Showing papers on "Sexual dysfunction published in 1993"

Prevalence of sexual dysfunction in women: Results of a survey study of 329 women in an outpatient gynecological clinic

Abstract: Few studies have investigated the prevalence of sexual dysfunction in nonclinical samples. In the present study, a standardized sexual function questionnaire was administered to 329 healthy women, aged 18-73 years, all of whom were enrolled in a Women's Wellness Center. About two-thirds of the sample were married or living with a partner, and most women were employed outside of the home. A broad range of sexual behavior frequencies were observed, with 48.5% reporting at least weekly intercourse, compared to 28.4% who were not sexually active at the time of study. Among the most common sexual problems reported were anxiety or inhibition during sexual activity (38.1%), lack of sexual pleasure (16.3%), and difficulty in achieving orgasm (15.4%). Other common problems were lack of lubrication (13.6%) and painful intercourse (11.3%), each of which was significantly more prevalent in the postmenopausal group. Despite these difficulties, 68.6% of the sample rated their overall sexual relationship as satisfactory. Age and relationship status were significant predictors of sexual satisfaction, with older women and singles reporting a higher incidence of sexual problems. Educational level, religious affiliation, and employment status were not predictive of sexual dysfunction in the present study.

Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease

Abstract: This study confirms the previously studied findings by using a more rigorous methodology concerning the association of sexual victimization history and irritable bowel syndrome or inflammatory bowel disease. Structured psychiatric and sexual trauma interviews were given to 28 patients with irritable bowel syndrome and 19 inflammatory bowel disease, and the prevalence rates of sexual victimization in the 2 groups were compared. A logistic regression analysis was performed to summarize the differences between patients who had severe trauma and those who had none, and to account for intercorrelations among the study variables. Results showed that patients with irritable bowel syndrome were more likely to have a history of previous sexual victimization. The odd ratios for current and lifetime psychiatric disorders in the 9 patients who had experienced severe forms of victimization showed that they were at significantly greater risk for affective, anxiety, and somatoform disorders as well as substance abuse and sexual dysfunction. It was also demonstrated that the best predictors of having experienced severe forms of victimization were gender, the number of medically unexplained physical symptoms, and self-reported anxiety and hostility. This study suggests that irritable bowel syndrome may be part of a chronic adjustment to previous sexual victimization in some patients. Language: en

The role of body image in sexually avoidant behavior.

Abstract: “Spectatoring” refers to a cognitive self-absorption, wherein individuals fixate on and carefully monitor personal body parts and/or the adequacy of personal sexual functioning. To examine this process within a university population, undergraduate and graduate students (108 male and 140 female) filled out questionnaires that assessed body image, sexual knowledge, global sexual attitudes (i.e., liberal—conservative), general psychological adjustment, and frequency of sexual behaviors. Multiple regression analyses were used to determine if spectatoring, operationalized by measures of body image, would significantly predict sexually avoidant behavior. Results indicated that body image scores significantly predicted frequency of sexual behaviors for both genders, while general sexual knowledge and psychological adjustment did not predict sexual behavior. Overall, sexual attitude scores were the best predictors of sexual approach/avoidance behaviors for both genders. Implications are drawn for future research using the assessment of more global sex attitudes in the study of spectatoring.

Sexual dysfunction during antidepressant treatment.

Abstract: Background The reported incidence of sexual dysfunction associated with antidepressant medication varies from 1.9% to 92%. The majority of studies reporting incidences were not systematically conducted. Method We interviewed 60 patients (22 men and 38 women, with anxiety and mood disorders) who were being treated with various antidepressants. We used a questionnaire focused on sexual side effects and other side effects. Results The incidence of sexual dysfunction during antidepressant use in our study is 43.3%. The sexual dysfunction was not limited to any particular diagnostic group nor to any particular antidepressant. There was no significant correlation between sexual dysfunction and anticholinergic side effects. The incidence of painful orgasm with antidepressants was 18% among males in our study. Conclusion The relatively high incidence of sexual dysfunction associated with antidepressant treatment in this systematic study emphasizes the importance of a detailed inquiry about sexual side effects as this interferes with treatment compliance.

