女性性功能障碍的诊治进展

<正>女性性功能障碍(FSD)是一种与年龄相关且渐进发展的疾病,主要包括性欲障碍、性唤起障碍、性高潮障碍、性疼痛障碍等类型。FSD与年龄、抑郁、受教育水平低下、饮酒、绝经期/绝经后期、慢性疾病、配偶健康状况不良、难产、离异等多种因素密切相关〔1〕。张爱霞等〔2〕发现南京市城区FSD发病率达     

顺产初产妇产后性功能障碍及影响因素分析

目的分析顺产初产妇产后性功能障碍(PFSD)的发生情况及影响因素,为防制PFSD和提高产妇生活质量提供依据。方法选取2016年1月至2018年6月在金华市人民医院医学生殖中心分娩的顺产初产妇为调查对象,采用女性性功能量表和爱丁堡产后抑郁量表评估产妇性功能和产后抑郁情况,采用Logistic回归模型分析PFSD发生的影响因素。结果共发放调查问卷1 055份,回收有效问卷1 020份,问卷有效率为96.68%。发生PFSD 641例,发生率为62.84%。其中性欲低下、性唤起障碍、阴道湿润障碍、性高潮障碍、性生活满意度障碍和性交疼痛的发生率分别为61.27%、 65.20%、 71.08%、 68.92%、 76.96%和35.78%。多因素Logistic回归分析结果显示,年龄25岁(OR=0.114,95%CI:0.077～0.169)、母乳喂养为主要喂养方式(OR=1.915,95%CI:1.255～2.922)、丈夫经常参与家务(OR=0.404,95%CI:0.252～0.645)、调查时已恢复工作(OR=9.147,95%CI:5.679～14.731)、产后抑郁症(OR=4.812,95%CI:3.004～7.708)是顺产初产妇发生PFSD的影响因素。结论顺产初产妇产后性功能障碍发生率为62.84%,与产妇年龄、喂养方式、丈夫家务参与情况、是否恢复工作及有无产后抑郁症均有关。     

土耳其妇女性功能障碍及危险因素

52～57女性性功能及其障碍可包括性欲、性兴奋、性润滑、性高潮、性满意和性交疼痛等6个方面。性功能可受年龄、受教育程度、性虐待或性传播疾病病史、情感或压抑问题及健康状况等因素的影响。该研究对土耳其妇女有关性功能障碍的发病情况及可能的相关危险因素进行了调查。方法土耳其默辛市不同社会文化背景的家庭妇女共200名接受了本次调查。纳入条件为有配偶及性活动并完整回答问卷的妇女;排除近1月内无性活动者。共有179(89.5%)例妇女符合上述条件,年龄18～67岁,按年龄段将其分为5组:18～27岁(n=23);28～37岁(n=55);38～47岁(n=43);48～5…     

一种新的女性性反应模式

医学上通常把性的结合分为兴奋期、平台期、高潮期及消退期.并根据性反应模式,将女性性功能异常分为性唤起障碍、性高潮障碍、性交疼痛及阴道痉挛等.     

020 土耳其妇女性功能障碍及危险因素[英]／Cayan S…／／Urol Int．

女性性功能及其障碍可包括性欲、性兴奋、性润滑、性高潮、性满意和性交疼痛等6个方面。性功能可受年龄、受教育程度、性虐待或性传播疾病病史、情感或压抑问题及健康状况等因素的影响。该研究对土耳其妇女有关性功能障碍的发病情况及可能的相关危险因素进行了调查。     

上海闸北区围绝经期妇女性功能障碍调查分析

目的调查分析上海闸北社区围绝经期妇女性功能障碍（FDS）发生情况,为延缓围绝经期妇女性功能障碍提供性知识的健康教育。方法选择2011年5月至9月上海闸北区北面区域社区居民中在本院进行健康体检的40～65岁围绝经期妇女825例为调查对象,并采用女性性功能指数（FSFI）问卷评估性功能调查,分析围绝经期妇女性功能障碍的发生率及相关影响因素。结果发放调查表825份,收回有效调查表746份,有效问卷回收率90．42％。本组40～65岁女性FSFI得分（16．45±4．33）分,FSD总的发生率为86．7％,围绝经期妇女随年龄的增长,FSn评分及单项评分逐渐下降（P〈0．05）,FSD发生率升高（P〈0．05）,以性满意度下降（72．9％）、性交疼痛（70．5％）和性高潮障碍（70．2％）为主。结论围绝经期妇女性功能障碍发生率高,伴有不同程度性功能障碍,以性满意度下降、性交疼痛和性高潮障碍为主。对围绝经期妇女进行性知识的健康教育,可改善其性生活质量,有利于延缓衰老。     

产后性功能障碍的流行病学特征及临床干预措施分析

目的 调查产后性功能障碍的流行病学特征，并制定针对性临床干预措施。方法 选取2020年2月—2021年2月在温州市中心医院健康体检的500例产妇为调查对象，向所有产妇发放一般问卷和疾病相关问卷。统计有效调查问卷中女性产后性功能障碍的患病率和相关发病因素，根据结果制定临床干预措施。结果 500例调查对象问卷有效回收率为83.00%(415/500),其中存在产后性功能障碍的女性占43.37%(180/415)。女性产后性欲低下、阴道润滑困难、性唤起困难、性交痛、性满意度下降及性高潮障碍发生率依次为45.56%、33.89%、39.44%、27.22%、37.22%及32.22%。年龄>35岁、顺产/阴道助产、产后性生活时间<42 d、夫妻感情差及产后焦虑抑郁均是女性产后性功能障碍的危险因素(OR>1,均P<0.05)。产妇干预后盆底功能PFIQ-7、PFDI-20评分[(7.05±2.84)分、(14.84±4.05)分]均低于干预前[(88.64±5.22)分、(227.52±21.91)分];1个月性生活次数、性高潮频次[(9.61±2.35)次/月、(5.44±1.72)次/月]均高于干预前[(3.27±0.23)次/月、(1.34±0.25)次/月],差异均有统计学意义(t=81.740、56.524、16.400及14.171,均P<0.05)。结论 年龄、分娩方式、产后性生活时间、夫妻感情及精神状态均可能导致女性产后性功能障碍，产妇产后应做好盆底肌康复锻炼和心理支持。     

人乳头瘤病毒感染患者性功能障碍发生状况及影响因素分析

目的:研究人乳头瘤病毒(human papilloma virus,HPV)感染女性性功能障碍(female sexual dysfunction,FSD)发生状况及相关影响因素。方法:选取2019年5-7月在首都医科大学附属北京妇产医院妇瘤科门诊就诊的HPV阳性患者300例作为研究对象,通过填写一般问卷及女性性功能指数量表(FSFI)收集资料,分析HPV感染患者FSD发生现状及相关影响因素。结果:300例患者中,FSD发生率为81.00%(243/300),平均FSFI评分为(17.34±9.73)分。在性功能的6个维度中,出现障碍的比例由高到低依次是性欲低下(82.00%)、性满意度下降(69.00%)、性唤起困难(66.67%)、性高潮障碍(62.33%)、性交疼痛(52.00%)、阴道润滑困难(49.33%)。不同年龄、文化程度、职业、收入、焦虑与否的HPV感染患者FSD发生率差异有统计学意义(均P<0.05)。Logistic回归分析显示,年龄>40岁(OR=7.747,95%CI:3.329~18.030,P<0.001)、高中/大专及以下学历(OR=4.029,95%CI:1.540~10.542,P=0.005)、焦虑(OR=4.028,95%CI:1.713~9.472,P=0.001)是HPV感染患者发生FSD的独立影响因素。结论:HPV感染患者的FSD发生率较高,其FSFI评分明显降低,性功能的6个维度中,性欲低下的发生率最高。对于年龄>40岁、高中/大专及以下学历以及合并焦虑的HPV感染患者应尤其重视,早期识别并给予干预,改善其生活质量。     

