a three-factor solution: sexual satisfaction, control, and distress. Reliability was good, both internal consistency and test-retest reliability. Convergent validity using intravaginal ejaculatory latency time was excellent: control domain (0.75), sexual satisfaction domain (0.60), and distress domain (0.68). Known-groups validity was very good, all domain mean scores being statistically significantly worse in men with PE compared with the men reporting no PE problems. CONCLUSION: The Index of Premature Ejaculation is a reliable and valid questionnaire for the assessment of control over ejaculation, satisfaction with sex life, and distress in men with PE. This tool has the potential to add value to interpretations of improvements in ejaculation latency resulting from new treatments of PE.

Adult↗
PubMed2006

Changing paradigms from a historical DSM-III and DSM-IV view toward an evidence-based definition of premature ejaculation. Part I--validity of DSM-IV-TR.

BACKGROUND: In former days, information obtained from randomized well-controlled clinical trials and epidemiological studies on premature ejaculation (PE) was not available, thereby hampering the efforts of the consecutive DSM Work Groups on Sexual Disorders to formulate an evidence-based definition of PE. The current DSM-IV-TR definition of PE is still nonevidence based. In addition, the requirement that persistent self-perceived PE, distress, and interpersonal difficulties, in absence of a quantified ejaculation time, are necessary to establish the diagnosis remains disputable. AIM: To investigate the validity and reliability of DSM and ICD diagnosis of premature ejaculation. METHODS: The historical development of DSM and ICD classification of mental disorders is critically reviewed, and two studies using the DSM-IV-TR definition of PE is critically reanalyzed. RESULTS: Reanalysis of two studies using the DSM-IV-TR definition of PE has shown that DSM-diagnosed PE can be accompanied by long intravaginal ejaculation latency time (IELT) values. The reanalysis revealed a low positive predictive value for the DSM-IV-TR definition when used as a diagnostic test. A similar situation pertains to the American Urological Association (AUA) definition of PE, which is practically a copy of the DSM-IV-TR definition. CONCLUSION: It should be emphasized that any evidence-based definition of PE needs objectively collected patient-reported outcome (PRO) data from epidemiological studies, as well as reproducible quantifications of the IELT.

Coitus↗
PubMed2006

Postpartum sexuality concerns among first-time parents from one U.S. academic hospital.

INTRODUCTION: Sexual perceptions and activities are influenced by pregnancy and childbirth due to both physical and emotional changes. AIM: Our goal was to illuminate the sexuality issues of concern to first-time parents (mothers and fathers) of healthy, singleton newborns in one U.S. academic hospital. MAIN OUTCOME MEASURES: Number of sexuality concerns and self-reported degree of resolution by months postpartum and gender of parent. METHODS: Anonymous, cross-sectional postal survey of two first-time parent cohorts: 4 months postpartum (113 responses/404 mailed = 28.0%) and 12 months postpartum (99 responses/394 mailed = 25.1%). RESULTS: Approximately half of the parents reported questions or concerns on between two and eight of 19 sexuality topics. Only 11% of participating mothers and 17% of participating fathers had one or no concerns (P = 0.27 by gender), and 17% of mothers and 9% of fathers had >13 concerns (P = 0.12 by gender). There were fewer maternal concerns if they did not live with the father (P = 0.01), slightly fewer if the delivery was vaginal vs. cesarean (P = 0.07), and no differences by forceps/vacuum use or episiotomy/vaginal tear. The top concerns at 4 months postpartum were quite similar by gender and included when to resume intercourse, birth control, and the sexual impact of physical recovery from delivery. At 12 months, mothers and fathers both frequently reported a sexuality impact from the mother's body image concerns and desire discrepancy. One year postpartum, there were three sexuality topics with fairly high prevalence (more than one-third parents had this concern) that persisted (no self-reported resolution among at least one-third of parents): child-rearing differences with spouse, greater desire by the man than the woman, and the mother's body image. CONCLUSIONS: New mothers and fathers both have postpartum sexuality concerns/questions, many of which can be addressed by healthcare providers.

Adult↗
PubMedDate not supplied

Nursing assessment of altered sexuality: a review of salient factors and objective measures.

TOPIC: Nursing assessment of altered sexuality. PURPOSE: To review salient factors affecting assessment and objective measures available for use in assessment. SOURCE: Literature specific to nursing assessment of sexuality and to instruments measuring altered sexuality. CONCLUSIONS: Many standards of care include the assessment of sexuality, and nurses believe it to be an important aspect of care. However, the assessment of altered sexuality does not often occur in actual practice. The use of an objective measure of sexuality is recommended for both initial and on-going assessments in acute-care and community-based settings.

Female↗
PubMed1995

Sexual function in women with advanced multiple sclerosis.

Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eight (59.6%) of the women reported decreased sexual desire. Seventeen (36.2%) reported decreased lubrication. Five (10.6%) others did not know if they lubricated or not. Eighteen women (38.3%) reported diminished orgasmic capacity and six (12.8%) others had never had an orgasm. Sensory dysfunction in the genital area was experienced by 61.7% of the women and 76.6% had weakness of the pelvic muscles. Sixty six per cent had bowel problems and 89.4% had bladder dysfunction. The changes in sexual function correlated both with neurological symptoms from the sacral segments, such as weakness of the pelvic floor and bladder and bowel dysfunction, and to other symptoms such as ataxia and vertigo as well as with age and the occurrence of amenorrhoea. A significant correlation was found between expanded disability status scale (EDSS) score and cohabitation. Problems with sexual function were reported significantly more often by women with lower EDSS scores. Most women (83%) found the interview a positive experience.

Adult↗