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Addressing issues of sexuality with spinal cord injured persons.

For many years society viewed the spinal cord injured person as an asexual being. Within the past 10 years health care providers have recognized the need to incorporate information sexuality into the care of this population. This article reviews the physiologic and psychologic changes experienced by the spinal cord injured person, explores methods of enhancing the physiologic function inherent in the sexual experience, and presents nursing's role in sexual counseling.

Humans↗

Sex and arthritis.

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Adaptation, Physiological↗

Sildenafil effects on sexual and cardiovascular responses in women with spinal cord injury.

OBJECTIVES: Sexual dysfunction is common in women with spinal cord injuries (SCIs) and other neurologic conditions. Sildenafil has previously been shown to be safe and effective in the treatment of erectile dysfunction due to SCI. This study is the first to evaluate the sexual and cardiovascular effects of sildenafil in women with SCIs in a controlled, laboratory setting. METHODS: Nineteen premenopausal women with SCIs were randomly assigned to receive either sildenafil (50 mg) or placebo in a double-blind, crossover design study. Physiologic and subjective measures of sexual response, heart rate, and blood pressure were recorded during baseline and sexual stimulation conditions. Adverse events were also recorded. RESULTS: Significant increases in subjective arousal (SA) were observed with both drug (P <0.01) and sexual stimulation conditions (P <0.001), and a borderline significant (P <0.07) effect of drug administration on vaginal pulse amplitude (VPA) was noted. Maximal responses occurred when sildenafil was combined with visual and manual sexual stimulation. Cardiovascular data showed modest increases in heart rate (+/-5 bpm) and mild decreases in blood pressure (+/-4 mm Hg) across all stimulation conditions, consistent with the peripheral vasodilatory mechanism of the drug. Sildenafil was well tolerated with no evidence of significant adverse events. CONCLUSIONS: Findings suggest that sildenafil may partially reverse the sexual dysfunction commonly associated with SCI in women. Consistent with previous findings in men, the sexual effects of the drug were most evident under conditions of optimal stimulation. Mild, clinically insignificant cardiovascular effects were also noted. Further large-scale studies of sildenafil's effects in women with neurogenic sexual dysfunction are strongly indicated.

Adult↗

Surgical correction of post-operative retrograde ejaculation.

Retrograde ejaculation is a known complication of bladder neck surgery. Revision of a bilharzial bladder neck obstruction accentuates the incidence of this complication. Some of the difficulties in the surgical correction of retrograde ejaculation are directly related to pathological changes caused by bilharziasis. In this study a new length of premontanal urethra is formed using the trigonal urothelium and the trigonal muscles with their intact sympathetic innervation to correct retrograde ejaculation following bladder neck surgery. Normal (antegrade) ejaculation was restored in four of five men using this procedure. The physiological basis of the procedure is discussed.

Adult↗

Sexuality: a challenge for nursing practice.

Nursing has made significant progress towards individualised, holistic patient care. Yet caring for patients who have concerns about sexuality and body image remains a challenge, despite considerable literature on the subject. This article explores reasons for this and suggests learning exercises to enable nurses to examine their own attitudes to body image and sexuality.

Attitude of Health Personnel↗

Chronic orofacial pain: is the puzzle unraveling?

Conditions involving chronic orofacial pain represent a major health problem, and patients with persistent pain are difficult to manage successfully. These conditions are often comorbid with additional health issues such as sleep disturbances, cardiovascular, gastrointestinal and reproductive system complaints, weight loss or weight gain, swelling, numbness, sweating and flushing, and concerns regarding loss of libido, drive, attention, and memory. Neuroendocrine and autonomic pain-stress responsivity and the consequences of pain for sensory, motor, immune and reproductive functions, and mood seem to account for the broad range of comorbid complaints. Susceptibility to a particular response appears to explain intra-individual differences in disease expression. Understanding of these regulatory, mostly adaptive processes will support novel treatments to manage many troublesome comorbid complaints for which current approaches are unsatisfactory.

Adaptation, Physiological↗

[Adverse effects of psychiatric drugs on sexual functions].