Stress, sexual functioning, and marital satisfaction

Abstract: The relationship of stress to sexual functioning and marital satisfaction was investigated in 165 men and women, age 21–84, approximately half of whom were unemployed. Adults completed inventory measures of life experiences, hassles, marital satisfaction, and sexual functioning. Regression analysis showed that for men, unemployment was associated with difficulty attaining an erection. This effect increased significantly with age. Wives of unemployed men also reported greater erectile difficulties for their spouses than wives of employed men. This result was mediated by marital satisfaction: For women whose husbands were unemployed, marital satisfaction had a strong negative relationship to reported erectile difficulty. Contrary to expectations, hassles scores were positively related to sexual desire for both men and women. Although unemployment in women was not related to any sexual dysfunction, desired frequency of intercourse declined with age more sharply for women who were unemployed than for those wh...

Improvement in fluoxetine-associated sexual dysfunction in patients switched to bupropion.

Abstract: Background This study was conducted to determine the effect of bupropion on the sexual functioning of male and female outpatients who developed anorgasmia or delayed orgasm while receiving fluoxetine treatment for depression Method Thirty-nine patients who satisfied criteria for participation in the study discontinued fluoxetine treatment and entered a 2-week washout phase followed by an open 8-week bupropion treatment phase Three parameters of sexual functioning were followed throughout the study: orgasm function, libido, and satisfaction with overall sexual functioning Depression was also evaluated at each visit Results All patients reported orgasm delay and/or failure at the time of fluoxetine discontinuation Orgasm function, libido, and satisfaction with sexual functioning improved during the 2-week fluoxetine washout period and during the bupropion treatment phase Ninety-four percent of patients (29/31) had complete or partial resolution of their orgasm dysfunction at the end of bupropion treatment, and 81% of patients (25/31) were "much" or "very much" more satisfied with their overall sexual functioning Most patients entered the study with decreased libido on fluoxetine Libido was "much" or "very much" increased for 81% of patients (25/31) at the end of the study In addition, depression scores on the Hamilton Rating Scale for Depression and Clinical Global Impressions-Severity scale significantly improved during the bupropion treatment phase Finally, bupropion was well tolerated by most patients Conclusion Bupropion may be an appropriate antidepressant for patients who develop sexual dysfunction during fluoxetine treatment or for whom sexual dysfunction is a concern

The Menopause: Health Implications and Clinical Management

Abstract: Objective: To review the anatomy, physiology, clinical symptoms, long-term health effects, and treatment of the menopause and climacteric syndrome, with a special emphasis on features, such as incontinence, particularly relevant to geriatric medicine. Data sources: English-language publications on menopause and the climacteric. Study selection: Articles and books containing recent information pertinent to the topics covered. Studies in human subjects were given priority, but primate studies that amplify physiologic concepts are included. Data synthesis: Due to increased longevity, the average US woman will spend one-third of her life as a postmenopausal individual. Anatomic and physiologic changes associated with the peri- and postmenopausal state include hot flushes, genitourinary atrophy, and bone loss. Possible correlates of the menopausal transition and postmenopause include affective changes and unfavorable alterations in lipoproteins and other cardiac risk factors. Clinical correlates of these changes can include incontinence, sexual dysfunction, increased risk of fracture, dysphoric mood, and increased risk of cardiovascular disease. Formal indications for estrogen therapy are hot flushes, genital atrophy, and osteoporosis prevention; other common clinical uses are reviewed. Non-contraceptive estrogens can be administered orally, transdermally, vaginally, or by injection. Each route and preparation has some unique features with respect to actions and side effects. Progestins, in adequate doses, protect against the unwanted side effect of endometrial hyperplasia; alternatives to progestin use are presented. Non-hormonal alternatives for some peri- and postmenopausal symptoms are described. Conclusions: A discussion of the menopause and the benefits and risks of hormone therapy should be part of the routine health care of older women. Since the use of hormone therapy is elective, health care providers must elicit the goals, needs, and preferences of each patient, supply her with relevant information, and serve as a facilitator of her individual decision.

