The impact of menopause on sexual function in women and their spouses

BackgroundThe purpose of this study is to evaluate the impact of menopause on sexual function in women and their spouses.MethodsThis is a cross-sectional study that was conducted from January 2018 to May 2019 in Rasht (North of Iran). The participants included 215 menopausal women and their spouses. Data were collected using the demographic questionnaire, the Female Sexual Function Index (FSFI) questionnaire, and the International Index of Erectile Function (IIEF) questionnaire.ResultsOn the basis of the FSFI and IIEF scores, 36.28% (78/215) women reported female sexual dysfunction (FSD) and 17.2% (37/215) men reported erectile dysfunction (ED) with 8.37% (N = 18) being mild, 5.58% (N = 12) mild to moderate, and 3.25% (N = 7) moderate ED. After adjusting differences in the female age distribution, the total score and scores of the IIEF subscales were also not significantly lower in the spouses of women with FSD than women without FSD.ConclusionAlthough, significant correlations between male erectile function and menopausal female sexual function have not identified; but, low scores of the subscales of FSFI in female participants mostly impaired sexual satisfaction and overall satisfaction in their spouses.     

Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials

BACKGROUND: This review was undertaken to assess the effectiveness of management strategies for sexual dysfunction caused by antidepressant medication. METHODS: Electronic databases and reference lists were searched, and pharmaceutical companies and experts contacted to identify randomised controlled trials comparing management strategies for antidepressant-induced sexual dysfunction. RESULTS: Fifteen trials involving 904 people were included. One trial involving 75 people with sexual dysfunction due to sertraline assessed changing antidepressant. Switching to nefazodone was significantly less likely to result in the re-emergence of sexual dysfunction than restarting sertraline (RR 0.34, 95% CI 0.15 to 0.6). Meta-analysis of two trials involving 113 men with erectile dysfunction found that the addition of sildenafil resulted in less sexual dysfunction at endpoint on rating scales including the International Index of Erectile Function (IIEF) (WMD 19.36, 95% CI 15.00 to 23.72). Another trial found the addition of bupropion led to improved scores on the Changes in Sexual Functioning Questionnaire desire-frequency subscale (WMD 0.88, 95% CI 0.21 to 1.55). In a further study the addition of tadalafil was associated with greater improvement in the erectile function domain of the IIEF than placebo (WMD 8.10; 95% CI 4.62 to 11.68). Other augmentation strategies failed to show statistically significant improvements in sexual dysfunction compared with placebo. DISCUSSION: The currently available evidence is rather limited, with small numbers of trials assessing each strategy. However, while further randomised data is awaited, for men with antidepressant-induced erectile dysfunction, the addition of sildenafil appears to be an effective strategy.     

Sexual dysfunction in patients with allergic rhinoconjunctivitis.

BACKGROUND: Sexual dysfunction in chronic diseases has recently attracted attention owing to its impact on quality of life (QoL). Allergic rhinoconjunctivitis (ARC) affects QoL, causing limitations in many areas. However, there has not been research on changes in sexual function in patients with ARC. OBJECTIVE: To report the effect of ARC and its treatment on sexual function in men and women. METHODS: Forty-three sexually active patients with seasonal ARC aged 22 to 49 years were included in the study. The control group was composed of 40 healthy individuals aged 22 to 46 years. Conjunctival symptom scores (CSSs) and nasal symptom scores (NSSs) of patients with symptomatic ARC were determined, as were sexual function scores (SFSs) using the Female Sexual Function Index and the International Index of Erectile Function during allergen exposure in the pollination period and after treatment with oral desloratadine, 5 mg/d, for 30 days. The SFSs were evaluated in the control group. RESULTS: The CSSs and NSSs significantly improved in treated ARC (P < .001). In women, Female Sexual Function Index results in symptomatic ARC were significantly lower than in treated ARC and controls (P = .003). In men, International Index of Erectile Function results in treated ARC (P = .001) and controls (P < .001) were significantly higher than in symptomatic ARC. Furthermore, correlation between improvement in CSSs and NSSs and that of SFSs was determined (P = .007 for women; P = .001 for men). CONCLUSION: Improvement in sexual function as a variable of QoL may accompany the treatment of symptoms in patients with ARC.     

