行为疗法治疗女性性功能障碍56例报告

目的 :探索在我国应用行为疗法治疗女性性功能障碍的疗效 ,并结合国情进行改良 ,以提高可行性并有利于推广应用。　方法 :征得自愿接受行为疗法的 56例女性心理性性功能障碍病人 ,按玛斯特斯 约翰逊提出的性感集中训练为基本模式 ,结合中国国情进行改良 ,着重在突破传统观念的束缚 ,加强健康性观念、性知识和性技巧的教育 ,在进行心理治疗和行为疗法的同时处理好婚姻问题、社会问题 ,并强调配偶积极参与治疗的重要性。　结果 :治愈 2 6例 (46 .43 % ) ,好转 2 4例 (42 .86 % ) ,总有效率 89.2 9% ,无效 6例 (1 0 .71 % )。　结论 :行为疗法治疗女性性心理性功能障碍有着显著的疗效 ,但尚存在费时较长并对治疗医生专业素质要求较高等问题     

女性性功能障碍生理学研究进展

女性性功能障碍（female sexual dysfunction，FSD）发病率很高，根据美国统计占成年妇女的30％～50％，是一种与年龄相关、呈进行性发展的疾病。2000年Xin等通过对我国540名23～55岁的健康女性进行女性性功能简明指数（BISF-W）评定，发现性生活不满意者、达高潮困难者、性生活每月少于2次者分别为55．5％、39．68％和31．75％。由于传统思想的影响，对FSD的研究远落后于男性性功能障碍。目前对FSD发病机制的研究不够深入，各项研究处于起步阶段。本文对FSD的生理学研究进展作一简要综述。     

女性系统性红斑狼疮患者性功能障碍的研究进展

系统性红斑狼疮好发于育龄期女性,被广泛报道存在性功能障碍,患病率高,机制复杂,成为不可忽视的问题。目前临床可用光学体积描记法、阴道pH值测定、女性生殖道温度测定,以及多普勒超声等客观手段评价女性性功能障碍临床治疗效果,主观评价法可采用访谈类质性研究和自评量表等。影响因素包括社会人口学因素、心理状态及自我感知因素、疾病相关因素。目前认知行为疗法及激素调节等措施可以改善患者性功能障碍。然而现阶段相关研究并不透彻,尚缺乏进一步队列研究、基础研究及临床干预手段的探索。     

糖尿病女性性功能障碍研究进展

糖尿病是一种常见病、多发病,而女性性功能障碍是其并发症之一。研究显示糖尿病血管病变、神经病变、内分泌失常和心理因素是女性性功能障碍的主要发病原因。本文就近年来糖尿病女性性功能障碍研究进展做一综述。     

血液透析患者性功能障碍临床研究

目的：探讨男性血液透析患者性功能障碍的影响因素.方法：对164例维持性血液透析患者（MHD）采用自我行为量表（SCS）、抑郁自评量表（SDS）及勃起功能国际指数问卷（IIEF-5）进行问卷调查.结果：发现年龄、糖尿病和高BDI得分是独立的影响性功能障碍的指标,在性功能指标得分较低的患者其健康相关生活质量量表的各项得分也显著降低,得分均具有统计学意义.结论：男性血液透析患者性功能障碍与抑郁程度、高龄、糖尿病及生活质量均有关系.     

乳腺癌术后患者性功能障碍的研究进展

综述乳腺癌术后患者性功能障碍状况,分析乳腺癌术后患者性功能障碍的影响因素,提出乳腺癌手术及术后综合治疗都会不同程度影响患者的性功能,改善性功能的干预措施包括心理干预、健康教育、配偶关爱、药物干预等。     

