Showing papers on "Sexual dysfunction published in 2009"

Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis

Abstract: Background:Sexual dysfunction (SD) is an important underestimated adverse effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. The aim of the present meta-analysis was to quantify SD caused by antidepressants on the basis of studies where sexua

Sexual dysfunction, depression, and the impact of antidepressants.

Abstract: Sexual dysfunction is a common symptom of depression. Although decreased libido is most often reported, difficulties with arousal, resulting in vaginal dryness in women and erectile dysfunction in men, and absent or delayed orgasm are also prevalent. Sexual dysfunction is also a frequent adverse effect of treatment with most antidepressants and is one of the predominant reasons for premature drug discontinuation. Selective serotonin reuptake inhibitors are the most widely prescribed antidepressants and have significant effects on arousal and orgasm compared with antidepressants that target norepinephrine, dopamine, and melatonin systems. The availability of an antidepressant that does not cause or exacerbate sexual dysfunction represents an advance in pharmacotherapy for mood disorders and should reduce treatment noncompliance and decrease the need for switching antidepressants or adding antidotes. The purpose of this review was to provide an update on the prevalence, psychobiology, and relative adverse effect burden of sexual dysfunction associated with different antidepressants.

Sexuality: Measures of Partnerships, Practices, Attitudes, and Problems in the National Social Life, Health, and Aging Study

Abstract: Objectives. The National Social Life, Health, and Aging Project (NSHAP) was designed to examine the relationship between sexual behavior, sexual problems, and health among older women and men. We describe measures of sexual partnerships, sexual practices, sexual problems, attitudes toward sex, and nonsexual intimacy in the fi rst wave of NSHAP. Methods. We compare measures of sexuality for those 57 ‐ 85 years old, by age, separately for men and women. We construct scales of sexual mores, sexual interest, and relationship satisfaction and discuss properties of each scale. Results. Sexuality among older adults tends to vary with age and gender. At all ages in this study, men are more likely than women to have a partner, more likely to be sexually active with that partner, and tend to have more positive and permissive attitudes toward sex. The proportions in a sexual partnership, behavior, problems, and attitudes all differ substantially by age. And these age patterns often differ for men and women. Discussion. Data obtained in the NSHAP can be used to construct key measures of sexuality among older adults; to examine sexuality itself; and to explore the link between sexuality, health, well-being, and other dimensions of the lives of older adults.

Sexual dysfunction and spousal communication in couples coping with prostate cancer.

Abstract: Objective: To characterize the sexual function of both prostate cancer patients and their partners, and to examine whether associations between sexual dysfunction and psychosocial adjustment vary depending on spousal communication patterns. Methods: In this cross-sectional study, 116 prostate cancer patients and their partners completed psychosocial questionnaires. Results: Patients and partners reported high rates of sexual dysfunction. Within couples, patients' and their partners' sexual function was moderately to highly correlated (r=0.30–0.74). When patients had poor erectile function, their partners were more likely to report that the couple avoided open spousal discussions; this in turn was associated with partners' marital distress (Sobel's Z=12.47, p=0.001). Patients and partners who reported high levels (+1SD) of mutual constructive communication also reported greater marital adjustment, regardless of their own sexual satisfaction. In contrast, greater sexual dissatisfaction was associated with poorer marital adjustment in patients and partners who reported low levels (−1SD) of mutual constructive communication (p<0.05). Conclusion: Our findings underscore the need for psychosocial interventions that facilitate healthy spousal communication and address the sexual rehabilitation needs of patients and their partners after prostate cancer treatment. Although some couples may be reluctant to engage in constructive cancer-related discussions about sexual problems, such discussions may help alleviate the negative impact that sexual problems have on prostate cancer patients' and their partners' marital adjustment. Copyright © 2008 John Wiley & Sons, Ltd.

