Evaluation and treatment of female sexual disorders

This paper presents a pilot study exploring the utility and feasibility of use of a vesicovaginal fistula (VVF) patient educational brochure. Women awaiting or recently having undergone VVF surgery examined a six-paneled educational brochure detailing the causes, treatment options, and prevention methods of VVF. Participants answered demographic questions and gave detailed responses to a questionnaire that addressed the brochure material. A convenience sample of 50 patients, with a mean age of 26.1 years, participated. Universally, these women felt that the information they learned from the brochure was useful. Suggestions by participants regarding prevention of VVF included laboring in a hospital (80%), educating other women (30%), and discouraging early marriage (8%). Primary barriers to prevention and treatment included financial restraints (84%) and transportation difficulties (30%). The utilization of a simple, low-cost educational brochure has the ability to educate women on the causes, treatment, and prevention of VVF. Oral presentation Annual Meeting of the Society of Gynecologic Surgeons, Savannah, GA, April 14–16, 2008. Partially funded by the National Institute of Diabetes and Digestive and Kidney Diseases, DK068389 to H.E.R.     

Evaluation and treatment of female sexual disorders

Prevalence data suggest that more than 40% of women experience sexual problems and that 12% of these women are distressed by the problem. In the 1960s, Masters and Johnson introduced what is now considered the classic linear model of female sexual response based on a physiologic foundation. Recently, Rosemary Basson introduced a nonlinear interconnected model which emphasizes the importance of emotional intimacy and satisfaction as integral components of the female sexual response cycle. According to the Diagnostic and Statistical Manual (DSM-IV TR), there are six female sexual disorders: hypoactive sexual desire disorder, aversion disorder, sexual arousal disorder, female orgasmic disorder, vaginismus, and dyspareunia. Despite the high prevalence, few healthcare professionals take the time or feel adequately trained to assess and treat these sexual problems. Sexuality questionnaires play an integral role in the diagnosis and treatment of male and female sexual dysfunctions. They are used to (1) identify/diagnose individuals with a particular dysfunction, (2) assess the severity of the dysfunction, (3) measure improvement or satisfaction with treatment, (4) examine the impact of the dysfunction on the individual’s quality of life (relationship satisfaction, mood, sexual confidence), and (5) study the impact of the dysfunction on the partner and his or her quality of life. Patient-reported outcomes (PRO) are increasingly important in both clinical practice and research settings. The instruments reviewed have played a significant role in furthering our understanding of the impact of female sexual function on the patient and partner and its treatment. It is important for the clinician and researcher to familiarize themselves with the best available measures for identifying specific dysfunctions, measuring distress due to the sexual dysfunction, assessing treatment efficacy, and objectively evaluating the quality of life issues of women with these dysfunctions. However, even the best PRO cannot replace the clinician–patient interview and the careful gathering of the patient’s sexual history. PROs should always be interpreted and integrated with the woman’s history.     

The definition and epidemiology of septic shock

Septic shock is the ultimate consequence of the systemic inflammatory response generated by the infection. Its steadily increasing incidence and its morbidity and mortality are a major public health issue.     

Ejaculatory disorders: epidemiology and current approaches to definition, classification and subtyping

Ejaculatory disorders (disorders of emission, ejaculation and orgasm) are the most frequent sexual complaint. Conventional algorithms on ejaculatory disorders are based on an organic or psychogenic dichotomy, with the latter being traditionally considered the main etiological cause. The scope of this review is to propose a new classification of ejaculatory disorders, with special emphasis on epidemiology and subtyping of the most frequent: premature ejaculation (PE). There is growing agreement on definition, diagnosis, and treatment options. In many cases, ejaculatory disorders can be classified by psycho-neuro-uro-endocrine symptoms. Epidemiological data, new classifications and subtyping, together with new diagnostic procedures and the availability of pharmacological aids, place this topic in the mainframe of sexual medicine. This will soon demolish the barriers to seeking help perceived by patients suffering ejaculatory disorders.     

Impact of pelvic floor disorders and prolapse on female sexual function and response

Pelvic floor disorders and FSD are prevalent and challenging problems. These disorders include prolapse of the uterus, cervix, vagina, bladder, and rectum and incontinence. These diseases likely affect women's sexual well-being through physical and emotional effects. Women with pelvic floor disorders often have co-existing urologic and sexual complaints. Patients who present with these urologic problems should be questioned about their sexual function. Surgical treatment in these patients may be curative of their sexual disorders (e.g., by repairing incontinence) but may also have undesired effects on sensation, blood flow, and the anatomy. These effects can affect sexual arousal and orgasm or cause dyspareunia. It is hoped that a better understanding of the anatomy of this area will guide us in a more targeted approach to management of these conditions.     