Depressive symptomatology and male sexual functions in late life

BACKGROUND: We aimed to investigate the association between depressive symptoms and various male sexual functions, and to identify which depressive symptoms are most predictive of erectile dysfunction (ED). METHODS: This was an analytic cross-sectional study with 160 sexually active men aged 50 or above recruited from a large primary care treatment centre. The 5 domains (erectile function, EF; intercourse satisfaction, IS; orgasmic function, OF; sexual desire, SD; overall satisfaction, OS) of the International Index of Erectile Function (IIEF-15) were used to assess various sexual functions. Depressive symptomatology was measured by Geriatric Depression Scale and reconfirmed with General Health Questionnaire. RESULTS: The level of depressive symptoms was negatively associated with erectile function (p<0.01), orgasmic function (p=0.02), intercourse satisfaction (p=0.04) and overall satisfaction (p<0.01), and was independent of age, education and number of health conditions, but was not associated with sexual desire (p=0.97). Erectile dysfunction was significantly associated with age (OR=1.12; 95% CI 1.05-1.19; p<0.01) and level of depressive symptoms (OR=1.39; 95% CI 1.05-1.85; p=0.02) after multivariate adjustment. In particular, only "low mood" (p=0.03) and "worthlessness" (p=0.03) remained positively associated with ED after multivariate adjustments. LIMITATIONS: Cross-sectional design cannot demonstrate direction of causality. CONCLUSIONS: We are the first to implicate "low mood" and "worthlessness" in the association between depressive symptoms and ED, and this is the first study to investigate the association in Chinese.     

Relation between intracavernosal dose of prostaglandin Pge 1 and mean duration of erection in men with different underlying causes of erectile dysfunction

Aim

To analyze differences in effect of intracavernosally applied alprostadil (prostaglandin PGE 1) on men with different underlying causes of erectile dysfunction.

Methods

Forty eight men with erectile dysfunction lasting for at least six months were stratified according to the etiology of erectile dysfunction into one of 4 groups comprising 12 patients. The groups were the following: psychogenic, arteriogenic, veno-occlusive, and neurological erectile dysfunction group. All men filled out International Index of Erectile Function (IIEF)-5 questionnaire, which is a 5-question version of International Index of Erectile Function Questionnaire, underwent clinical examination including neurological assessment, were tested for nocturnal penile tumescence, and had Doppler color sonography of penile arteries. Intracavernosal alprostadil was then applied to the patients, starting with a 5 μg dose and then increased in 5 μg increments until the final dose of 20 μg was reached. We measured the time from the moment of application until the start of erection and time of erection duration. For statistical analysis, non-parametric Friedman test for significant differences between repeated measurements in small groups and Wilcoxon test for differences between doses were used.

Results

Significant relation was found between the applied dose of intracavernosal alprostadil and the duration of erection in all 4 groups of men with erectile dysfunction. In patients with arteriogenic erectile dysfunction, mean (±standard deviation) duration of erection for consecutive doses of alprostadil 5 μg, 10 μg, 15 μg, and 20 μg were 40.0 ± 20.6, 54.6 ± 23.6, 65.0 ± 29.6, and 82.1 ± 35.4 minutes, respectively, with significant increase for each dose. In patients with veno-occlusive dysfunction, mean durations of erection significantly increased from 8.2 ± 7.8 minutes at 10 μg to 17.3 ± 9.5 minutes at 20 μg. In patients with neurogenic erectile dysfunction, mean durations of erection were 40.4 ± 16.6, 61.7 ± 24.7, 82.5 ± 34.4, and 101.0 ± 28.5 minutes respectively, with significant increase for each dose. In patients with psychogenic erectile dysfunction, mean durations of erection were 32.4 ± 15.4, 45.8 ± 15.1, 69.9 ± 23.5, and 98.3 ± 37.9 minutes respectively, with a significant increase for each dose.