Several groups of pharmacological agents have been reported to disrupt normal sexual function. Psychotropic medications, such as antidepressants and antipsychotics, have also been associated with sexual side effects. The procedure by which, the basic physiologic mechanisms of the normal sexual phases (libido, arousal, and orgasm) are disrupted by some psychotropics provide a framework to minimize sexual side effects when initiating and continuing treatment. Successful management of sexual complaints during treatment should begin with a systematic approach to determine the type of sexual dysfunction, potential contributing factors, and finally delineating strategies that should be tailored to the individual patient. This article provides guidelines for the assessment, management, and prevention of sexual side effects associated with antidepressant and antipsychotic treatment.

Female↗

Sexual function in spinal cord injury men. I. Assessing sexual capability.

Precise diagnoses are seldom made upon complaints of sexual dysfunction by spinal cord injured men. The dysfunction is inevitably attributed to the neurological condition and available treatments are offered with little knowledge of the individual residual capacity or other contributing factors. Current practice emphasizes these treatment approaches, but the high rejection rate associated with the most widely used technique of intracavernous injections suggests that remaining sexual function should also be investigated. This study explores remaining function using physiological recording techniques and classifying the subjects according to the innervation of the reproductive system. The results show that, with objective measurements and proper classification of the subjects, 100% of individuals with high lesions maintain penile responses to reflexogenic stimulation and up to 90% of those with lower lesions maintain penile responses to psychogenic stimulation. These latter subjects also show naturally occurring emissions in 100% of the cases when they suffer from lesions to the conus terminalis and when they use psychogenic stimulation as a means of inducing erection and emission. Results from subjective reports reveal that spinal cord injured men underestimate their sexual capacity, while diagnoses based on clinical findings are better predictors.

Coitus↗

Sexual dysfunction in stroke patients.

The impact of cerebrovascular accident (CVA) on sexual behavior in stroke patients was studied in 113 patients (78 men, 35 women). Seventy-five patients were interviewed with their spouses present. The mean age of the men and women patients was 68.6 years and 68.0 years respectively. Significant decline in libido after stroke was reported by both men and women. The men had a significant decrease in ability to achieve erection and to ejaculate in the period after stroke. Similarly, significant problems were reported by the women regarding normal vaginal lubrication and orgasm after CVA. Sixty-six men (84%) and 21 women (60%) enjoyed their sex lives before their stroke as compared to only 23 men (30%) and 11 women (31%) after stroke. Seventy-four men (95%) and 27 women (76%) were satisfied with sexual activity before their stroke as compared to only 20 men (26%) and 13 women (37%) after stroke. Women patients with right-sided lesions had lesser decline in sexual function than women with left-sided lesions or men with either right or left hemispheric lesions. The most common factor identified as causing decline in sexual activity was the fear that having sex might adversely affect blood pressure and cause another stroke. The sexual problems of these patients are of sufficient magnitude and frequency to warrant further investigation of the physiologic effects of sexual activity on blood pressure and cardiac function after stroke.

Adult↗

Animal models in urological disease and sexual dysfunction.

There are several conditions associated with dysfunction of the lower urinary tract or which result in a reduction in the ability to engage in satisfactory sexual function and result in significant bother to sufferers, partners and/or carers. This review describes some of the animal models that may be used to discover safe and effective medicines with which to treat them. While alpha adrenoceptor antagonists and 5-alpha-reductase inhibitors deliver improvement in symptom relief in benign prostatic hyperplasia sufferers, the availability of efficacious and well-tolerated medicines to treat incontinence is less well served. Stress urinary incontinence (SUI) has no approved medical therapy in the United States and overactive bladder (OAB) therapy is limited to treatment with muscarinic antagonists (anti-muscarinics). SUI and OAB are characterised by high prevalence, a growing ageing population and a strong desire from sufferers and physicians for more effective treatment options. High patient numbers with low presentation rates characterizes sexual dysfunction in men and women. The introduction of Viagra in 1998 for treating male erectile dysfunction and the success of the phosphodiesterase type 5 inhibitor class (PDE5 inhibitor) have indicated the willingness of sufferers to seek treatment when an effective alternative to injections and devices is available. The main value of preclinical models in discovering new medicines is to predict clinical outcomes. This translation can be established relatively easily in areas of medicine where there are a large number of drugs with different underlying pharmacological mechanisms in clinical usage. However, apart from, for example, the use of PDE5 inhibitors to treat male erectile dysfunction and the use of anti-muscarinics to treat OAB, this clinical information is limited. Therefore, current confidence in existing preclinical models is based on our understanding of the biochemical, physiological, pathophysiological and psychological mechanisms underlying the conditions in humans and how they are reflected in preclinical models. Confidence in both the models used and the pharmacological data generated is reinforced if different models of related aspects of the same disorder generate confirmatory data. However, these models will only be fully validated in retrospect once the pharmacological agents they have helped identify are tested in humans.