The neurophysiology of female sexual function

Recent research on the neural control of female sexual function is reviewed. The control of female genital responses has not been extensively studied and significant gaps in our knowledge remain. Sexual arousal is largely the product of spinal level reflexes. A network of interneurons processes the sensory information and generate complex patterns of activities that are then distributed to the autonomic and somatic efferents. The spinal reflexive systems are under inhibitory and excitatory control from the brainstem and hypothalamic sites. Further research is necessary to identify the mechanisms underlying female sexual function, the pathogenesis of sexual dysfunctions and their possible treatment.     

Managing female sexual dysfunction

ObjectiveProvide an overview of sexual dysfunction in female urologic cancer patients, approaches for assessing sexual problems, and interventions to treat sexual dysfunction in this patient population.MethodsA review of the literature in urologic oncology was conducted. Research on other female pelvic cancers with similar treatments was also reviewed.ResultsSexual health is an important element of women's quality of life that is often not discussed and problems remain unaddressed. Urologic cancer treatments commonly result in sexual dysfunction (e.g., dyspareunia, vaginal dryness, problems with orgasm) in female patients, although more research is necessary to understand the impact of non-surgical treatments (e.g., radiation, chemotherapy, immunotherapy). As such, provider teams should complete necessary screening for sexual dysfunction during and after treatment. The 5 A's model (i.e., Ask, Advise, Assess, Assist, Arrange Follow-Up) provides a helpful guide for communicating about and addressing sexual health concerns with patients during the screening process. If it is determined that referral for further assessment and treatment of sexual dysfunction is needed, a number of non-pharmacologic (e.g., pelvic floor physical therapy; psychosexual counseling) and pharmacologic treatment approaches are available.ConclusionSexual dysfunction is common in female urologic cancer survivors. Routine assessment and appropriate referral are essential for high quality patient care.     

女性性功能障碍的常见病因

女性的性功能障碍是一种常见和多发疾病,给夫妻生活带来显著的不良影响,而明确其病因是合理诊治的基础。本文介绍了女性性功能障碍的常见病因,主要包括心理与社会因素、神经因素、性激素异常、疾病因素、药物因素和产后。     

Biology of female sexual function

Although the psychosocial and relationship aspects of female sexuality have been extensively investigated, studies concerning the anatomy, physiology and pathophysiology of female sexual function and dysfunction are limited. The paucity of biologic data may be attributed to a lack of reliable experimental models and tools for investigating female sexual function and to limited funding, which is critical for developing experimental approaches. Research efforts by several investigators in different laboratories have been establishing experimental models needed for investigating the physiologic mechanisms involved in the genital arousal response of sexual function. These experimental models have permitted assessment of genital hemodynamics, vaginal lubrication, regulation of genital smooth muscle contractility and signaling pathways, providing preliminary information about the role of neurotransmitters and sex steroid hormones in sexual function. Further research is needed to define the neurotransmitters responsible for vaginal smooth muscle relaxation and the role of sex steroid hormones and their receptors in modulating genital hemodynamics, smooth muscle contractility, and neurotransmitter receptor expression. Finally, a global and integral understanding of the biologic aspects of female sexual function requires investigation of the vascular, neurologic (central and peripheral), and structural components of this extremely complex physiologic process.     

The prevalence of sexual problems in female medical students

Female sexual dysfunction and even female sexual function are widely unknown. We therefore evaluated the sexual behaviour of younger and older women using a questionnaire. A total of 998 young women entered the study at Hannover Medical school. They were between 19 and 43 years old (median 24 years), and 64% answered the questionnaire. A total of 97.1% of the female students were heterosexual, 1.6% were lesbians and 1.3% were bisexual. Lack of sexual intercourse in the previous month was recorded by 21.1%, while 21.3% recorded intercourse 1-3 times a month, 46.8% 1-3 times a week and 5.5% daily. Adverse reactions to sexual situations were reported by 25% of the women, 20.5% had a negative perception for special partners or circumstances. Some 55% of the evaluated women were satisfied with their sexual life in the last month, 20% were fairly satisfied and 21% were un-satisfied. This study of a selected population of medical students shows a wide variety of sexual problems with a high prevalence of different disorders.     

Physiology of female sexual function and dysfunction

Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30-50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed for assessing subjective measures of sexual arousal and function. Objective measurements used in conjunction with the subjective assessment help diagnose potential physiologic/organic abnormalities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed.