The physiologic basis of male sexual dysfunction.
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Dihydrotestosterone↗
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[Concerning some important sexual problems].
Sexology is the study of normal and abnormal sexual phenomena, as well as the treatment of sexual dysfunctions. Sexual science is at the dawn of its history, with many of its aspects--be they physiological or sociological--still awaiting investigations. It appears that about three-quarters of all cases of sexual dysfunctions can be handled by the general practitioner or by the gynecologist. As for the remaining patients, they should be referred to a psychologist-sexologist or a psychiatrist specialized in sexual therapy. The practitioner has to be careful not to allow himself to be drawn in a situation of uncontrolled psychotherapy. First of all, he must begin with a full and systematic gynecological examination of the patient.
Family Practice↗
Neurotransmitter, opiodergic system, steroid-hormone interaction and involvement in the replacement therapy of sexual disorders.
Dopamine (DA) and serotonin (5-HT) are the neurotransmitters most directly involved in sexual activity. DA plays a stimulatory role while 5-HT has an inhibitory effect. The two monoaminergic systems modulate the secretion of many hormones (GnRH, LH, testosterone, prolactin and endorphins) involved in sexual functional capacity. Furthermore, hormones influence synthesis and storage of brain neurotransmitters. Impotence can often be associated to clinical depression and altered neurotransmitter function. Moreover, stress represents an unbalance between various neurotransmitter systems and can induce impotence especially when disorders of the endorphinic system are present. Replacement therapy is based upon the understanding of these basic concepts. Impotence due to an underlying depressive illness must be treated with dopaminergic antidepressant drugs; while in stressful conditions a good response to the naloxone test is the preliminary criterion to subsequent naltrexone treatment. When a hormonal deficiency has been proved, the hormone replacement therapy is of course highly effective (gonadotropins in hypogonadotropic syndromes, testosterone in aging, etc.). Finally, idiopathic impotence could be treated by DA agonist and/or 5-HT antagonist drugs either alone or better yet in association with psychotherapy.
Adult↗
Neurobiology of sexual behavior.
Recent advances in the neurobiology of sexual behavior have helped to refine our understanding of the neuroanatomical, neuroendocrine and neurochemical systems that modulate responses to sexual stimulation. Both appetitive and consummatory sexual behaviors have been studied in several laboratory species and in humans using traditional and novel behavioral paradigms. New knowledge has emerged concerning the role of hypothalamic, limbic and brainstem structures, neuropeptides, brain monoamines and nitric oxide in the control of partner preference, sexual desire, erection, copulation, ejaculation, orgasm and sexual satiety. Brain imaging of visually evoked sexual arousal in humans has also been examined.
Animals↗
Nocturnal penile tumescence studies in spinal cord injured males.
Traditional methods of evaluating sexual function in disabled individuals using neurological examinations, interviews, and psychological screening has been well established. A patient's ability to have erections and ejaculations are recorded through interviews with the patient and his partner. Therefore, to obtain a more objective view of the patient's sexual function, we used a nocturnal penile tumescence monitor in 12 tetraplegics and 12 paraplegics. Patients were interviewed for sexual histories before and after the injury. Their penile size was monitored during sleeping time using two strain gauges attached to each end of the penile shaft. The bridge output from these strain gauges was amplified to a single channel recorder. The spontaneous increase of penile circumference and its duration was recorded. The result showed that: tetraplegics had a greater increase of penile size and longer duration of erection than paraplegics, there is no correlation between incompleteness of spinal lesion and erection, there is no correlation between the presence of bulbocavernosus reflex and erection, and there is no correlation between sex dreams and erections.
Adult↗
Safety and tolerability of atypical antipsychotics in patients with bipolar disorder: prevalence, monitoring and management.
Atypical antipsychotics are associated with fewer movement disorders and a lower risk of tardive dyskinesia than conventional antipsychotics, but are not without side-effects. Metabolic side-effects associated with some of the atypical antipsychotics are a concern for both clinicians and patients. Adverse events related to central nervous system effects, weight gain, and alterations in glucose, lipid, and prolactin levels in patients with depression, bipolar, and anxiety disorders have been reported. Balancing the significant benefits of treatment with these agents against the potential risks of metabolic disturbances and other adverse effects is crucial. Emerging data are making it possible to determine the risk-benefit analysis for specific atypical antipsychotics in individual patients and allow for targeted selection of treatment. A new concept of effectiveness is emerging that attempts to balance adverse effects of treatment with patient quality of life. Patients treated with atypical antipsychotics should have their weight, waist circumference, glucose, and lipids monitored on a regular basis. Monitoring of prolactin levels is not suggested; however, a baseline measurement before initiating treatment can be useful, with subsequent assessment only if a patient demonstrates symptoms. Prevention of weight gain is important. Diet and exercise should be considered for prevention and management, with the use of pharmacologic strategies approached with caution in patients with mood disorders. If a patient is at high risk of developing diabetes, certain pharmacologic agents have been shown to delay the onset of overt diabetes. Once diabetes or dyslipidemia are diagnosed, management should proceed in accordance with approved guidelines for these conditions.
