Inventories for male and female sexual dysfunctions

Several illnesses can distress sexual health and disrupt sexuality, an integral part of being human. These illnesses are not different in origin from those affecting other health areas, but, because sexuality is involved, effective communication and empathy between the physician and the patient may be severely hindered by negative feelings such as anxiety and guilt. A detailed general and sexual history is, however, an essential step in evaluating patients for sexual dysfunction (SD). Finding the correct way to ask questions and to decode answers on sexual health and disease might be difficult and, in some way, embarrassing. Hence, validated and standardized sexual inventories might help physicians confront SD. These case-history tools have the advantage of being standardized, easy to administer and score, relatively unobtrusive and substantially inexpensive. This review describes the main sexual inventories hitherto described and validated in different sexual areas of health and disease, and the advantages of the two main formats available to clinicians, that is, structured interviews (SIs) and self-report questionnaires (SRQs). Both types of inventories are composed of a set of standardized, written probe questions requiring a finite number of responses, driven by an interviewer (SIs) or by the patients themselves (SRQs). SRQs allow more time and intimacy to organize and develop answers to delicate questions, as are those on sexual life. In addition, SRQs could also be very useful in quantifying disease severity and treatment outcome. On the other hand, SIs help achieve a better patient-physician relationship and reduce the risk of misunderstandings.     

Similarities and differences in female and male rat voiding

We measured in adult rats, under anaesthesia, bladder pressure by transvesical cystometry and flow rate by an ultrasound transducer in the distal urethra. The urinary flow was discontinuous in both sexes. No difference between the sexes in bladder pressure oscillations or in non-oscillatory voiding was found but during the oscillatory activity there was a difference in the relationship between bladder pressure and urinary flow. In the female, the bladder pressure decreased when the flow started and increased when the flow decreased resembling species whose urinary flow is continuous. Basically the flow was stable but it was divided into periods of variable duration by full or partial closure of urethral sphincter. In the male rat, the oscillatory flow consisted of short, fast spikes occurring just before the bladder pressure reached the maximum, after which the flow spike decreased slowly. Overall, no differences were seen in bladder pressure data between the genders. However, the maximal flow rate was lower and micturition time was shorter in female rats. When we recorded occasionally occurring micturitions without high-frequency oscillations of intraluminal pressure (IPHFOs) (non-oscillatory voiding), no differences between the genders were seen. The difference during oscillatory voiding between male and female rat can be understood against anatomical and hormonal backgrounds, and by the relative role of rhabdosphincter, which did not activate during non-oscillatory voidings when no differences were detected.     

Psychobiological correlates of delayed ejaculation in male patients with sexual dysfunctions

The pathogenesis of delayed ejaculation (DE) is rather unknown, though the contribution of various psychological, marital, hormonal, and neurological factors has been advocated. In this study we systematically investigated the relative relevance of the aforementioned factors in 1,632 men who were seeking medical help for sexual dysfunction. The severity of DE was classified according to Kaplan criteria. Mild and moderate forms of DE (MMDE) recognized different risk factors than the most severe ones (anejaculation or severe DE [ASDE]). ASDE was essentially coupled with the presence of neurological diseases or with the use of serotoninergic drugs. Serotoninergic drugs also significantly increase (by at least 10-fold) the risk for MMDE, which, however, was also coupled with other relational factors (eg, partner's impaired climax, patient's hypoactive sexual desire [HSD]) or intrapsychic factors (eg, stress at work). At multiple regression analysis, some organic pathological conditions (such as psychiatric disorders and hypogonadism) were also associated with MMDE. In particular, hypogonadism retained significance for DE even after adjustment for HSD (adjusted odds ratio = 2.08 [1.11-3.89]; P < .05), suggesting other effects of testosterone deficiency on the ejaculatory reflex besides reduced libido. In conclusion, the present study demonstrates that multiple psychobiological determinants are associated with DE, a still obscure condition that substantially impairs psychosexual equilibrium of the couple.     

Obesity and sexual dysfunction, male and female

Obesity has become a worldwide public health problem of epidemic proportions, as it may decrease life expectancy by 7 years at the age of 40 years: excess bodyweight is now the sixth most important risk factor contributing to the overall burden of disease worldwide. Overweight and obesity may increase the risk of erectile dysfunction (ED) by 30-90% as compared with normal weight subjects. On the other hand, subjects with ED tend to be heavier and with a greater waist than subjects without ED, and also are more likely to be hypertensive and hypercholesterolemic. The metabolic syndrome, characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, associates with ED. Moreover, women with the metabolic syndrome have an increased prevalence of sexual dysfunctions as compared with matched control women. Lifestyle changes aimed at reducing body weight and increasing physical activity induce amelioration of both erectile and endothelial functions in obese men. Moreover, preliminary evidence suggests that a Mediterranean-style diet might be effective in ameliorating sexual function in women with the metabolic syndrome. Lifestyle changes, mainly focussing on regular physical activity and a healthy diet, are effective and safe ways to reduce cardiovascular diseases and premature mortality in all population groups; they may also prevent and treat sexual dysfunctions in both sexes.     