The Impact of Aging on Human Sexual Activity and Sexual Desire

Abstract: This article empirically studies how much aging modifies human sexual activity and sexual desire, and what the most important determinants in this change are. The analyses are based on 2 representative national sex surveys conducted in Finland in the 1990s. As a result of female widowhood, aging men had a higher incidence of sexual intercourse compared with aging women; and in relationships, women were more likely than men to report lack of sexual desire. In regression analysis, age was a predictor of sexual activity but not of sexual desire, when controlling for the impact of other factors. Relationship duration did not play an important role in sexual activity or sexual desire when controlling for a number of other variables. Sexual desire, valuing sexuality, and a healthy partner were important to female sexual activity; and high sexual self-esteem, good health, and active sexual history were important to male sexual activity. To keep up their sexual desire, both men and women needed good health, good sexual functioning, positive sexual self-esteem, and a sexually skilful partner.

A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America.

Abstract: To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviors among mature adults in the United States of America, a telephone survey was conducted in 2001-2002. A total of 1491 individuals (742 men/749 women) aged 40-80 years completed the survey. Overall, 79.4% of men and 69.3% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (26.2%) and erectile difficulties (22.5%) were the most common male sexual problems. A lack of sexual interest (33.2%) and lubrication difficulties (21.5%) were the most common female sexual problems. Less than 25% of men and women with a sexual problem had sought help for their sexual problem(s) from a health professional. Many men and women in the United States report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.

Individualizing quality-of-life outcomes reporting: how localized prostate cancer treatments affect patients with different levels of baseline urinary, bowel, and sexual function.

Abstract: Purpose Although it is the most powerful predictor of early prostate cancer treatment-related complications and quality-of-life (QOL) outcomes, most studies do not stratify results by baseline function. Further, reporting functional outcomes as averaged numerical results may obscure informatively disparate courses. Using levels of treatment-related dysfunction, we address these problems and present the final QOL outcomes of our prospective cohort study of patients with early prostate cancer. Methods We created categories for sexual, bowel, and urinary function, measured using numerical scores of the validated Prostate Cancer Symptom Indices and stratified into “normal, ”“ intermediate” and “poor” levels of function by incorporating patient-reported symptom and distress information. We present QOL outcomes for 409 patients 36 months after radical prostatectomy, external-beam radiation therapy, and brachytherapy. Results Different levels of baseline sexual, bowel, and urinary function produced distinctive treatmentrelated changes from baseline to 36 months. In general, the average scale increases in dysfunction were greatest among patients with normal baseline function, although patients with normal and intermediate baseline function had similar increases in sexual dysfunction. For patients whose baseline urinary obstruction/irritation was poor, both average scale scores and most patients’ level of function improved after treatment, particularly after surgery. Conclusion The use of functional levels to stratify treatment-related outcomes by pretreatment functional status and to display the proportions of patients with improved, stable, or worsened function after treatment provides information that more specifically conveys the expected impact of treatment to patients choosing among localized prostate cancer treatments.

Sexual Dysfunction in Women With Type 1 Diabetes: Long-term findings from the DCCT/ EDIC study cohort

Abstract: OBJECTIVE —This study aimed to 1 ) examine the prevalence of sexual problems in women with type 1 diabetes, 2 ) compare this prevalence rate with that of an age-matched control group, 3 ) study the influence of diabetes-related somatic factors on female sexuality, and 4 ) study the influence of psychological variables on the sexual functioning of both groups RESEARCH DESIGN AND METHODS —A total of 120 women with diabetes visiting the outpatient diabetes clinic completed questionnaires evaluating psychological adjustment to diabetes, marital satisfaction, depression, and sexual functioning Medical records were used to obtain data on HbA1c, use of medication, BMI, and early-onset microvascular complications An age-matched control group of 180 healthy women attending an outpatient gynecological clinic for preventive routine gynecological assessment also completed the non–diabetes-related questionnaires RESULTS —More women with diabetes than control subjects reported sexual dysfunction (27 vs 15%; P = 004), but a significant difference was found only for decreased lubrication No association was found between sexual dysfunction and age, BMI, duration of diabetes, HbA1c, use of medication, menopausal status, or complications Women with more complications, however, reported significantly more sexual dysfunctions, and the presence of complications altered treatment satisfaction Both diabetic and control women with sexual dysfunction mentioned lower overall quality of the marital relation and more depressive symptoms than their respective counterparts without sexual problems Depression was a significant predictor for sexual dysfunction in both women with diabetes and control subjects CONCLUSIONS —Sexual problems are frequent in women with diabetes They affect the overall quality of life and deserve more attention in clinical practice and research

Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women

Abstract: Objective: The objective of this study was to provide evidence that the transformation of DHEA into both androgens and/or estrogens locally in cells of the three layers of the vagina (epithelium, lamina propria, and muscularis) would have effects of greater impact, including effects on sexual function, than only effects on superficial epithelial cells as achieved with estrogens. Methods: This prospective, randomized, double-blind, and placebo-controlled phase III clinical trial has evaluated the effect of daily local intravaginal application of Prasterone (dehydroepiandrosterone; DHEA) for 12 weeks on the domains of sexual dysfunction, namely, desire/interest, arousal, orgasm, and pain at sexual activity, in 216 postmenopausal women with moderate to severe symptoms of vaginal atrophy. Results: A time- and dose-dependent improvement of the four domains of sexual function was observed. At the 12-week time interval, the 1.0% DHEA dose led, compared with placebo, to 49% (P = 0.0061) and 23% (P = 0.0257) improvements of the desire domains in the Menopause Specific Quality of Life and Abbreviated Sex Function questionnaires, respectively. Compared with placebo, the Abbreviated Sex Function arousal/sensation domain was improved by 68% (P = 0.006), the arousal/lubrication domain by 39% (P = 0.0014), orgasm by 75% (P = 0.047), and dryness during intercourse by 57% (P = 0.0001). Conclusions: By a local action in the vagina, DHEA applied daily at doses at which serum steroids remain well within normal postmenopausal values exerts relatively potent beneficial effects on all four aspects of sexual dysfunction. Such data indicate that combined androgenic/estrogenic stimulation in the three layers of the vagina exerts important beneficial effects on sexual function in women without systemic action on the brain and other extravaginal tissues.

Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia.

Abstract: Background Provoked vestibulodynia is believed to be the most frequent cause of vulvodynia in women of childbearing age, with prevalence rates of up to 12% in the general population. Despite this high prevalence and the fact that vestibulodynia impacts negatively on quality of life, in particular sexual functioning, there has been a paucity of sound research to elucidate the condition's etiology. More specifically, few studies have focused on the role of psychologic factors in the experience of vulvo-vaginal pain and associated sexual impairment. Objectives The present study aimed to determine the extent to which fear avoidance variables (catastrophizing, anxiety, fear of pain, hypervigilance) and self-efficacy differentially influenced changes in levels of induced and intercourse pain and also associated sexual dysfunction in these women. Methods Data were obtained from 75 vestibulodynia participants who completed a gynecologic examination, structured interview, and standardized questionnaires. Results The results of regression analyses revealed that higher catastrophizing, fear of pain, and hypervigilance in addition to lower self-efficacy together accounted for 15% of the variation in increased intercourse pain intensity. Among these, only catastrophizing contributed unique variance to intercourse pain. Results also showed that higher state anxiety and fear of pain (escape/avoidance) and also lower self-efficacy explained 22% of the variation in women's sexual impairment. However, only self-efficacy was found to be an independent correlate of sexual impairment. Conclusion Findings support a theoretical model of vestibulodynia as a pain disorder influenced among others by cognitive and affective factors.

Sexual health communication during cancer care: barriers and recommendations.

Abstract: With improved cancer survival rates, it is becoming increasingly important to focus on quality of life issues throughout all stages of cancer treatment. Sexual problems often result from the physical and psychological side effects associated with cancer and cancer treatment regimens, yet few cancer patients recall discussing sexual risks before treatment or treatment options for sexual dysfunction after treatment. This review summarizes the literature, to date, on patient and clinician communication about sexual dysfunction. Patients' views about the importance of these discussions and patient and clinician barriers to sexual dysfunction communication are presented. We adapted a behavioral health counseling model, the 5 A's, and present it as a proposed framework for sexual health communication with cancer patients in a multidisciplinary setting.

Physical Women, Emotional Men: Gender and Sexual Satisfaction in Midlife

Abstract: In late midlife, heterosexual women report markedly lower levels of sexual satisfaction than heterosexual men. This article explored the social factors contributing to this difference, using data from 1,035 sexually-active heterosexual adults, aged 40–59 years, who participated in the National Health and Social Life Survey (NHSLS). Conducted in 1992, NHSLS interviewed a nationally representative random sample of U.S. adults about diverse aspects of sexual life (Laumann et al., 1994, The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press). Contrary to gender stereotypes, women’s emotional satisfaction was closely associated with bodily sexual practices, whereas men’s physical pleasure was linked to relational factors. Lower levels of sexual satisfaction at older ages appeared to stem from differences between the Baby Boom and older generations rather than from aging per se.

Nurses' knowledge, attitudes, and practices regarding provision of sexual health care in patients with cancer: critical review of the evidence

Abstract: Background The experience of living with cancer is associated with a variety of consequences in several central aspects of a patient’s quality of life, including intimacy, body image, human relationships, sexuality, and fertility. Despite their importance, incidence, and impact on psychosocial well-being, sexual health care (SHC) is a matter not frequently dealt with by nurses in daily practice.

The impact of rheumatic diseases on sexual function.

Abstract: Sexuality is a complex aspect of the human being’s life and is more than of only the sexual act. Normal sexual functioning consists of sexual activity with transition through the phases from arousal to relaxation with no problems, and with a feeling of pleasure, fulfillment and satisfaction. Rheumatic diseases may affect all aspects of life including sexual functioning. The reasons for disturbing sexual functioning are multifactorial and comprise disease-related factors as well as therapy. In rheumatoid arthritis and ankylosing spondylitis patients, pain and depression could be the principal factors contributing to sexual dysfunction. On the other hand, in women with Sjogren’s syndrome, systemic lupus erythematosus and systemic sclerosis sexual dysfunction is apparently most associated to vaginal discomfort or pain during intercourse. Finally, sexual dysfunction in patients with fibromyalgia could be principally associated with depression, but the characteristic symptoms of fibromyalgia (generalized pain, stiffness, fatigue and poor sleep) may contribute to the occurrence of sexual dysfunction. The treatment of sexual dysfunction will depend on the specific patient’s symptoms, however, there are some general recommendations including: exploring different positions, using analgesics drug, heat and muscle relaxants before sexual activity and exploring alternative methods of sexual expression. This is a systemic review about the impact of several rheumatic diseases on sexual functioning. There are no previous overviews about this topic so far.

Assessment of sexuality among middle-aged women using the Female Sexual Function Index.

