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PubMed1989

Sexual difficulties. A general practice speciality.

Sexual problems afflict many patients, and most general practitioners will have to deal with these diagnostic challenges. Between 25 and 50 per cent of difficulties have an organic cause, the remainder are emotional or psychogenic in origin. The PLISSIT counselling model is looked at, and the areas covered by the psychosexual history are discussed. A brief description of sexual physiology in men and women explains the impact of psychological factors. The effect of disease on sexuality, and its role in dysfunction, is explored and some principles of the methods of treatment are looked at. Sexual therapy and counselling provide an opportunity for the general practitioner to practise holistic medicine, and to deal with issues of great concern to patients.

Australia↗
PubMed2003

The effect of hysterectomy on sexual functioning.

The effect of hysterectomy on sexual function is an issue of debate. There are reasons to believe that removal of the uterus can have adverse effects on female sexual functioning by disrupting the anatomical relations in the pelvis. In this article, we review the literature on the impact of hysterectomy (without oophorectomy and for benign conditions) on the sexual functioning of premenopausal women. There is evidence that women for whom there is a clinical indication for hysterectomy are often experiencing a decreased quality of life. After successful treatment of dysfunctional uterine bleeding, either by hysterectomy or uterus-saving alternatives, the majority of women report experiencing improved sexual functioning. Nonetheless, the research on the effect of hysterectomy on female sexual functioning is not conclusive. Prehysterectomy sexual functioning and psychosocial state are significant predictors for posthysterectomy sexual dysfunction and depression. A minority of women report developing sexual dysfunctions as a result of hysterectomy. The nature and extent of these dysfunctions have not been adequately investigated. Many investigations in this area are flawed by methodological imperfections. For example, qualitative changes in sexual functioning and changes in the physiology of sexual function often were not adequately addressed. In the future, researchers should include both objective measures of physiological functioning and use standardized and validated self-report questionnaires. A critical attitude towards the indications of hysterectomy remains mandatory.

Adaptation, Psychological↗
PubMed1994

[Sexuality and genito-urinary cancers].

In mythological terms, cancer symbolizes death and suffering, and sexuality, on the other hand, symbolizes life and pleasure. This diagnosis whether explicit or not, calls for two-fold reflection. Firstly the individual is faced by the inexorable approach of death and is called to bury his fantasies of immortality. Secondly, it also constitutes a threat to the body-image, and this may have profound repercussions on sexuality. The author investigates the impact of genito-urinary cancers and also cancers of the breast, which are included on the basis of its symbolic nature, on the patient's personal life: conjugal dynamism, socio-professional life and, in particular, physiological changes of sexual function.

Attitude to Death↗
PubMed2001

[Sexuality of the diabetic woman].

Diabetes Mellitus frankly increases the prevalence of sexual problems in men, mainly in the form of erectile dysfunctions. Its effects on sexual function of the diabetic women have been less objectively studied, due to cultural reasons and methodological difficulties. The different phases of the sexual cycle, as well as their physiological control, are similar in human males and females. Several studies suggest an increased prevalence of sexual problems also in diabetic females. Their rate seems similar to that of the males. An increased prevalence of Female Sexual Arousal Disorder has been found in 6 studies of 6 comparing diabetic to non diabetic females. Its main symptom was a deficient vaginal lubrication, making sexual intercourse unpleasant. This disorder is the female equivalent to erectile dysfunction. It probably results from similar mechanisms, involving damages in the vascular and autonomic nervous systems, as well as alteration in the nitric oxide production and efficacy. The prevalence of Hypoactive Sexual Desire Disorder was also increased in most studies (5 of 8, significantly in 3). This could result from the increased prevalence of depression in diabetic females. The Dyspareunia's prevalence was not significantly increased (0 of 6 studies). Available figures are not consistent as regards the orgasmic disorders (prevalence increased in only 4 of 8 studies). No significant correlation of female sexual dysfunction with diabetes duration, balance, or complications has been found. Conversely some significant correlations with depression or poor acceptance of diabetes have been found, supporting a causative role of psychological factors. Although still limited the therapeutic options should not be neglected. Merely prescribing a water soluble lubricating gel may greatly improve the sexual life of couples. Doctors should talk themselves about sexual function with their female diabetic patients. Most of these are too much embarrassed to ask themselves their doctor, although their sexual problems may seriously interfere with their quality of life and that of their partner.