The role of the urologist in the management of female sexual dysfunctions

PURPOSE OF REVIEW: The present minireview is aimed at investigating the association between female sexual dysfunction and urinary incontinence or lower urinary tract symptoms, two of the most frequently encountered urological disorders. RECENT FINDINGS: Sexual dysfunction in women is a multifactorial and multidimensional condition combining several biological, psychological, medical, interpersonal and social components. According to the National Health and Social Life Survey, approximately 43% of American women suffer from sexual disorders. There have been few investigations about the prevalence and predictors of female sexual function or sexual dysfunction across Europe. Based on everyday clinical practice and according to the most recent peer-reviewed publications, there is a critical correlation between urogynaecological conditions and women's sexual disorders. Interestingly, an increasing number of papers have raised the issue of women's sexual function in patients who have undergone urogynaecological radical pelvic surgery for urological malignancies. The role of the urologist in treating the couple covers the third part of this paper, and attempts to show the significant correlation between the presence of any female sexual dysfunction and so-called patient-partner satisfaction. SUMMARY: This minireview underlines the significant role of the urologist in the management of female sexual dysfunctions, mainly in women with urogynaecological disorders. Evaluation by the patient's partner and its impact on urological patients has also been stressed.     

Psycho-biological correlates of free-floating anxiety symptoms in male patients with sexual dysfunctions

Anxiety has a relevant impact on everyday life, including sexual life, and therefore is considered the final common pathway by which social, psychological, and biological stressors negatively affect sexual functioning. The aim of this study is to define the psycho-biological correlates of free-floating anxiety in a large sample of patients complaining of erectile dysfunction (ED)-based sexual problems. We studied a consecutive series of 882 ED patients using SIEDY, a 13-item structured interview, composed of 3 scales that identify and quantify organic, relational, and intrapsychic domains. MHQ-A scoring from Middlesex Hospital Questionnaire (MHQ) was used as a putative marker of free-floating anxiety symptoms (AS). Metabolic and hormonal parameters, nocturnal penile tumescence (NPT) test, and penile Doppler ultrasound (PDU) examination were also performed. MHQ-A score was significantly higher in patients complaining of difficulties in maintaining erection and in those reporting premature ejaculation (6.5 +/- 3.3 vs 5.8 +/- 3.3 and 6.6 +/- 3.3 vs 6.1 +/- 3.3, respectively; both P < .05). Moreover, ASs were significantly correlated to life stressors quantified by SIEDY scale 2 (relational component) and scale 3 (intrapsychic component) scores, as dissatisfaction at work or within the family or couple relationships. Among physical, biochemical, or instrumental parameters tested, only end-diastolic velocity at PDU was significantly (P < .05) related to ASs. In conclusion, in patients with ED-based sexual problems, ASs are correlated to many relational and life stressors. Conversely, organic problems are not necessarily associated with MHQ-A score.     

Osteoporosis: differences and similarities in male and female patients

Osteoporosis is associated with decreased bone strength as a consequence of decreased bone density and altered quality. It is a result of a disruption of balance between bone breakdown and bone formation, caused by increased bone resorption by osteoclasts or without appropriate screening, one's first awareness of the disease is a fracture. It results in increased mortality and significant morbidity. In the last decade, great strides have been made in defining the diagnosis and establishing effective modes of treatment for this disorder. Our current state of knowledge indicates that although this disease affects both sexes, there are clear differences that have clinical importance.     

Similarities between interstitial cystitis and male chronic pelvic pain syndrome

Few clinical conditions encountered by the urologist cause more patient and clinician frustration than interstitial cystitis and male chronic pelvic pain syndrome, also know as nonbacterial prostatitis. This frustration is fueled by the chronicity of often disabling urogenital (and often associated systemic) symptoms coupled with delayed care, misdiagnosis, and suboptimal clinical responses. Basic research and therapeutic trials for these syndromes have historically taken two separate paths. However, mounting evidence suggests that significant overlap may exist between them in epidemiology, pathophysiology, and even therapy. This discussion reviews some of the common features of these clinical problems and makes a case that they might in fact represent different manifestations of the same disease process.     