Animals↗

Seminal plasma magnesium and premature ejaculation: a case-control study.

OBJECTIVE: To determine the relationship between premature ejaculation (PE) and serum and seminal plasma magnesium levels, in a case-control study. PATIENTS AND METHODS: Thirty-eight patients referred to the authors' urology outpatient clinic were evaluated in two groups; cases comprised 19 men complaining of PE, defined using the Diagnostic and Statistical Manual of Mental Disorders IV criteria and an intravaginal ejaculatory latency time (IELT) of <1 min, and a control group of 19 married men with a normal IELT. All men had a history taken, a systemic physical examination and laboratory studies. After organic and psychogenic disorders were excluded, the 19 patients were included in the study. Seminal plasma and serum magnesium levels were determined using atomic absorption spectrophotometry. RESULTS: The mean (sd) plasma magnesium level was 94.7 (10.9) mg/L in the cases and 116.7 (11.6) mg/L in the controls. There was a significant relationship between seminal plasma magnesium, but not the plasma level, and PE (P < 0.001 and 0.597 respectively). CONCLUSION: PE is significantly related with a lower level of seminal plasma magnesium. The pathological physiology of this relationship requires more investigation.

Adult↗

Androgen insufficiency in women.

Androgens are directly secreted by the ovaries and adrenals in women, and androgen precursors from these glands are converted in a variety of peripheral tissues into androgens. The major androgen in women is testosterone, and its action in target tissues can be mediated through the androgen receptor or through the estrogen receptor after aromatization to estradiol. Low sexual desire that causes personal distress (or hypoactive sexual desire disorder [HSDD]) is the most common form of female sexual dysfunction, and androgen insufficiency is one cause of this problem. In addition to a low libido, the clinical construct of the female androgen insufficiency syndrome includes the presence of persistent, unexplained fatigue and a decreased sense of well-being. Although there is conflicting information about the relationship between serum testosterone concentrations and sexual desire, multiple randomized, double-blind, placebo-controlled treatment trials have demonstrated that testosterone improves libido significantly more than placebo. Doses that provide physiologic to slightly supraphysiologic serum free or bioavailable testosterone concentrations are safe and associated with only mild androgenic side effects of acne and hirsutism. Oral, but not parenteral or transdermal, testosterone may decrease high-density lipoprotein cholesterol. At present, no testosterone preparation has been approved by the FDA for the treatment of low sexual desire (HSDD), so all such therapy is considered to be off-label use at this time.

Androgens↗

Alfuzosin for symptomatic benign prostatic hyperplasia: long-term experience.

PURPOSE: Evidence of the long-term efficacy and safety of alfuzosin treatment for LUTS indicative of BPH was examined. MATERIALS AND METHODS: An English literature search of MEDLINE, PubMed and proceedings from scientific meetings from 1974 to 2004 was done. Search terms included benign prostatic hyperplasia, alfuzosin, treatment, alpha(1)-adrenergic receptor blocker, long-term, followup, lower urinary tract symptoms, complications or adverse events, sexual, retention and cardiovascular. RESULTS: Currently alpha(1)-adrenergic receptor blocking agents are first line treatment for BPH. Although all alpha-blocking compounds show similar levels of efficacy for LUTS treatment, newer agents such as alfuzosin tend to demonstrate improved selectivity for the prostate and bladder with few vasodilatory effects and they have tolerability advantages over older alpha-blocking compounds. Immediate, sustained and newer extended release alfuzosin formulations significantly improve LUTS indicative of BPH but extended release alfuzosin may be more convenient to administer and it tends to show better vasodilatory tolerability than the older immediate release formulation. CONCLUSIONS: When used to treat BPH, alfuzosin provides symptom relief, decreased residual post-void urine volume and a decreased risk of acute urinary retention, which are maintained during long-term use. Most vasodilatory side effects occur early in treatment and they become less frequent thereafter. Patient quality of life also improves with maximal improvements observed after 12 months of treatment. Continued study will further clarify the physiological, clinical and personal benefits produced by alfuzosin when used for the management of LUTS indicative of BPH.

Adrenergic alpha-Antagonists↗