Arousal↗
PubMed1976

Multidisciplinary approach to sex education of spinal cord-injured patients.

The need for sex education of spinal cord-injured patients is often unmet by current rehabilitation programs. In the programs which do exist, therapeutic objectives vary widely, indicating a need for clarity and communication among professionals. An interdisciplinary approach to evaluating and treating sexual dysfunction is described which provides information to patients and families about sexual disorders related to spinal injury and offers counseling services to patients experiencing problems in their altered sex relations. Physiological, psychological, and social aspects of human sexuality as they are integrated into a multidisciplinary sex education program are discussed with specific recommendations for content which should be included in the information-giving counseling process.

Counseling↗
PubMed2005

Telemetric monitoring of corpus spongiosum penis pressure in conscious rats for assessment of micturition and sexual function following spinal cord contusion injury.

Disruption of bladder function and sexual reflexes are major complications following spinal cord injury (SCI). We examined the use of telemetric monitoring of corpus spongiosum penis (CSP) pressures for assessment of micturition and erectile events following SCI in rats. Pressure catheters were implanted in the bulb of the CSP of seven male Long-Evans hooded rats, subjected to a standardized weight drop SCI (10 g x 12.5 mm) at T10. CSP pressures were analyzed for spontaneously occurring micturition and erectile events, and during ex copula reflex erection tests until 25 days after SCI. Urine volume was determined until 21 days after SCI. Results show initial loss of bladder function after SCI with gradual return of reflex micturition. When compared to baseline (BL), micturition pressure characteristics after SCI included prolonged duration, increased area under the curve (AUC), increased mean pressures, increased number of pressure peaks, and increased peak frequency. At 21 days after SCI, the urine volume per micturition was significantly increased. The number of full erectile events decreased significantly following SCI. Pressure wave analyses demonstrated increased AUC, increased maximum pressures, increased suprasystolic peak duration, increased AUC of the suprasystolic peaks, and increased maximum pressures of the suprasystolic peaks during recovery. The number of partial erectile events decreased significantly following SCI. Ex copula reflex erection testing demonstrated significantly decreased latency. The study demonstrates that telemetric monitoring of CSP pressures in conscious rats is a valuable and reliable method for assessing recovery of autonomic function following SCI.

Animals↗
PubMed2003

A framework for the present and future development of experimental models of female sexual dysfunction.

Female sexual dysfunction (FSD) is currently categorized according to disorders of (i). desire, (ii). arousal, (iii). orgasm and (iv). sexual pain. The advancement of research defining the physiological, pathophysiological and psychological mechanisms of these disorders, and to develop treatments for FSD, has been hampered by the paucity of experimental paradigms and animal models. It may be that animal models of FSD are best suited to address arousal disorders that include persistent or routine inability to attain or maintain genital lubrication or engorgement. Although still limited in scope, experimental models of FSD have involved a range of in vitro to in vivo methodologies. Specifically, the in vitro and in situ models include vaginal or clitoral smooth muscle preparations, histological evaluation and vaginal blood flow assessments. Previously, in vivo studies of sexual responses focussed on behavioral paradigms involving lordotic posturing and receptivity, as well as indices of motivation using a dual chamber pacing method. Recently, a new model of female sexual arousal was developed using pharmacological CNS stimulation; responses that were found to be sensitive to cardiovascular status, aging and hormonal conditions. It is important that a wide variety of animal models continue to be developed to reflect the multifactorial basis of the condition.