Prevalence of sexual dysfunctions in Argentina

The objective of this study consisted in assessing the prevalence of erectile dysfunction (ED) and other sexual dysfunctions in a group of men who attended a prostate awareness week campaign. In total, 2715 men attended to 'Semana de la Prostata 2001' campaign and received an additional questionnaire on sexual health. The prevalence of ED, desire and ejaculatory disorders was of 41.7, 33.8 and 49.3%, respectively; however, not all of them lived these difficulties as a real sexual problem because only 918 men (37.8%) acknowledged having 'any sexual difficulty'. Only 13.7% of the attendees consulted a physician for this reason in the past. This first Argentinean study proves the high prevalence of sexual dysfunctions in our population.     

Adverse effects of drug therapies on male and female sexual function

Sexual dysfunctions (SD) are adverse effects of common drug therapies that have rarely been considered in investigations so far. Possibly it is barely known that many widespread and frequently prescribed medications and drug therapies can have significant impact on vascular and nerval processes as well as on endocrinologic and psychoneuroendocrinologic systems and therefore can influence sexual functions. Impotence and disorders of the erectile function can mainly be caused by antidopaminergic mechanisms, whereas ejaculatory disorders and anorgasmia often can be explained by antiserotoninergic effects. Anticholinergic and adrenoloytic agents can also cause a particular impairment of erectile functions. The following considerations will show that the detection and treatment of SD (also in women!) should be given much more attention since drug-induced SDs occur predominantly in indications where a SD itself can be a symptom of the disease.     

Effects of childhood circumcision age on adult male sexual functions

The effects of childhood circumcision on male sexual function have been debated. However, there are no studies, to our knowledge, that assess the possible effects of childhood circumcision age on male sexual function. In an attempt to answer this question, we performed a prospective study to determine the possible relationship between circumcision age and male sexual function, using a validated questionnaire, the Golombok-Rust Inventory of Sexual Satisfaction. We found no relationship between childhood circumcision age and overall sexual function; however some specific domains of sexual function (i.e. avoidance and communication) seemed to be affected by the age at circumcision procedure in this cohort of sexually active males. In addition, prevalence of sexual dysfunction was higher, with premature ejaculation being the most common dysfunction in the survey. We concluded that childhood circumcision age might affect some domains of male sexual function in adulthood, but not the overall function.     

The frequency of sexual dysfunctions in male partners of women with vaginismus in a Turkish sample

The aim of this investigation is to determine the sexual history traits, sexual satisfaction level and frequency of sexual dysfunctions in men whose partners have vaginismus. The study included 32 male partners of vaginismic patients, who presented at a psychiatry department. Subjects were evaluated by a semi-structured questionnaire. The questionnaire was developed by researchers for assessing sexually dysfunctional patients and included detailed questions with regard to socio-demographic variables, general medical and sexual history. All participants also received the Golombok Rust Inventory of Sexual Satisfaction (GRISS). According to DSM-IV-TR criteria, 65.6% of the investigated males were diagnosed with one or more sexual dysfunctions. The most common problem was premature ejaculation (50%) and the second one was erectile dysfunction (28%). The transformed GRISS subscale scores provided similar data. It is concluded that the assessment of sexual functions of males who have vaginismic partners should be an integral part of the management procedure of vaginismus for optimal outcome.     

妇科良性疾病与女性性功能障碍相关性分析

目的探讨妇科良性疾病与女性性功能障碍(FSD)相关性,为防治FSD的发生及防治提供理论依据。方法采用横断面调查方法,选取中等收入城市及农村居民区20岁及其以上女性进行问卷调查,收集其人口学特征及目前所患妇科疾病(经诊断确诊过的疾病)等信息。采用中文版女性性功能量表(FSFI)进行FSD评估,总分小于26.55说明存在FSD。应用多因素非条件Logistic回归模型分析妇科良性疾病与FSD相关性。结果发放问卷1 130份,收回1 068份(回收率94.5%),去除不符合要求问卷80份,共纳入有效问卷988份。988例被访者中妇科良性疾病患者占39.8%(393/988),为患病组,其余为健康组。393例患者中,性功能障碍者占71.2%(280/393),高于健康组性功能障碍患病率(P0.05)。与健康组相比,患病组在总分及性欲、性唤起、性高潮方面的评分分值均较健康组低(P0.05)。多因素非条件Logistic回归分析显示,妇科良性疾病、年龄(≥40岁)及绝经是FSD的独立危险因素,较高的教育水平是其保护性因素。结论 FSD是一个重要的公共卫生问题,甘肃省在妇科良性疾病者中FSD现患率较高,应加强性健康教育,降低FSD发生率。     

Difference in physiogenomics between male and female infertility

Infertility is an important condition in reproductive medicine. According to this work, there is only one identified physiogenomic relationship on chromosome 5 (CAMK4) for male but there are four identified physiogenomic relationships on chromosome 12 (CD9), chromosome 19 (BSG), chromosome 2 (ADCY3) and chromosome 4 (AFP). Although it has been determined for a long time, there is no clear cut genetic difference between male and female infertility. Systemic approach on the pathophysiology and genomics might provide useful information to better understand the pathogenesis of infertility. In this work, physiogenomics analysis for infertility in male and female was performed.     