Conclusion

Men with different underlying cause of erectile dysfunction show different response to the intracavernosally applied alprostadil. In order to achieve the optimal result, the treatment should be started with the smallest doses which are gradually increased until the maximum effect is reached.Erectile dysfunction is a condition that affects a many men. Epidemiological studies have shown that more than half of the men between 40 and 70 years have at least some degree of erectile dysfunction (1). This is also a social problem, since it negatively affects the quality of the relationship with their partner. The treatment of this condition is very important for both the affected man and his partner and should be started as soon as possible (2).In recent years, orally effective agents (phosphodiesterase type 5 inhibitors) became the most frequently prescribed treatment for erectile dysfunction (3-7). However, some men do not respond to oral treatment or have contraindications for such a treatment. For this group of men, intracavernosal application of vasoactive agents is the second best choice, which is still widely used (8). Prostaglandin PGE1 (alprostadil) was proven to be the safest vasoactive agent, as well as an effective one (8-13). In order to maximize the effects and minimize the potentially dangerous side effects, such as priapism, it is very important to carefully select the starting dose of this medication in men with different underlying causes of erectile dysfunction. The aim of this study was to evaluate the response to different doses of intracavernosally applied alprostadil in this population of men.     

前列腺癌近距离治疗后勃起功能障碍相关的研究进展

前列腺癌近距离治疗与前列腺癌根治行切除术都能对早期前列腺癌患者起到根治的疗效,但前者发生勃起功能障碍的发生率较低。勃起功能障碍(ED)的定义为持续或反复不能达到并维持阴茎勃起状态而影响性生活,常使用国际勃起功能评分。其发生的原因可分为血管源性及非血管源性。前列腺癌近距离治疗后勃起功能障碍的治疗,是药物治疗、物理治疗及心理咨询相结合的综合性治疗。5型磷酸二酯酶抑制剂(PDE5)抑制剂和前列地尔是目前治疗前列腺近距离治疗后ED的一线用药。     

A Randomized,Double-Blind,Placebo-Controlled Crossover Study of Cappra? for the Treatment of Mild or Mild to Moderate Erectile Dysfunction in Thai Male

Erectile dysfunction (ED) is one of the major health concerns affects the quality of life among Thai male. The treatment of ED by the first-line drugs is limited to a certain group of patients due to their side effects and costs. Alternative medicine can be beneficial for the treatment of ED. This is a randomized, double-blind, placebo-controlled, crossover study aimed to assess the efficacy and safety of Cappra^®, a traditional herbal medicine which was used in Thailand for decades, for the treatment of mild and mild to moderate ED in Thai patients. A total of 63 patients with mild or mild to moderate ED were randomized to receive Cappra^® or placebo for two weeks in the first period, followed by one week washout period. The patients were switched to the alternative treatment in the second period. The efficacy was assessed by the International Index of Erectile Function (IIEF) questionnaire and adverse events. Sixty one patients completed the study. There was an improvement of IIEF score for all domains in Cappra^® group compared with placebo group. The mean change of IIEF score from baseline for erectile function domain of Cappra^® was significantly higher than placebo (4.87 vs 3.44, p = 0.032). The most common adverse events were dizziness (13.3% Cappra^®, 9.6% placebo), face numbness (1.6% Cappra^®, 0% placebo), and tachycardia (1.6% Cappra^®, 0% placebo). The results from this study demonstrated that Cappra^® is effective and well-tolerated and can be used as alternative therapy for mild and mild to moderate ED.     