人乳头瘤病毒感染患者性功能障碍发生状况及影响因素分析

目的:研究人乳头瘤病毒(human papilloma virus,HPV)感染女性性功能障碍(female sexual dysfunction,FSD)发生状况及相关影响因素。方法:选取2019年5—7月在首都医科大学附属北京妇产医院妇瘤科门诊就诊的HPV阳性患者300例作为研究对象,通过填写一般问卷及女性性功能指数量表(FSFI)收集资料,分析HPV感染患者FSD发生现状及相关影响因素。结果:300例患者中,FSD发生率为81.00%(243/300),平均FSFI评分为(17.34±9.73)分。在性功能的6个维度中,出现障碍的比例由高到低依次是性欲低下(82.00%)、性满意度下降(69.00%)、性唤起困难(66.67%)、性高潮障碍(62.33%)、性交疼痛(52.00%)、阴道润滑困难(49.33%)。不同年龄、文化程度、职业、收入、焦虑与否的HPV感染患者FSD发生率差异有统计学意义(均P0.05)。Logistic回归分析显示,年龄40岁(OR=7.747,95%CI:3.329～18.030,P0.001)、高中/大专及以下学历(OR=4.029,95%CI:1.540～10.542,P=0.005)、焦虑(OR=4.028,95%CI:1.713～9.472,P=0.001)是HPV感染患者发生FSD的独立影响因素。结论:HPV感染患者的FSD发生率较高,其FSFI评分明显降低,性功能的6个维度中,性欲低下的发生率最高。对于年龄40岁、高中/大专及以下学历以及合并焦虑的HPV感染患者应尤其重视,早期识别并给予干预,改善其生活质量。     

女性性功能障碍的流行病学研究现状

<正>女性性功能障碍(FSD)是指女性个体不能参与她所期望的性行为、在性行为过程中不能或难以得到满足,并造成人际关系紧张,是一种与年龄相关、渐进性发展的严重影响女性生活质量的常见和多发疾病[1],已日益引起人们的重视。FSD的分类方法较多,基本上都是依据性反应周期来划分,均包括了性欲障碍、性唤起障碍、性高潮障碍和性交疼痛,其中以性欲障碍最为常见。女性人群中的性问题广泛     

Prevalence and comorbidity of sexual dysfunctions in a Portuguese clinical sample

We investigated the prevalence and comorbidity of sexual dysfunction in a clinical Portuguese sample. A total of 96 participants (47 females and 49 males with a diagnosis of sexual dysfunction (DSM-IV; American Psychological Association, 1994) assigned by a group of trained sex therapists) answered the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the International Index of Erectile Function (IIEF; Rosen et al., 1997). Results indicated erectile dysfunction (70%) and female hypoactive sexual desire disorders (40.4%) as the most prevalent complaints, with premature ejaculation (22.4%), vaginismus (25.5%), and female orgasmic disorder (21.3%) also showing relevant prevalences. Comorbidity studies indicated higher levels of overlapping among female sexual difficulties with strong associations between desire, subjective arousal, and orgasmic disorders, as well as between dyspareunia and vaginismus.     

Duplex Doppler ultrasound assessment of clitoral hemodynamics after topical administration of alprostadil in women with arousal and orgasmic disorders

There are limited hemodynamic data in women with arousal or orgasmic disorders and even fewer normative control hemodynamic data in women without sexual dysfunction. In addition, there is limited experience with topical vasoactive agents (used to maximize genital smooth muscle relaxation) applied to the external genitalia during hemodynamic evaluations. The aim of this study was to report duplex Doppler ultrasound clitoral cavernosal arterial changes before and after topical PGE-1 (Alprostadil) administration in control women and in patients with arousal and orgasmic sexual disorders. We found that women with sexual arousal and orgasmic disorders had significantly (p < 0.05) diminished clitoral peak systolic and end diastolic velocity responses compared to controls. Further research is needed to establish the diagnostic role of topical vasoactive agents in the hemodynamic evaluation of women with sexual dysfunction.     

Are our definitions of women's desire,arousal and sexual pain disorders too broad and our definition of orgasmic disorder too narrow?

Since each individual female sexual dysfunction is complex, it is necessary to subtype them in addition to dividing them into life-long or acquired disorder. The complexity of women's sexual arousal necessitates appreciation of a number of different types of arousal disorders that vary not only in etiology but also in management. The coexistence of sexual arousal and sexual desire, which develops during a sexual experience, explains the frequent comorbidity of arousal and desire disorders. Subtyping of hypoactive sexual desire disorder allows analysis of lack of receptivity and of any marked loss of the traditional markers of sexual desire over and beyond a normative lessening with relationship duration. Dyspareunia and vaginismus require further analysis prior to any definitive therapy. The definition of orgasmic disorder needs to include loss of orgasmic intensity and the possibility of coincident arousal disorder.     