Subclinical human papillomavirus infections in male sexual partners of female carriers

The male sexual partners of 156 women with human papillomavirus infection of the cervix uteri were examined. In 120 men (77 per cent) penile lesions were found on examination of the penis via a colposcope (peniscopy) the most common of which were flat acetowhite lesions (53 per cent). Predilection sites of lesions were the urethral meatus and the corona glandis (23 and 19 per cent of the lesions, respectively). Using filter in situ hybridization human papillomavirus-deoxyribonucleic acid was found in penile smears of 61 men (39 per cent). The cancer-associated viral types (human papillomavirus 16 and 18) were identified in 75 per cent of the human papillomavirus positive men. Viral types of sexual partners were identical in 87 per cent. The correlation between infections with human papillomavirus 16 and 18, and the severity of the cervical lesion was significant in corresponding sexual partners. Our results support the hypothesis that male sexual partners represent a risk factor by acting as a reservoir for genital infections with papillomaviruses. The majority of human papillomavirus infections are of subclinical character. They require sensitive diagnostic techniques, such as peniscopy and hybridization for their identification. Detection and treatment of subclinical human papillomavirus infection in men may be important for the prevention of genital cancer in women.     

甲状腺功能紊乱影响男性性功能及生殖功能的机制研究进展

甲状腺功能紊乱可影响机体生长代谢以及类固醇性激素的合成与分泌,大量临床与基础研究提示,甲状腺激素异常可造成性功能及生育障碍。甲亢患者不仅可出现早泄(PE),也可出现勃起功能障碍(ED);同样甲减患者不仅可出现ED,也可出现PE;甲状腺激素可对睾丸间质细胞、支持细胞、精子的发生产生影响。本文就甲状腺功能紊乱对男性PE、ED及不育的影响及其机制的研究进展进行综述。     

A new atypical antipsychotic: quetiapine-induced sexual dysfunctions

In this paper, we evaluated the new antipsychotic, quetiapine-induced sexual dysfunctions (SDs). The study group consisted of 36 patients with schizophrenia receiving quetiapine. The changes in general sexual functions were assessed by using Arizona Sexual Experience Scale (ASEX) and Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale at baseline and week 4. Also, prolactin (PRL) values were determined at baseline and week 4. There was statistically significant difference with respect to the mean ASEX score at week 4 compared with baseline. The most frequent SD was diminished libido in both male (31.8%) and female subjects (28.6%). No significant correlation was found between ASEX scores and PRL values. The results suggest that SDs are an important problem using even novel antipsychotic, quetiapine.     

Analysis of sexual functions in male nondiabetic hemodialysis patients and renal transplant recipients

Disturbance of sexual functions among hemodialysis patients and renal transplant recipients (RTRs) is controversial. Diabetes mellitus (DM) is known to have a significant negative impact on sexual functions. Most previous studies concerning the issue of disturbance of sexual functions among hemodialysis patients and renal transplant recipients have included diabetic patients also, which might have influenced their results. The aim of this study was to evaluate sexual functions of nondiabetic male (NDM) dialysis patients and RTRs, and to compare our findings with those of the others. Twenty‐five nondiabetic male RTRs, 25 age‐matched NDM hemodialysis patients, and 25 age‐matched NDM controls were the subjects of this study. Sexual functions of all subjects were assessed using the International Index of Erectile Function (IIEF) questionnaire. Statistical analysis was performed using appropriate statistical tests with the level of significance set at P < 0.05. Data were described using mean, standard deviation (SD), median and interquartile range (IQR). Renal transplant recipients (RTRs) and hemodialysis patients had depressed erectile function (EF) and Intercourse satisfaction (IS) function, but normal orgasmic (OF) function. Sexual desire (SxD) function of RTRs group, although subnormal, was better than that of hemodialysis patients. Overall satisfaction (OS) of RTRs, unlike that of hemodialysis patients, was normal. Sexual dysfunction is prevalent even in NDM hemodialysis patients and RTRs. Although ED is equally prevalent among these two groups, it is more profound among the former one. OF is spared in these patients. Renal transplantation seems to normalize OS and improve SxD function of nondiabetic male renal transplant recipients (NDM RTRs).