Animals↗
PubMed1993

Sexual function in women. Do antihypertensive drugs have an impact?

Drug-induced sexual dysfunction is well known to occur with antihypertensive drugs in men. There are much less data on the effects of drugs on female sexual function. The physiology of the female sexual response has similarities to that of the male sexual response and there are therefore good reasons for suspecting that antihypertensive drugs are likely to adversely affect sexual function in women. Present evidence suggests that clonidine, methyldopa, guanethidine and reserpine are associated with adverse effects on sexual function. In healthy volunteers, labetalol appears to reduce vaginal lubrication, but there are no studies in patients receiving the drug therapeutically. Thiazide diuretics may be associated with the worsening of sexual problems, which interestingly appear to be ameliorated by weight reduction. Present evidence on the effects of vasodilators is limited but the evidence suggests that sexual function in women receiving calcium antagonists is not altered by changing to an angiotensin converting enzyme (ACE) inhibitor. Although present evidence suggests that effects on female sexual function may not be very great, it should be recognised that there are very few data in this area. Further work is clearly necessary.

Antihypertensive Agents↗
PubMed1991

The role of medications in geriatric sexual function.

Geriatric patients take proportionately more drugs than do their younger counterparts. This, along with an aging sexual physiology, places them at greater risk for experiencing adverse drug reactions affecting sexual function. The major therapeutic categories implicated in drug-induced geriatric sexual dysfunction are the psychotherapeutic agents, such as the antidepressants and the neuroleptics, and the cardiovascular agents, predominantly the antihypertensives. There are limited drug therapies available for the treatment of sexual dysfunction in the elderly. Therapies associated with some limited clinical success include the use of testosterone and bromocriptine for impotence associated with androgen deficiencies, intracavernosal injection of vasoactive drugs, and yohimbine. Women with inadequate maintenance of vaginal lubrication may benefit from topical lubricants or estrogens and orally or transdermally administered estrogens.

Aged↗
PubMed2001

Female sexual dysfunction.

The ideal approach to female sexual dysfunction would be a collaborative effort between therapists and physicians and would include a complete medical and psychosocial evaluation, and inclusion of the partner spouse in the evaluation and treatment process. Despite significant anatomic and embryologic parallels between men and women, the multifaceted nature of female sexual dysfunction clearly is distinct from that of the man. The clinician cannot approach female patients or their sexual function problems in the same fashion as in male patients. The context in which a woman experiences her sexuality is equally if not more important than the physiologic outcome she experiences, and these issues should be determined before beginning medical therapy or determining treatment efficacies.

Animals↗
PubMed1988

Practical overview of sexual function and advancing age.

Sexuality remains a vital aspect of human life well into advanced age. Previous sexual history, opportunity, and overall health status determine whether the sexual activity option is exercised. Normal aging is associated with some physiological changes in genital function. If elderly patients seek help for sexual problems, therapeutic interventions focus on elimination or alleviation of physical and pharmacological interferences, as well as on optimal adaptation to physiologically altered responses.

Aged↗
PubMed1981

Sexual health care clinician in an acute spinal cord injury unit.

This article introduces the role of the sexual health care clinician, a nonphysician specialist trained to diagnose and treat sexual dysfunctions of disabled persons. Under medical supervision, the clinician is part of the treatment team in an acute spinal cord injury unit, a general rehabilitation center and an extended care unit. The clinician's role includes direct patient care; education for professionals, students and community agencies; liaison with other rehabilitation groups; and research. The process of sexual rehabilitation is conceptualized and experience with the specialty in an acute setting is described. Experience indicates that sexual assessment, diagnosis and management is a technical specialty which requires in-depth training. The major contributions of the service are an early legitimization of sex-related concerns; the crystallization of physiologic emotional and social capabilities and needs; and the specific instructions for experimentation with various sexual alternatives.

Adult↗