Perceived Sexual Dysfunction amongst Patients with Inflammatory Bowel Disease

Abstract: 300 patients with inflammatory bowel disease (IBD) were randomly selected from the community-based register held in Leicester. They were invited to participate in a study investigating personal proble

Sexual rehabilitation after treatment for prostate cancer

Abstract: Although there is little evidence that sexual behavior causes prostate cancer, men with prostate cancer often have sexual dysfunction before the cancer diagnosis is made. Each treatment for prostate cancer increases the prevalence of sexual problems. After nerve-sparing radical prostatectomy, the chance of recovering erections is better for men who are younger and in whom both neurovascular bundles can be spared. Definitions of "potency" after nerve-sparing surgery have not specified the rigidity of the erections achieved. Thus, some men classified as "potent" may wish additional sexual rehabilitation. The chance that definitive radiation therapy will cause erectile dysfunction probably has been overestimated. The prevalence rate may be closer to 25% of men with new problems compared with the 50% often cited in the literature. Men are more at risk to have erection problems after radiation therapy if the quality of erections before treatment was borderline. Hormonal therapy has an impact on the central mechanisms mediating sexual desire and arousability. Therefore, with most treatment methods, only approximately 20% of men remain sexually functional. Newer antiandrogenic drugs interfere less with sexual function, but their long-term ability to control prostate cancer is still under investigation. Sexual rehabilitation should be addressed by the primary care team. Sexual partners should be included in brief sexual counseling, even when a mechanical treatment for erectile dysfunction is prescribed.

Gender differences in masturbation and the relation of masturbation experience in preadolescence and/or early adolescence to sexual behavior and sexual adjustment in young adulthood.

Abstract: A comparison of male and female masturbation practices was undertaken in a sample of university students to determine if the long-standing finding that young adult men in this country masturbate more than young adult women was still evident in the 1980s. Despite the efforts in the past quarter century to encourage women in our society to take greater responsibility for their own bodies and their own sexuality and to engage in more sexual self-exploration and self-stimulation, results show that women continue to masturbate much less than men. Twice as many men as women had ever masturbated and the men who masturbated did so three times more frequently during early adolescence and young adulthood than the women who masturbated during these same age periods. A second purpose of this study was to determine whether having masturbation experience during preadolescence and/or early adolescence was related to intercourse experience, sexual satisfaction, sexual arousal, or sexual difficulties in relationships during young adulthood. No such linkage was observed, suggesting that early masturbation experience is neither beneficial nor harmful to sexual adjustment in young adulthood.

Prosexual drugs: empirical status of the "new aphrodisiacs".

Abstract: The search for an effective aphrodisiac has been a perennial pursuit of most societies throughout history. In the past decade, attention has focused increasingly on the prosexual effects of oral pharmacological agents with central neurotransmitter actions. The role of various dopaminergic, adrenergic, and serotonergic agents, in particular, has been intensively investigated in both human and animal studies. Some of these drugs have been considered for their potential role in the treatment of sexual dysfunction, while others have contributed to our understanding of basic neurophysiological processes in sexual arousal. This review provides a critical evaluation of current laboratory and clinical research on the "new aphrodisiacs," including studies in both patient populations and normal volunteers. Several conceptual and methodological problems are addressed, such as the definition and measurement of sexual response, the need to separate specific and nonspecific drug effects on sexual response, and the lack of studies in women. Although no single drug has proven to be clinically safe and reliably effective for human use, several promising candidates have been identified. Overall, research on prosexual drugs has contributed significantly to our understanding of basic mechanisms in sexual response, as well as providing new treatment options for common sexual disorders.

Frequency of sexual problems and sexual dysfunction in middle-aged Danish men

Abstract: The frequency of sexual dysfunction of a representative group of Danish middle-aged men was recorded, using a questionnaire and an interview that contained, respectively, 12 and 23 questions about sexual problems. The study sample consisted of 439 51-year-old men, all of whom received the questionnaire. Of these men, 100 were also interviewed. Interviewed men more frequently reported erectile dysfunction and previous contact with a therapist due to sexual problems at interview than in the questionnaire. Thus, 16 men (4% of the study population) who reported erectile dysfunction in the questionnaire constituted only a fraction of the true number. At interview nearly 40% of the men reported some kind of sexual dysfunction. There were, however, only 7% who found their problems abnormal for their age—and only 5% of the interviewed men intended to seek treatment for their problems.

Sexual arousal in diabetic females: physiological and self-report measures.