Antipsychotic Agents↗
The development of a scale for the assessment of sexual behaviour in Australian women.
The aim of this study was to develop a simple method of assessing female sexual response, suitable for use in clinical investigations. Following a review of interview, physiological and psychological methods, a Scale of Sexual Response was developed. Sexually dysfunctional women and women who stated they had no sexual problems completed the Scale. The results demonstrated that 11 of the 15 subscales had concurrent validity. The 4 subscales relating to auto eroticism did not distinguish between groups. Significant changes were demonstrated in 4 subscales following successful therapy of the sexual dysfunction. The scale was shown to be reliable.
Australia↗
Functional anatomy of the human vagina.
Anatomy studies normally precede physiology. While the anatomy of the penis and the biochemical and molecular regulation of erection are largely known, the exact anatomical description of the human clitoris was produced in 1998, the taxonomy of female sexual dysfunctions classified in 1999, and biochemistry of female excitation described only in 2002. There are various reasons for this. Female sexual physiology is much more complex than that of the male, and cultural and religious considerations have discouraged the scientific study of female sexuality. However, it is now apparent that modern sexology cannot be truly 'medical' if female sexual anatomy and the physiology of female sexual response are unknown.
3',5'-Cyclic-GMP Phosphodiesterases↗
Reproductive disturbances in patients with epilepsy.
In persons with epilepsy, both seizures and antiepileptic drugs can disturb reproductive health. For example, seizures can alter the release of hypothalamic and pituitary hormones, while some antiepileptic drugs alter concentrations of sex steroid hormones. Women with epilepsy are at increased risk for polycystic ovary syndrome and disorders of the menstrual cycle. Studies have found reduced fertility rates among men and women with epilepsy. The reasons for this reduction in fertility are likely to be both psychosocial and physiologic, and again, both epilepsy itself and antiepileptic drugs are implicated. Sexual dysfunction is common among patients with epilepsy and can have a somatic, psychological, or social basis. To provide the best care for patients with epilepsy, particularly women of reproductive age, clinicians must consider both the gender-based biology of epilepsy and the effects of antiepileptic drugs on reproductive health.
Anticonvulsants↗
Intracavernous medication for treatment of premature ejaculation.
Sixteen men complained of premature ejaculation during a five-month period between May, 1987, and October, 1987. Eight patients entered this study using intracavernous vasoactive drugs as treatment for their problem. The patients, ages twenty-four through fifty-eight (average 42 years), were all physically healthy and taking no medications. Five patients had normal findings on nocturnal tumescence monitor, while 3 patients did not use the monitor. A mixture of phentolamine mesylate, 1.0 mg/mL, and papaverine hydrochloride, 30 mg/mL, was used. The dosage required was from 0.10 mL to 0.40 mL. All 8 patients responded successfully to this treatment. Three patients stated they were cured and stopped the treatment. The other 5 patients continued using the medication after fourteen months. The drug-induced erection lasted between two and four hours despite ejaculation. There have been no side effects through April, 1988. All patients report satisfaction with the results of this treatment. The study showed that intracavernous medication therapy can be successful in the treatment of premature ejaculation.
Adult↗
Caring for the orthopaedic patient with sickle cell disease.
Sickle cell disease (SCD) is an inherited, chronic, painful condition seen primarily in blacks and populations from the Mediterranean and Caribbean areas. The crescent or sickle shaped red blood cells have a shorter lifespan causing severe anemia; they are sticky and easily clump together causing intravascular occlusions which eventually damage vital organs. Providing nursing care for patients with sickle cell disease can be very challenging because of the chronic nature of the illness. Understanding the disease phenomena can facilitate nursing assessments and help nurses individualize care for these clients.
Adaptation, Psychological↗
Sexual activity after a myocardial infarction.
Sexual dysfunction after a myocardial infarction is a common problem said to occur in 50% to 75% of all patients. Sexual dysfunction often antedates the myocardial event. The advice given by current textbooks is too often based on anecdotal reports that lack scientific accuracy. Studies of the cardiovascular response during sexual intercourse are few, but those that exist consistently show that there are wide individual variations in heart rate, blood pressure, and oxygen consumption. Recent reports have also identified potentially dangerous arrhythmias during intercourse. Patients who reach 5 to 6 metabolic equivalents (METS) on stress-testing without ischemia or arrhythmias can in all likelihood resume their normal sexual activities without any risk. All other cases have to be considered individually according to the current physiologic knowledge.
Coitus↗
Sexual dysfunction with aging and systemic hypertension.
The incidence of sexual dysfunction increases with age and in the presence of systemic hypertension. An interplay between endocrine, neurologic and vascular systems mediates normal male sexual function. Androgens primarily regulate libido and maintenance of genital tissue, while the autonomic nervous system and arterial blood flow play key roles in the physiology of the male sexual response, particularly penile erection. Vascular disease related to hypertension, diabetes mellitus and atherosclerosis may be the main factor contributing to the sexual dysfunction that occurs with aging. Hormonal alterations probably play less of a role. The importance of neurologic abnormalities remains to be determined. Although specific diagnostic testing can be useful in defining abnormalities in each of these systems, treatment of sexual dysfunction in the setting of hypertension in the elderly patient remains a challenge.