Sexual dysfunction in 156 ambulatory HIV-infected men receiving highly active antiretroviral therapy combinations with and without protease inhibitors

We conducted a cross-sectional study of 156 ambulatory HIV-infected homosexual or bisexual men to assess and compare the prevalence and characteristics of sexual dysfunction according to treatment combinations (group A, protease inhibitor [PI] treatment; group B, no PI treatment; and C, PI treatment interrupted >1 month previously). The study was based on a self-administered 163-item questionnaire that included a French translation of the International Index of Erectile Function, five sections of the Derogatis Sexual Functioning Inventory, and open questions. Data analysis was performed using Mann-Whitney and Kruskal-Wallis H nonparametric tests (quantitative values) and chi2 tests (qualitative values) using SPSS software (SPSS, Chicago, IL, U.S.A.). One hundred fifty-six patients completed the study. The median age +/- SD of the patients was 40.5 +/- 7.7 years, and the median CD4+ cell count +/- SD was 415 +/- 236/mm3. One hundred eleven (71%) of 156 patients reported some degree of sexual dysfunction since the beginning of their treatment (65 [71%] of 91 group A patients; 15 [65%] of 23 group B patients; and 31 [74%] of 42 group C patients), with no significant difference among the groups. Of the 111 patients, 99 (89%) reported decrease or loss of libido, 76 (68%) reported orgasmic perturbation, 96 (86%) reported erectile dysfunction, and 65 (59%) reported ejaculation perturbation, with no significant difference among the three groups. There were no significant differences among the three groups regarding the International Index of Erectile Function and Derogatis Sexual Functioning Inventory scores. These data suggest that PI-based therapy does not seem to increase sexual dysfunction in this patient population.     

肾移植及不同动脉吻合方式对阴茎勃起功能的影响

目的评价不同动脉吻合方式对肾移植受者阴茎勃起功能的影响。方法选取年龄23～58岁、移植肾存活1年以上、血清肌酐维持在130μmol/L以下的已婚男性肾移植受者63人,对患者移植前、移植后6月及1年的勃起功能进行调查（依据国际问卷表IIEF-5）,检测其中39例患者分别在移植前和移植后2个月其性功能相关激素的情况。结果肾移植前与移植后6月及1年患者的IIEF评分相比,有显著性差异（P〈0.05）;移植术后患者的性功能相关激素水平与血液透析期间有显著性差异（P〈0.05）;移植术后6月供肾动脉与髂外动脉端侧吻合患者的勃起功能与髂内动脉端端吻合患者的勃起功能相比,有显著性差异（P〈0.05）。结论肾移植后,患者的性功能相关激素显著好转,勃起功能也得到了改善,而采用髂外动脉端侧吻合患者的勃起功能要好于髂内动脉端端吻合患者。     

Sildenafil citrate for the sexual dysfunction in antidepressant-treated male patients with posttraumatic stress disorder. A preliminary pilot open-label study

BACKGROUND: Previous studies have suggested that posttraumatic stress disorder (PTSD) may be associated with pervasive sexual dysfunction. Sildenafil citrate was established as a highly effective and well-tolerated oral agent for the treatment of sexual dysfunction of various etiologies. There are no studies that have examined the efficacy of oral sildenafil in PTSD patients with sexual dysfunction. OBJECTIVE: The current study evaluated the impact of sildenafil added to an ongoing antidepressive treatment in male PTSD patients. METHODS: Ten consecutive male PTSD patients who complained of sexual dysfunction were enrolled in an open-label 4-week fixed-dose study of sildenafil citrate 50 mg/day p.r.n. Patients were evaluated at baseline and after treatment with the Clinician-Administered PTSD Scale (CAPS); sexual function assessments were performed using the International Index of Erectile Function. RESULTS: All patients completed the study and statistically significant improvement was observed in all evaluated domains of sexual functioning: erectile function (53.5%), orgasmic function (40.3%), sexual desire (53%), intercourse satisfaction (82%) and overall satisfaction (57.4%). Oral sildenafil treatment appeared to be well tolerated and no single patient stopped the treatment. Improvements in various CAPS subscales were also obtained; however, there was no significant correlation between improvement in sexual functioning and the changes in CAPS subscale scores. CONCLUSION: Sildenafil seems to be an efficacious, safe and well-tolerated treatment of sexual dysfunction in antidepressant-treated male PTSD patients.     

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to receive pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence.     