Abstract: Objective The purpose of the present investigation was to assess sexual function among middle-aged women and determine related risk factors (personal and partner) for sexual dysfunction. Methods In this cross-sectional study, women aged 40‐59 years were requested to fill out the Female Sexual Function Index (FSFI) and a general demographic questionnaire containing personal and partner data. Results A total of 409 women with a mean age of 47+ 5.3 years were surveyed. Of these, 42.1% were premenopausal, 24.4% perimenopausal and 33.5% postmenopausal. At the time of survey, 10.5% of women were hysterectomized, 1.5% used psychotropic drugs, and 9.8% were on hormone therapy (HT) for the menopause; 28.1% had less than 12 years of schooling and 80.4% had only one partner at the moment of survey. Among their male partners, 7.3% abused alcohol, 10.3% had erectile dysfunction, 11.2% premature ejaculation and 63.83% were faithful partners. Mean (+ standard deviation) scores for the FSFI domains were: desire (3.7+ 1.2), arousal (3.1+ 2.5), lubrication (3.3+ 2.6), orgasm (2.6+ 2.3), satisfaction (4+ 1.7), and pain/dyspareunia (3.2+ 2.6). The mean total FSFI score was 20.1+ 12.4 (median 24.7). In this series, the prevalence of female sexual dysfunction (FSFI score � 26.55) was 55.7%, with women presenting difficulties across all domains of female sexual function but mostly in the dyspareunia and lubrication domains. Logistic regression analysis determined that female age (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6‐6.8), p ¼ 0.001), postmenopausal status (OR 2.8, 95% CI 1.3‐6.1, p ¼ 0.007), partner’s age (OR 2.0, 95% CI 1‐4, p ¼ 0.03), educational level (OR 2.7, 95% CI 1.5‐5, p ¼ 0.001), and the presence of erectile dysfunction (OR 3.8, 95% CI 1.3‐10.9, p ¼ 0.01) and premature ejaculation (OR 4.1, 95% CI 1.4‐11.7, p ¼ 0.0001) significantly increased the risk for female sexual dysfunction. Partner faithfulness (OR 0.2, 95% CI 0.1‐0.4, p ¼ 0.001) and menopausal HT use (OR 0.4, 95% CI 0.1‐1, p ¼ 0.04) decreased this risk. Conclusions In this series, male sexual health and demographic profile and female HT use were relevant determinants for sexual functioning among middle-aged women.

Measuring sexual and urinary outcomes in women after rectal cancer excision.

Abstract: PURPOSE:This study was designed to investigate sexual and urinary dysfunction in women who underwent rectal cancer excision, and the influence of tumor and treatment variables on long-term outcomes.METHODS:Data were prospectively collected on 295 women who underwent rectal cancer excision at a terti

Concerns About Sexuality After Breast Cancer

Abstract: Cancer treatment, especially chemotherapy, creates changes in the female body that affect sexual desire, sexual functioning, and emotional relationships. Although healthy women also experience physiological changes leading to menopause, these changes occur gradually leaving them sexually active 5 to 10 years longer and with fewer problems in sexual functioning. Studies show that breast cancer patients experience sexual problems soon after treatment, and continue in follow-up. Research also describes the normal decline in sexuality among healthy women as they age. Furthermore, relationship problems occur when couples experience sexual problems, sometimes threatening their attachment.These problems can be anticipated and addressed through the physician's communication with their patient. Other solutions include effective psychologic and emotional counseling and pharmaceutical and over the counter assistance for hot flashes, vaginal dryness, and pain to assist with the physiological issues.

Prevalence of sexual dysfunction during pregnancy

Abstract: OBJECTIVE: This study aims to evaluate the sexual function and to determine the prevalence of sexual dysfunction among teenagers and adult women during pregnancy using the Female Sexual Function Index (FSFI). METHODS: A cohort study was conducted with 271 healthy pregnant women presenting a stable relationship with their partners. These women contributed to the survey since the laboratory diagnosis of their present pregnancy. Anonymous questionnaires evaluated aspects of sexual activity and female sexual function. This last item was assessed through the FSFI questionnaire. RESULTS: The women sexual function showed a similar pattern during the first and second trimesters; however, it presented a significantly clear decrease in the third trimester. There was a significant difference in the scores of all FSFI domains when comparing the second and third trimesters. The sexual dysfunction among pregnant teenagers was rated 40.8% in the first trimester, 31.2% in the second and 63.2% in the third. For pregnant adults, the dysfunction was rated, respectively, 46.6%, 34.2% and 73.3%. CONCLUSION: The sexual function is affected during pregnancy with a significant decrease in all FSFI domains in the third trimester considering both pregnant teenagers and adults. Prevalence of sexual dysfunction is high during pregnancy and reaches higher levels in the third trimester in both age groups; however, teenagers presented better sexual function ratings.