Sexual dysfunction, Part I: Classification, etiology, and pathogenesis.

BACKGROUND: The sexual dysfunctions are extremely common but are rarely recognized by primary care physicians. They represent inhibitions in the appetitive or psychophysiologic changes that characterize the complete adult sexual response and are classified into four major categories: (1) sexual desire disorders (hypoactive sexual desire, sexual aversion disorder), (2) sexual arousal disorders (female sexual arousal disorder, male erectile dysfunction), (3) orgasmic disorders (inhibited male or female orgasm, premature ejaculation), and (4) sexual pain disorders (dyspareunia, vaginismus). METHODS: Articles about the sexual dysfunctions were obtained from a search of MEDLINE files from 1966 to the present using the categories as key words, along with the general key word "sexual dysfunction." Additional articles came from the reference lists of dysfunction-specific reviews. RESULTS AND CONCLUSIONS: Cause and pathogenesis span a continuum from organic to psychogenic and most often include a mosaic of factors. Organic factors include chronic illness, pregnancy, pharmacologic agents, endocrine alterations, and a host of other medical, surgical, and traumatic factors. Psychogenic factors include an array of individual factors (e.g., depression, anxiety, fear, frustration, guilt hypochondria, intrapsychic conflict), interpersonal and relationship factors (e.g., poor communication, relationship conflict, diminished trust, fear of intimacy, poor relationship models, family system conflict), psychosexual factors (e.g., negative learning and attitudes, performance anxiety, prior sexual trauma, restrictive religiosity, intellectual defenses), and sexual enactment factors (e.g., skill and knowledge deficits, unrealistic performance expectations). Understanding the cause and pathophysiology of sexual disorders will help primary care physicians diagnose these problems accurately and manage them effectively.     

Perspectives of sex therapy outcome: a survey of AASECT providers

Randomly selected AASECT members who reported that they conduct sex therapy (N = 289) responded to a questionnaire about their sex therapy caseloads. Desire discrepancies between partners was the most common problem (31%). Least commonly reported problems were vaginismus (5%), ejaculatory inhibition (5%), and primary erectile dysfunction (2%). Highest success rates (client satisfaction with sexual functioning) were for premature ejaculation (62%), secondary orgasmic dysfunction (56%), and desire discrepancies (53%). Primary erectile dysfunctions had the lowest success rate (25%). The most commonly used treatment methods were a focus on communication skills, general sex education, homework assignments, and a focus on the sexual interaction; sensate focus, and the discussion of nonsexual individual and/or relationship issues also were quite commonly used. From a discriminant function analysis, the combined Therapists and Multiple-certified provider groups reported focusing on sexual interactions more than the combined Counselors and Educators; the Educators were the least likely providers to use a focus either on sexual interactions or on homework assignments. The Counselors were the most likely, and the Educators the least likely, to use communication skills. Therapists and the Multiple-certified providers estimated higher treatment success rates than Counselors and Educators for premature ejaculation, secondary erectile dysfunction, vaginismus, primary orgasmic dysfunction, sexual avoidance, ejaculatory inhibition, and sexual arousal problems. The Educators were the least successful with dyspareunia. Educators and Counselors were similar in reporting the fewest clients with sexual arousal problems. Therapists and Multiple-certified providers reported spending more treatment hours with desire discrepancies and desire problems. The implications of the findings for clinical practitioners and researchers are discussed.     