An exploration of the motivation of pregnant women to perform pelvic floor exercises using the revised theory of planned behaviour

Objectives. To investigate the motivation of pregnant women towards the practice of pelvic floor exercises during pregnancy using the revised Theory of Planned Behaviour (RTPB), incorporating measures of past behaviour. Design. Longitudinal cohort study. Methods. Women (n= 289) attending antenatal clinics in the North‐East of Scotland were interviewed in the third trimester of pregnancy regarding their practice of pelvic floor exercises. Beliefs and attitudes about the exercises were investigated by self‐administered questionnaire using the RTPB as a framework. A follow‐up postal questionnaire was sent between 6 and 12 months after delivery. Results. TPB variables (attitude, subjective norm, and self‐efficacy) explained 53.1% of the variance in intention to practise pelvic floor exercises during pregnancy. Perceived vulnerability to incontinence (attitude to the current behaviour) had no relationship with intention. Measures of past behaviour significantly improved the percentage of explained variance in intention. Confidence in ability to perform pelvic floor exercises correctly (self‐efficacy) reliably predicted subsequent practice. Conclusions. Future compliance with pelvic floor exercises may be enhanced by effective instruction to enhance confidence in ability to contract the correct muscles and promotion of measures to help establish a habit of exercising the pelvic floor muscles.     

Preservation of Denonvilliers' fascia for nerve‐sparing laparoscopic total mesorectal excision: A neuro‐histological study

Urogenital complications due to pelvic autonomic nerve damage frequently occur following rectal surgery. We investigated whether total mesorectal excision (TME) with preservation of the Denonvilliers' fascia (DVF) can effectively prevent the removal of pelvic autonomic nerves through microscopy. Twenty consecutive male patients with mid‐low rectal cancer who received TME with preservation or resection of the Denonvilliers' fascia (P and R groups, respectively) were included. Serial transverse sections from surgical specimens were studied histologically. Nerve fibers at the surfaces of the mesorectum were counted. Clinical correlation between the amount of nerve fibers removed and post‐operative sexual function was analyzed. Nerve fibers closely localized to the DVF in the R group displaying rich erectile activity (positive anti‐nNOS immunostaining). At the anterior surface of the mesorectum, the mean numbers of nNOS‐positive nerve fibers per specimen in the P group were significantly lower than the R group (3.0 ± 1.8 vs. 5.0 ± 2.3, P < 0.05). Compared to the R group, patients in the P group had higher IIEF scores and better erectile function at 3 and 6 months post‐operatively. The DVF is a key risk zone for pelvic denervation during laparoscopic TME. Preservation of the DVF can prevent the removal of autonomic nerves and protect post‐operative erectile function. Clin. Anat. 32:439–445, 2019. © 2019 Wiley Periodicals, Inc.     

盆底生物反馈电刺激治疗女性轻中度压力性尿失禁的疗效观察简

目的探讨盆底生物反馈电刺激治疗对女性轻、中度压力性尿失禁的临床疗效。方法选择2012年3月～2013年5月大连市妇幼保健院诊治的120例轻、中度压力性尿失禁患者,年龄33-77岁。将患者分2组,每组60例。60例接受盆底生物反馈电刺激治疗的患者作为治疗组.60例仅作常规盆底肌肉锻炼的患者作为对照组。记录治疗组患者治疗前后盆底肌的肌电变化客观指标。进行对比分析。结果治疗组症状缓解明显,痊愈率为48.3％,显效率为46.7％,无效率为5.0％,总有效率95.0％。对照组治疗效果较差.痊愈率为10.0％,显效率为26.7％,无效率为63-3％,总有效率36.7％;治疗组有效率明显高于对照组,差异有统计学意义（P〈0.05）。治疗组患者接受治疗后,盆底肌2s快速收缩表面肌电图（sEMG）最大值、盆底肌持续10s收缩sEMG平均值、盆底肌肉60s耐受收缩sEMG平均值均较治疗前有明显提高,差异有统计学意义（P〈0.05）。结论盆底生物反馈电刺激治疗是安全、有效的治疗女性轻、中度压力性尿失禁的方法。     

Computational tools in rehabilitation of erectile dysfunction.

Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection adequate for satisfactory intercourse. It is a common problem among approximately 50% of men between the ages of 40 and 70. Erectile dysfunction is not only stressful to both the affected individual and his partner, but it can also negatively affect self-esteem. Biomechanical models have recently been developed to study both the structural and hemodynamic factors involved in normal and pathological erectile conditions. These computational models, which are reviewed in the present paper, allow for better understanding of the mechanisms acting in ED and provide a suitable basis for development of state-of-the-art interdisciplinary treatment approaches aimed to improve the quality of life for these men.     

Y形网片在女性盆底功能疾病中的应用

BACKGROUND: The Y-shaped mesh graft material weaved using lightweight polypropylen has the appropriate porosity, which not only can make the vaginal tissues grow and fuse rapidly on the mesh, but also can maintain good biological strength to ensure the fixed strength for the presacral suspension. OBJECTIVE: To retrospectively analyze the clinical effect of Y-shaped mesh for the biological function reconstruction of the female pelvic floor. METHODS: Ten female cases of pelvic floor dysfunction were enrolled, aged 37-73 years, and all were given the treatment of sacral colposuspension under laparoscopy. Then perioperative complications were recorded; patients were followed up regularly to record the Pelvic Organ Prolapse Quantification (POP-Q) score at different time points; and the subjective satisfaction was investigated using the Pelvic Floor Impact Questionnaire (PFIQ-7). RESULTS AND CONCLUSION: After at least 6-month follow-up, no postoperative pelvic infection, nerve damage and complications appeared, the patients healed well, and no mesh erosion, infection and other adverse reactions occurred. The POP-Q and PFIQ-7 scores at 1, 3 and 6 months after repair were significantly improved than those before repair (P < 0.05). These results suggest that the Y-shaped biological mesh repairing female midpelvic floor dysfunction has good biocompatibility, and can restore the anatomy of the pelvic floor.     

Genital Chronic GVHD in Men after Hematopoietic Stem Cell Transplantation: A Single-Center Cross-Sectional Analysis of 155 Patients

We assessed the prevalence and clinical features of genital skin changes in men after allogeneic hematopoietic stem cell transplantation (HSCT) and evaluated the correlation between genital chronic graft-versus-host disease (cGVHD) and other manifestations of cGVHD as well as sexual issues. In a cross-sectional cohort study, 155 male recipients alive 1 year or more after HSCT were assessed during their annual follow-up evaluation. Correlation between genital skin changes and other cGVHD manifestations was evaluated, and post-transplantation sexual contentment and sexual functioning were assessed by 2 self-assessment questionnaires, including the 5-item version of the International Index of Erectile Function (IIEF-5) and the modified Brief Sexual Symptom Checklist (mBSSC). Median time between HSCT and genital examination was 5.9 years (range, 1 to 30.3 years). Thirty-one of 155 patients (20%) presented with genital skin changes. Twenty-one of those (13%) presented clinically inflammatory genital skin changes considered as genital cGVHD: 12 had inflammatory (noninfectious) balanoposthitis, 6 had lichen sclerosis–like lesions, 5 had phimosis, and 2 patients had more than 1 feature. Patients with inflammatory genital skin changes had a significantly higher coincidence of oral (P < .0001), ocular (P < .002), and/or cutaneous cGVHD (P < .026) when compared with patients without genital lesions. The rate of IIEF-5 questionnaire response was 59% (91 of 155). Among them, 67% reported erectile dysfunction. Erectile dysfunction was significantly more frequent in patients with genital cGVHD (P = .0075). Seventy-five of 155 patients (48%) answered the mBSSC questionnaire. Only 40% of them reported sexual contentment. Genital skin changes in male recipients after allogeneic HSCT are frequent and seem to be an under-reported relevant late effect. Inflammatory genital skin changes can be considered as a form of genital cGVHD often associated with manifestations of extragenital mucocutaneous cGVHD.     