乳腺癌患者性功能障碍相关因素分析

目的 :探讨乳腺癌患者性功能障碍的相关因素 ,以利于开展乳腺癌患者性功能障碍的防治工作以及提高患者生活质量。　方法 :以统一自制的性功能状况问卷 ,对门诊 6 5例康复期的乳腺癌患者问卷调查治疗前后的性功能状况。　结果 :患者年龄和认知因素与患者性功能障碍患病率显著相关。 4 5～ 5 5岁组和 5 6～ 6 5岁组性功能障碍患病率分别为 6 6 .7%、73.9% ,与小于 4 5岁组 (33.3% )相比 ,有显著统计学差异 (P <0 .0 1) ;认为性生活不是生活重要内容者性功能障碍患病率为 70 .3% ,与认为性生活是生活重要内容者 (4 7.6 % )相比 ,有统计学差异 (P <0 .0 5 ) ;在调查因素中 ,肿瘤分期、治疗方式、阴道干燥、性欲降低、性交痛及认知因素与患者新发性功能障碍的发生显著相关 (P <0 .0 5 )。　结论 :乳腺癌患者治疗后 ,性功能障碍的发生与肿瘤分期、治疗方式、认知因素及阴道干燥等显著相关 ;提示为防治乳腺癌患者性功能障碍 ,从事肿瘤专业的医务人员在治疗过程中应与患者交流关于性功能障碍的问题 ,并进行全面评价 ,指导患者解决这些问题的方法。     

女性性功能障碍病因学研究进展

女性性功能障碍是一种年龄相关性性疾病 ,呈进行性发展 ,发病率高 ,严重影响着妇女的生活质量。然而 ,它并未得到足够的重视。本综述着重讨论其局部调节机制及病因学因素 ,希望日后随着对女性性功能障碍的病理生理学机制研究的不断深入和认识的不断提高 ,研究出恰当的治疗措施     

女性性功能障碍的研究进展

女性性功能障碍与年龄有关 ,呈进行性发展 ,其发病率较高 ,约有 30 %～5 0 %女性发生此症。根据美国健康及女性生活质量调查 ,1749例女性中有性功能障碍者达 43% ,在美国 5 0～ 74岁女性中有 970万人主诉有阴道滑润度减少及不易有性高潮。女性性功能障碍是女性健康中一个重要的影响生活质量的内容。由于对女性性功能障碍的研究很少 ,因此对女性性反应及女性性功能障碍的解剖学及生理学知之甚少。根据对男性阴茎勃起反应的生理学方面的了解 ,近年来才对女性性功能障碍开始了一些研究 ,估计不久的将来 ,对女性性功能健康问题的诊断及治疗将会…     

评估勃起功能障碍男性患者的女性伴侣的性功能：对男性性功能障碍的治疗可以改善女性伴侣的性功能吗？

勃起功能障碍（ED）既影响患者也影响其女性伴侣对性生活的满意度，对ED的治疗，比如口服万艾可，能明显提高患者的满意度，而治疗是否也能提高女性伴侣对性生活的满意度呢？Cayan S等的研究对此作出了回答。研究者将87名妇女按她们的性伴侣是否有ED分为2组。男性ED患者中，30例分别行阴茎假体治疗（17例）或口服枸橼酸西地那非治疗（13例）。     

Thyroid dysfunction in infertile women

Objective: To determine the frequency of thyroid dysfunction in infertile women referred for thyroid evaluation. Design: A retrospective case-control study. Place and Duration of Study: This study was carried out at Centre for Nuclear Medicine (CENUM), Mayo Hospital, Lahore, from July 2003 to December 2006. Patients and Methods: Age matched infertile (n=140 each) and fertile women (n=152 each) referred to CENUM for thyroid evaluation were investigated for incidence of hyperthyroidism (TSH < 0.03 mIU/L), hypothyroidism (TSH < 0.03 mIU/L) and thyroid autoimmunity (antithyroid peroxidase antibody titer>20 IU/L). Serum free T4 (FT4), free T3 (FT3) and antithyroid peroxidase antibody (TPO-Ab) was determined by radioimmunoassay (RIA) and TSH by immunoradiometric assay (IRMA). Results: Most of the infertile women (89.3%), like control women (93.4%), were euthyroid. The difference of overall thyroid dysfunction was not statistically significant in infertile and control women (10.7% vs. 7.9%; p=0.395). The same was true for incidence of hyperthyroidism (4.3% vs. 5.3%; p=0.701) as well as hypothyroidism (6.4% vs. 2.6%; p=0.104). In infertile women, the incidence of hypothyroidism (6.4%) was slightly higher as compared to hyperthyroidism (4.3%). In euthyroid women of both groups, mean FT4, FT3 and TSH levels were significantly higher (p < 0.05) in infertile women and double number of them had serum TSH>2.5 mIU/L compared to fertile women (31.2% vs. 15.6%; p<0.01). Similarly, more infertile women were TPO-Ab positive (titer>20 IU/L) than control women (7.2% vs. 1.4%; p < 0.05). Conclusion: Increased incidence of high normal TSH and raised TPO-Ab titer indicate relatively more frequent occurrence of compensated thyroid function in infertile women than normal women of reproductive age. This necessitates considering them a subgroup of women in which all aspects of pituitary-thyroid axis should be thoroughly investigated than merely TSH testing.     

Assessment of sexual function in women with pelvic floor dysfunction

Forty-seven women participated in a pilot study for a multi-centre randomized controlled trial of the effectiveness of pelvic floor muscle training (PFMT) for women with prolapse. Women with symptomatic stage I or II prolapse [measured by Pelvic Organ Prolapse Quantification (POP-Q)] were randomized to a 16-week physiotherapy intervention (PFMT and lifestyle advice; n = 23) or a control group receiving a lifestyle advice sheet (n = 24). Symptom severity and quality of life were measured via postal questionnaires. Blinded POP-Q was performed at baseline and follow-up. Intervention women had significantly greater improvement than controls in prolapse symptoms (mean score decrease 3.5 versus 0.1, p = 0.021), were significantly more likely to have an improved prolapse stage (45% versus 0%, p = 0.038) and were significantly more likely to say their prolapse was better (63% versus 24%, p = 0.012). The data support the feasibility of a substantive trial of PFMT for prolapse. A multi-centre trial is underway.     

Assessment of sexual function in women with pelvic floor dysfunction

This article reviews sexual function questionnaires used in urogynecology, impact of pelvic floor dysfunction (PFD) on sexual function, and impact of surgical treatment of PFD on sexual function, with a focus on the experience and publications of validated sexual function questionnaires in the urogynecologic literature. A review of the literature was performed to obtain data on sexual function and PFD focusing on those studies that utilized validated sexual function questionnaires. Validated questionnaires assure data that are reliable, quantifiable, and reproducible. Quality-of-life questionnaires, such as The King’s Health Questionnaire and the Incontinence Impact Questionnaire, include a few questions addressing sexual function but really deal with the overall impact of incontinence and/or prolapse on the patient’s QOL or well-being and do not focus on sexual function. General questionnaires focused on sexual function include the Female Sexual Function Index and the Sexual History Form 12, which were designed to evaluate sexual function and have undergone validation and reliability testing in a general population. General questionnaires are not condition-specific and may not be sensitive enough to detect differences due to PFD. The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ) is a condition-specific questionnaire focused on sexual function for use in women with PFD and has undergone rigorous validation and reliability testing. Many recent publications examining the impact of urinary incontinence (UI), fecal incontinence, and pelvic organ prolapse (POP) using validated generalized and disease-specific questionnaires have reported poorer sexual function in women with PFD. The PISQ has been used most commonly to evaluate sexual function after surgery for PFD, with increased PISQ scores in approximately 70%. Significant improvement is noted for sexual function related to physical and partner-related factors, with no changes for orgasm, desire, or arousal after surgical repair of PFD. Studies which used generalized sexual function questionnaires mainly found no change in sexual function following surgical treatment of POP and/or UI. In summary, the use of validated questionnaires shows that PFD is associated with a negative impact on sexual functions. Surgical correction of POP and/or UI improves sexual function in approximately 70% of patients, although some studies show no change with the use of non-condition-specific questionnaires.     