Client attributions for sexual dysfunction

This investigation examined attributions for sexual dysfunctions made by 63 individuals and 21 of their partners who presented at a sex therapy service for the following problems: erectile dysfunction, premature ejaculation, and female orgasmic dysfunctions. All participants completed measures of marital adjustment, locus of control, depression and a questionnaire which assessed: attributions of responsibility for the sexual problem, perceived control over sexual functioning, distress, effort made to improve the sexual relationship, and expectations about the efficacy of sex therapy for the problem. Results indicate that both identified patients and their partners, regardless of the dysfunction, blamed the sexual problem on the "dysfunctional individual" rather than on the circumstances or the partner. With respect to the partners, husbands of women with orgasmic dysfunction were more likely to blame themselves than the circumstances, while the opposite was true for wives of males with erectile difficulties. Individuals experiencing the dysfunction perceived themselves and their partners as having little, but equal control over the identified patient's sexuality. Correlational analyses indicate that in identified patients, the better the quality of the marital relationship, the greater the self-blame and the lower the partner blame. Those with happy marriages also made greater efforts to improve their sexual relationship and had higher expectations of success with therapy. The implications of the results for research on the role of attributions in sexual dysfunction and for assessment of cognitive factors in sexually dysfunctional individuals and their partners is discussed.     

Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey

STUDY OBJECTIVE: To investigate the association of sexual problems with social, physical, and psychological problems. DESIGN: An anonymous postal questionnaire survey. SETTING: Four general practices in England. PARTICIPANTS: 789 men and 979 women responding to a questionnaire sent to a stratified random sample of the adult general population (n = 4000). MAIN RESULTS: Strong physical, social, and psychological associations were found with sexual problems. In men, erectile problems and premature ejaculation were associated with increasing age. Erectile problems were most strongly associated with prostate trouble, with an age adjusted odds ratio of 2.6 (95% confidence intervals 1.4, 4.7), but hypertension and diabetes were also associated. Premature ejaculation was predominantly associated with anxiety (age adjusted odds ratio 3.1 (95% confidence intervals 1.7, 5.6)). In women, the predominant association with arousal, orgasmic, and enjoyment problems was martial difficulties, all with odds ratios greater than five. All female sexual problems were associated with anxiety and depression. Vaginal dryness was found to increase with age, whereas dyspareunia decreased with age. CONCLUSIONS: This study indicates that sexual problems cluster with self reported physical problems in men, and with psychological and social problems in women. This has potentially important consequences for the planning of treatment for sexual problems, and implies that effective therapy could have a broad impact on health in the adult population.     

Sexual dysfunction among female patients of reproductive age in a hospital setting in Nigeria

Although sexual dysfunction is an important public-health problem in Nigeria, little research has been conducted on this topic in Nigeria. This cross-sectional study was conducted to determine the prevalence of sexual dysfunction and their correlates among female patients of reproductive age using a questionnaire. Respondents were recruited from the out-patients clinics of a teaching hospital setting in Ile-Ife/ Ijesa administrative health zone, Osun State, Nigeria. Of 384 female patients interviewed, 242 (63%) were sexually dysfunctional. Types of sexual dysfunction included disorder of desire (n=20; 8.3%), disorder of arousal (n=l 3; 5.4%), disorder of orgasm (n=154; 63.6%), and painful coitus (dyspareunia) (n=55; 22.7%). The peak age of sexual dysfunction was observed among the age-group of 26-30 years. Women with higher educational status were mostly affected. The reasons for unsatisfactory sexual life mainly included psychosexual factors and medical illnesses, among which included uncaring partners, present illness, excessive domestic duties, lack of adequate foreplay, present medication, competition among wives in a polygamous family setting, previous sexual abuse, and guilt-feeling of previous pregnancy termination among infertile women. The culture of male dominance in the local environment which makes women afraid of rejection and threats of divorce if they ever complain about sexually-related matters might perpetrate sexual dysfunction among the affected individuals. Sexual dysfunction is a real social and psychological problem in the local environment demanding urgent attention. It is imperative to carry out further research in society at large so that the health and lifestyles of affected women and their partners could be improved.     

Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature

The research which has assessed the incidence and prevalence of sexual dysfunctions is reviewed. Twenty-three studies are evaluated. Studies completed with community samples indicate a current prevalence of 5–10% for inhibited female orgasm, 4–9% for male erectile disorder, 4–10% for inhibited male orgasm, and 36–38% for premature ejaculation. Stable community estimates with regard to the current prevalence of female sexual arousal disorder, vaginismus, and dyspareunia are not available. Recent studies completed with clinical samples suggest an increase in the frequency of orgasmic and erectile dysfunction and a decrease in premature ejaculation as presenting problems. Desire disorders have increased as presenting problems in sex clinics, with recent data indicating that males outnumber females. Methodological limitations of these studies are identified and suggestions for future research are offered.