Aged↗
Vaginal pulse amplitude response patterns during erotic conditions and sleep.
Vaginal photoplethysmography has been used to investigate sexual arousal response patterns in small samples of sexually functional and dysfunctional women, but selection of subjects for these studies has not been of a standardized nature. In the present study, two groups of women, who placed in either the upper or lower percentile ranks on the Sexual Arousal Inventory (Hoon et al., 1976a), were compared on a physiological measure of sexual arousal, vaginal pulse amplitude (VPA), during both waking erotic conditions and sleep. As hypothesized, no differences in VPA were found between groups during either waking or sleeping conditions. Contrary to expectation, groups also did not differ on subjective ratings of their laboratory arousal. With both groups combined, differences in VPA levels were evident between baseline and erotic conditions. Similarly, VPA levels differed between stages of sleep, with highest levels observed during rapid-eye-movement (REM) sleep. These findings suggest that self-reported low arousability is not based on lack of physiological response and that retrospective, self-report measures of sexual arousability differ in important ways from subjective and physiological measures of sexual arousal in the laboratory. In order to adequately assess sexual arousability, future researchers must either devise laboratory conditions that more closely resemble erotic stimuli occurring in subjects' natural environments or validate physiological measures of arousal in nonlaboratory settings. Finally, the nocturnal evaluation of VPA seems potentially useful for cases in which organic factors may be contributing to sexual dysfunction.
Adult↗
[Hormones and male sexuality].
In the review of the physiological, pathological and therapeutical aspects of the role of hormones in the erectile process four main topics are discussed: gonadotrop axis dysfunction, hyperprolactinemia, impotence and the potential climacteric male deficit. The conclusion for therapy is that only organic lowering of testosterone should be treated with a dosage adapted to the level of the decrease.
Androgens↗
Head injury and sexual dysfunction.
An extensive review of the head injury and human sexuality literature was completed, to augment an understanding of the impact of traumatic head injury on sexual functioning. Despite clinical evidence that sexual dysfunction after head injury is prevalent and of great import, sexual concerns have been neglected in much of the post-traumatic head injury and rehabilitation literature. Characteristics of head injury concerning cerebral physiology, post-traumatic sequelae, and the effects on sexual functioning are examined. Rehabilitation and family/spouse literature was also examined for information on sexuality. The majority of this article reviews research on sexual sequelae after head injury, such as impulsiveness/inappropriateness, changes in libido and sexual frequency, global sexual difficulties, and specific sexual dysfunctions. Treatment models for the sexual problems after head injury are also reviewed and found to be limited in number. Treatment issues and suggestions are addressed. This article provides information about the sexual problems of head-injured patients to facilitate the development of diagnostic and intervention programmes.
Brain↗
Medications and sexual function.
There seems to be a reluctance to self-report sexual dysfunction during clinical interviews. The rate of reported sexual dysfunction increases when information is sought aggressively in the clinical interview. The relationship to a specific therapeutic agent, however, can be clouded by the patient's perception and coexisting morbidity. Most of the data relating sexual dysfunction to specific drugs are anecdotal. The strongest proof of a casual effect is improvement in sexual function after withdrawal of the medication. Most of the adverse sexual effects of commonly used medications can be predicted from a simplified understanding of the human sexual response and physiologic mediators. Alternative therapeutic agents can be substituted by understanding these physiologic mechanisms and a careful clinical interview. Although polypharmacy is a problem for older persons, in some cases sildenafil can be used to correct drug-induced impotence.
Drug-Related Side Effects and Adverse Reactions↗
[The preventive effect of indeloxazine hydrochloride to the sexual dysfunction caused by anti-androgenergic agent (allylestrenol)].
Anti-androgenergic agents are usually used for patients with benign prostatic hypertrophy (BPH). However steroidal anti-androgenergic agents tend to suppress the sexual function. This side effect is very significant in middle-aged men. Therefore we studied the preventive effect of indeloxazine hydrochloride (INDX), which induces an increase of the dopamine level in the brain, on the sexual dysfunction induced by an anti-androgenergic agent (allylestrenol: ALE). Thirty-six patients with BPH were classified into two groups, one used ALE only, and the other ALE with INDX. For the subjective evaluation of the sexual function, a self assessment questionnaire method was employed before and after administration. We especially studied 3 questions, "morning erection", "erectile capacity" and "frequency of sex". For the objective evaluation of the sexual function, nocturnal penile tumescence (NPT) was measured using an erectometer. NPT occurs in healthy males as a physiological phenomenon and it shows the erectile capacity objectively. The levels of LH, total testosterone and free testosterone were also determined. In the ALE only group, sexual dysfunction was found subjectively and objectively, but in the ALE with INDX group, it was not found. Levels of LH, total testosterone and free testosterone were decreased in the both groups. There was no significant difference between the two groups. We hypothesized that the sexual dysfunction due to ALE is related with not only to the decrease of androgen, but also to suppression of the central nervous system; for example, the suppression of the area of the brain mediating sexual behavior.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