产后女性进行盆底肌康复治疗对其性功能障碍的改善效果

目的:探究产后女性进行盆底肌康复治疗对其性功能障碍的改善效果。方法:随机选取我院收治的120例产后女性患者,按照数字表法分组,将其分为试验组、对照组两组,对照组采用常规康复治疗,试验组开展盆底肌康复训练治疗,对比分析两组患者预后情况。结果:试验组女性患者治疗后3个月、6个月的性交频率与对照组患者相比明显较高,差异有统计学意义(t=-17.0692,-20.9648;P0.05)。试验组女性患者治疗后3个月、6个月的性功能评分与对照组患者相比明显较高,差异有统计学意义(t=-18.1220,-10.8083;P0.05)。结论:产后女性进行盆底肌康复治疗后,有利于提高性功能,增加性交频率,预后效果显著,临床意义重大。     

Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male erectile dysfunction.

BACKGROUND: Sildenafil (Viagra), a new oral drug for the treatment of erectile dysfunction, was licensed for use across Europe in 1998. AIM: To examine the effectiveness and safety of sildenafil as an oral treatment for erectile dysfunction. DESIGN OF STUDY: Systematic review and meta-analysis. SETTING: All published or unpublished randomised controlled trials comparing sildenafil with a placebo or alternative therapies. METHOD: Published studies were sought by computerised searches of electronic databases using the keywords 'sildenafil' and 'Viagra'. A hand search was also done of the British Medical Journal, Lancet, Journal of the American Medical Association, New England Journal of Medicine, British journal of General Practice, Drug, Inpharma and Scrip. An assessment of quality of all identified studies and data extraction was undertaken independently by two researchers. Results were combined in a meta-analysis where appropriate, using RevMan version 3. RESULTS: Twenty-one trials were identified. All trials showed a statistically significant improvement in erectile or sexual function in patients using sildenafil compared with a placebo. A meta-analysis of 16 trials reporting a global efficacy response showed that men were 3.57 (95% CI = 2.93-4.43) times as likely to have improved erections on sildenafil compared with those on a placebo. The number needed to treat to have one man with improved erections was two. The drug has a relatively safe side-effect profile. CONCLUSIONS: Available research shows that sildenafil is an effective treatment for male erectile dysfunction. Many trial participants had some baseline erectile function and it is probable that in clinical practice, where the erectile function tends to be more impaired, the number needed to treat may be higher.     

综合康复锻炼对改善低位直肠癌患者术后前切除综合征的效果

目的:探讨综合康复功能锻炼对改善低位直肠癌术后患者前切除综合征(anterior resection syndrome,ARS)的护理效果.方法:选择低位直肠癌术后并发ARS的98例患者,按住院号的顺序随机分为对照组和综合组,其中对照组49例患者采取常规盆底相关肌肉力量锻炼方案;综合组49例患者采取盆底肌锻炼与神经康复锻炼,分别比较两组患者干预前及干预后1,3,6个月时两组患者的前切除综合征评分(low anterior resection syndrome score,LARSS)及生存质量情况.结果:两组在干预前和干预后1个月时LARSS评分,差异无统计学意义(P＞0.05),综合组在干预后3个月和6个月时LARSS评分明显低于对照组,差异有统计学意义(P＜0.05);两组在时间效应、组间效应及时间组间效应值,差异均具有统计学意义(P＜0.05);两组在干预前及1个月时生活质量各维度评分,差异无统计学意义(P＞0.05);在干预后3个月和6个月时除环境功能外综合组患者的生活质量其他维度评分均高于对照组,差异有统计学意义(P＜0.05);除环境功能组间效应外,两组患者在生活质量所有指标的时间效应、组间效应及时间-组间效应,差异有统计学意义(P＜0.05).结论:通过开展盆底肌力锻炼联合神经康复锻炼较单纯盆底肌力锻炼更能够快速改善低位直肠癌术后ARS症状,对改善患者生存质量更为显著,在临床值得进一步推广.