Abstract: Diabetes mellitus, a major health problem afflicting 500,000 Americans each year, is a leading cause of male erectile difficulties. Diabetic women may be susceptible to a similar diabetic pathogenesis for sexual problems but information about the effect of diabetes on female sexual response is sparse and conflicting. Past research has been based upon self-report measures, a methodology flawed by susceptibility to response bias. Whether diabetic women differed from a matched nondiabetic control group in their physiological as well as subjective response to erotic stimulus exposures was investigated. Vaginal photoplethysmographic measures of capillary engorgement were taken while subjects individually viewed counterbalanced erotic and nonerotic videotape presentations. Graphically and statistically analyzed results indicated that diabetic women demonstrated significantly less physiological arousal to erotic stimuli than controls, whereas their subjective responses were comparable. These objective, physiological findings support and extend previous subjectively based research which found potential diabetes-related sexual dysfunction in female diabetics. The groups did not differ, however, in the reported occurrence of sexual difficulties.

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

Abstract: 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.

A comparison study of moclobemide and doxepin in major depression with special reference to effects on sexual dysfunction.

Abstract: A double-blind parallel-group comparison study of moclobemide versus doxepin in 237 patients with major depression confirmed that moclobemide was equal in efficacy and better tolerated than doxepin. It was less sedating and caused fewer anticholinergic adverse events as measured by the UKU side-effe

Drug-induced male sexual dysfunction. An update.

Abstract: Impotence, defined as the consistent inability to maintain an erect penis of sufficient rigidity for sexual intercourse, has been estimated to affect 10 million American men. An age dependence has been shown to exist, with 25% of men over age 65 affected. A large body of clinical experience and published reports in the literature link many commonly prescribed drugs with sexual dys-function.

The Zurich Study: XXI. Sexual dysfunctions and disturbances in young adults. Data of a longitudinal epidemiological study.

Abstract: In a cohort of young Swiss adults, sexual disturbances and dysfunctions were assessed by interview four times between ages 20 and 30 years. Over 10 years almost every second female and every third male subject reported disturbances. In females at age 30 years, the prevalence of orgasmic difficulties and of dyspareunia corresponded to non-clinical samples of other studies. Also, in accordance with the literature, impaired interest was much more prevalent in females. In males and females, sexual disturbances were to some extent associated with anxiety and depression; in addition, in women, they were also associated with social phobia and eating disorders. With regard to neuroticism, negative affect and reports of an unsatisfactory childhood, subjects with temporary disturbances resembled more strongly those with chronic problems than controls. Compared with the controls, women's sexual disturbances were more chronic and more strongly associated with minor psychiatric symptoms and personality deviance; this finding was less pronounced in men.

Gender differences in factors associated with hypoactive sexual desire

Abstract: Several factors have been identified as playing an etiological role in hypoactive sexual desire. It has been assumed that these factors appear equally among men and women, however, there is little empirical validation for this. An investigation of 69 men and women was undertaken to explore whether certain medical, psychological, sexual, and/or interpersonal factors were more likely to present in men versus women. Significant differences were found with regard to age, psychological distress, relationship satisfaction, level of stress, and the duration of another sexual dysfunction. Implications for a refined understanding of hypoactive sexual desire and for treatment are discussed.

Sexual function in women. Do antihypertensive drugs have an impact

Abstract: 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.

Treatment of Vasculogenic Sexual Dysfunction with Pentoxifylline

Abstract: Objective: To evaluate the use of pentoxifylline to treat impotence in men with mild to moderate penile vascular insufficiency. Design: Double-blind randomized clinical trial. Setting: Sexual Dysfunction Clinic at VA Medical Center, Sepulveda, CA. Participants: Convenience sample of couples. Intervention: Twelve weeks of treatment with placebo or 400 mg tid of pentoxifylline. Measurements: (1) Report of patient verified by partner as to number of coital episodes per month; (2) penile-brachial pressure index determinations. Results: Pentoxifylline therapy regularly increased the PBPI in impotent men in comparison with the placebo, frequently into the normal range. Pentoxifylline therapy was particularly useful in restoring the PBPI in men with the pelvic steal syndrome; six of seven such subjects improved into the normal range. During the pentoxifylline treatment period, in contrast with the control period, nine men were able to reestablish coital function and three had no improvement. Six couples did not attempt intercourse despite a professed interest in sexual activity; however five out of the six men experienced erections during episodes of fantasy or attempts at masturbation during treatment. There were no complications of therapy. Conclusions: These promising preliminary results suggest a well tolerated alternative therapy for erectile dysfunction in patients with mild to moderate penile vascular disease.