The metabolic syndrome: a cause of sexual dysfunction in women

Female sexual dysfunction (FSD) is a significant public health problem. We assessed the prevalence of FSD in premenopausal women with the metabolic syndrome as compared to the general female population. Compared with the control group (N = 80), women with the metabolic syndrome (N = 120) had reduced mean full Female Sexual Function Index (FSFI) score (23.2+/-5.4 vs 30.1+/-4.7, P < 0.001), reduced satisfaction rate (3.5+/-1.1 vs 4.7+/-1.2, P < 0.01), and higher circulating levels of C-reactive protein (CRP: 2.2 (0.6/4.9) vs 0.8 (0.2/2.9) mg/l, median (interquartile range), P = 0.01). There was an inverse relation between CRP levels and FSFI score (r = -0.32, P=0.02). Investigation of female sexuality is suggested for patients with the metabolic syndrome.     

Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction

OBJECTIVES: Sildenafil has been demonstrated to be safe and effective in the treatment of men with erectile dysfunction. The role of sildenafil in treating women with sexual dysfunction has heretofore not been reported. The purpose of this preliminary study was to ascertain the response of postmenopausal women with self-described sexual dysfunction treated with sildenafil for 3 months. METHODS: Thirty-three consecutive postmenopausal women with sexual dysfunction based on history were entered in this open-label, nonrandomized study. All patients received 50 mg of sildenafil. Efficacy was assessed at weeks 4, 8, and 12 using a newly developed 9-item, self-administered Index of Female Sexual Function (IFSF) and a global efficacy question ([GEQ] Did treatment improve your sexual function?). The IFSF quantifies the domains of desire, quality of sexual intercourse, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation. RESULTS: Of the group, 30 women (91 %) completed the study and were available for follow-up at 3 months. Mean baseline IFSF score before therapy was 24.8+/-9.8. Mean usage of sildenafil was 3.1+/-1.4 times per week for the duration of the study. The IFSF score improved to 29.5+/-7.6, 30.3+/-8.5, and 31.4+/-10.4 at 4, 8, and 12 weeks, respectively (P = 0.25). Mean scores for questions 2 (lubrication), 8 (orgasm), and 9 (clitoral sensation) improved by 23.2%, 7.4%, and 31.3%, respectively, at 12 weeks. Seven women (21%) noted improvement on the GEQ. Overall, only 6 (18.1%) of 33 patients had a significant (more than 60% improvement in IFSF score) therapeutic response. Clitoral discomfort and "hypersensitivity" occurred in 7 women (21%), 3 of whom withdrew from the study. Other side effects, which did not result in withdrawal from the study, included headache (n = 5), dizziness (n = 4) and dyspepsia (n = 3). CONCLUSIONS: The data suggest that sildenafil is well tolerated in postmenopausal women with sexual dysfunction. Overall sexual function did not improve significantly, although there were changes in vaginal lubrication and clitoral sensitivity. The role of sildenafil in treating sexual dysfunction in various cohorts of women remains to be determined.     

Molecular detection of Chlamydia trachomatis and semen quality of sexual partners of infertile women

Chlamydia trachomatis is considered as the bacterium that is more sexually transmitted as cause of male urethritis, epididymitis, orchitis and infertility. A total of 116 semen samples of men whose couples are infertile women were analysed. The quality of the semen was measured by standard procedures recommended by WHO while C. trachomatis was detected by the PCR assay. Thirty‐seven semen samples were positive for C. trachomatis (31.9%). Regarding semen analysis, no different values were observed between positive and negative samples to C. trachomatis. However, the presence of leucocytes and erythrocytes suggests an inflammatory process; however, these were high in negative samples to C. trachomatis. Furthermore, an association between low seminal volume at 1, 5 ml and the positivity to C. trachomatis was observed (OR=2, 1; CI₉₅% 1,16‐3,07). The total semen volume is a contribution by the various accessory glands (this reflects the secretory activity of the glands); a low semen volume could be due to an obstruction of the ejaculatory duct or infection of accessory glands by C. trachomatis. More studies are necessary to identify the causes of a reduced semen volume.