Quality of life following surgery for colorectal cancer: A literature review

Abstract: Colorectal cancer patients are faced with the debilitating consequences of either sphincter-sacrificing or sphincter-conserving surgery. The question central to the current literature review is: what is the prevalence of physical, psychological, social and sexual dysfunction among colorectal cancer patients with a colostoma (ostomates) compared with those patients whose sphincter function has been conserved (non-ostomates). Although the extant literature yields some inconsistent findings, a number of clear trends can be identified: (a) both patient groups are troubled by frequent or irregular bowel movements and diarrhea, and consequently often require dietary restrictions; (b) ostomates report higher levels of psychological distress than do non-ostomates; (c) psychological problems tend to be more frequent among younger patients and among women; (d) while both ostomates and nonostomates report restrictions in their level of social functioning, such problems appear to be more prevalent among patients with a colostoma; (e) the sexual functioning of male colostomists is consistently more impaired than that of patients with intact sphincters; and (f) a considerable number of women whose sphincter function has been sacrificed suffer from dyspareunia. There is need for more methodologically sound studies that: (1) employ well validated quality-of-life measures; (2) assess patients' quality of life prospectively in order to examine patients' psychosocial adaptation over time; and (3) identify those subgroups of patients who are at greatest risk to the adverse psychosocial sequalae of the disease and its surgical treatment.

Psychiatric aspects of heart transplantation

Abstract: There are many practical psychiatric, social, and ethical problems which accompany heart transplantation. These include pre- and postoperative anxiety and depressive conditions, post-operative delirium, and social and family dysfunctional syndromes. This paper reviews the literature critically in the following five areas: pre-transplant evaluation, coping with surgery, postoperative sequelae, rehabilitation, and management. Although most recipients have a good outcome from the physical and psychiatric points of view, a substantial minority experience family conflicts and sexual dysfunction after surgery. An average of 45% of patients from all studies returned to full-time employment. The distinctive role and contribution of the psychiatrist on the transplant team is discussed and important areas for future research are outlined.

Psychosexual Dysfunction in Women With Gynaecological Cancer Following Radical Pelvic Surgery

Abstract: Objective To assess the prevalence and severity of psychosexual dysfunction in women treated for cancer of the cervix and vulva by radical vulvectomy, Wertheim's hysterectomy and pelvic exenteration; and to identify the risk factors for sexual morbidity and ways in which it might be reduced. Design Retrospective study of patients by questionnaire and semistructured interview, 6 months to 5 years following surgery. Setting Gynaecology–Oncology Unit of a general hospital. Patients 105 English speaking women with gynaecological cancer. Results 90% of the women in relationships had been sexually active prior to surgery. Of this group, 24% had no sexual difficulties post-operatively; 66% of the latter still had problems more than 6 months later, and 15% of the latter never resumed intercourse (excluding those with a colpectomy). 82% of those aged less than 50 years who had had radiotherapy suffered sexual dysfunction. Lack of desire was the commonest problem, and half the women felt that their sexual relationship had deteriorated, yet only 16% felt that their marriage had worsened. Younger women were more likely to attribute personal and marital distress to their sexual problems. More information on sexual matters would have been liked by 28% of the women. Conclusions Sexual dysfunction is common following radical pelvic surgery and tends to remain a chronic problem. As well as organic causes there is a strong psychogenie element brought about by loss of fertility, disfigurement, depression and anxiety about one's desirability as a sexual partner. The presence of a stable relationship before the diagnosis of cancer helps women cope better, and young single women are a very vulnerable group. Patients want more information on sexual matters and the provision of sexual counselling may improve outcome in the future.

Sexual Dysfunction or Heterosexual Dysfunction

Abstract: The psychological literature on sexual dysfunction has been mainly concerned with the sexual problems of people in heterosexual relationships. This article takes as its starting point recent attempts to extend this literature to the sexual problems of homosexual women and men. It is argued that such attempts may not have taken sufficient account of the extent to which existing classification systems, nomenclature and theory of sexual problems are based on heterosexist and sexist assumptions about the nature of male and female sexuality, about sexual activity and about what is seen as sexually problematic.

Sexual Dysfunction Across Cultures

Abstract: Sexual behaviour is particularly open to cultural and social influences. Culture affects sexual behaviour, attitudes and expectations. This paper discusses the available data on the presentation of...