32例性早熟临床分析

目的　分析女性真性性早熟 (ICPP)患者的临床特点、探讨该病的诊断、治疗方法。方法　对1984年以来的 32例ICPP患者进行回顾性分析。结果　绝大多数ICPP患儿在月经来潮前都有不同程度的乳房发育、阴道分泌物增加等早期征象 ;而且身高也大多超出同龄人。结论　应重视ICPP患儿的早期临床征象 ,对疑似者尽早行GnRH兴奋试验。促性腺激素释放激素的衍生物 (GnRH -A)治疗ICPP ,不仅疗效显著 ,而且可明显改善患者的身高。     

中国城市儿童性早熟现状的调查研究

目的对国内城市儿童性早熟现状进行调查,为制定有效的预防策略,并推动儿童性早熟的临床规范化和个性化治疗提供理论依据。方法 2014年3月至12月在全国范围内开展"中国城市儿童性早熟现状调研"活动。调研共收集来自全国10余省市的2 687份问卷,其中1 714份问卷纳入统计分析。结果调查人群大多分布在全国10个主要省市,包括北京、上海、重庆、江苏、湖北等;调查患儿以女童为主,其男女比例约1∶16。诊断为中枢性性早熟的患者占75.79%(1 299/1 714);调查中初次诊断为中枢性性早熟患者占88.91%(1 524/1 714)。调查患者的骨龄为(10.00±1.77)岁,高于实际年龄(8.29±1.60)岁,差异有统计学意义(P0.001);初次诊断为CPP的患者的骨龄为(10.11±1.70)岁,高于实际年龄(8.35±1.57)岁,差异均有统计学意义(P0.001)。结论国内城市儿童性早熟就诊患者的年龄偏大,为防止患者就诊时已错过最佳的干预和治疗时机,应引起对疾病筛查的高度重视,做到早发现、早诊断和早治疗。     

女孩为什么会出现性早熟

近年来，儿童性早熟的发病率明显上升。据相关研究资料表明，其发病率达1％，仅次于肥胖症，已占小儿内分泌疾病的第二位。     

腹腔镜治疗原发性滤泡囊肿伴假性性早熟1例

<正>1病例简介患者,2岁4月,因"反复阴道褐色分泌物3月"就诊。母亲孕期和哺乳期无特殊药物史及激素接触史,母乳喂养至15月,无外伤、特殊疾病及药物史。查体:体重16kg,身高95cm,全身未见皮疹,乳房发育Tanner Ⅲ级,阴毛发育Tanner Ⅱ级,大阴唇稍肥厚,其余无特殊。骨龄相当3.3岁。2月前妇科超声示:子宫前位,前后径1.7cm,内膜0.15cm(单层),右附件2.1cm×1.8cm×1.9cm弱回声,内见直径     

女性性早熟的诊治

性早熟是一种生长发育异常疾病，表现为青春期提前启动，第二性征提前出现。在男女儿童性早熟中，女性多于男性。提前出现的性征与性别一致时为同性性早熟，与性别不一致时为异性性早熟。本文主要阐述女性同性性早熟。临床上以女孩在8岁前出现第二性征发育或10岁前月经初潮为诊断标准。随着生活水平的提高，目前给健康儿童进补的现象越来越普遍，使本病的发生率显著提高。     

特发性真性性早熟的诊治现状

真性性早熟是一种生长发育的异常,表现为青春期特征提前出现和与性别相一致的第二性征出现,同时生长加速、骨龄提前和具备生育能力,其中非器质性病变所致者为特发性或体质性性早熟。近年,本病的发病率显著增高。因此病对患者的最终身高和成年后生育能力有影响,所以对此病的早期诊断和及时治疗极为重要。现对其诊治现状进行综述。     

女性同性性早熟症的病因与定位诊断及处理

女性同性性早熟症 ,是指女童出现女性第二性征 (乳房发育 )或月经初潮的年龄早于正常女童平均年龄加 2个标准差。一般按英国正常女童青春发育的调查资料 ,临床上通常以 8岁前性征发育 ,或 10岁前月经初潮为准。一、病因与分类女性同性性早熟症大致分为两类。(一 )真性或依赖于促性腺激素释放激素 (ＧｎＲＨ)性性早熟因中枢神经系统下丘脑 垂体 卵巢轴过早激活 ,引起卵巢内卵泡过早发育所致。引起过早激活的原因有以下几方面。1 特发性或体质性性早熟症 :原因尚未阐明。2 脑性性早熟症 :较为少见 ,包括下丘脑后部肿瘤 ,如灰结节错构瘤 (有…     

中医治疗女童特发性性早熟的研究进展

近年来,随着生活水平不断提高,儿童性早熟发病率逐年上升。中医认为,性早熟与肝、脾、肾功能失调密切相关,发病机制复杂,中医药治疗性早熟效果显著。本文通过对近5年中医治疗女童特发性性早熟的辨治经验、临床研究与实验研究进行综述,以期对该领域进一步发展提供参考。     

Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample

BackgroundRelational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability.AimTo investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings.MethodsUsing a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration.OutcomesPatients completed the Female Sexual Function Index, the Couple’s Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test.ResultsMediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration.Clinical ImplicationsFindings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning.Strengths and LimitationsThe importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are strengths. The cross-sectional design precludes any causal conclusions and it is unknown whether the results generalize to male partners, partners within other relationship structures, and non-heterosexual couples.ConclusionGreater relational intimacy mitigates the adverse impact of impaired sexual functioning on sexual behavior and satisfaction in women.Witherow MP, Chandraiah S, Seals SR, et al. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. J Sex Med 2017;14:843–851.     

Standards for Clinical Trials in Male and Female Sexual Dysfunction: IV. Unique Aspects of Clinical Trials in Female Sexual Dysfunction

The focus of this article, the fourth in the series, Standards for Clinical Trials in Male and Female Sexual Dysfunction, is on aspects of clinical trial design and measurement that are specific to clinical trials for treatments of female sexual dysfunction. Challenges in this area include the limited extent of treatment development and clinical trial research across the spectrum of female sexual dysfunctions, changing regulatory considerations, changing diagnostic criteria for female sexual dysfunction, and the need to articulate assessment procedures to these changes. Discussion focuses on approaches to addressing these challenges in clinical trials in female sexual dysfunction.     

Standards for Clinical Trials in Male and Female Sexual Dysfunction: III. Unique Aspects of Clinical Trials in Male Sexual Dysfunction

This series of articles, Standards for Clinical Trials in Male and Female Sexual Dysfunction, began with the discussion of a common expected standard for clinical trial design in male and female sexual dysfunction, a common rationale for the design of phase I to IV clinical trials, and common considerations for the selection of study population and study duration in male and female sexual dysfunction. The second article in this series discussed fundamental principles in development, validation, and selection of patient- (and partner-) reported outcome assessment. The third and present article in this series discusses selected aspects of sexual dysfunction that are that are unique to male sexual dysfunctions and relevant to the conduct of clinical trials of candidate treatments for men.     

Sexual abuse experienced by married Egyptian women.

OBJECTIVE: To assess the prevalence of sexual abuse (SA) and associated factors among married women in Lower Egypt. METHODS: A cross-sectional clinic- and hospital-based survey was designed for married women aged between 16 and 49 years. The study was conducted with 936 women from the Dakahlia Governorate, which is considered representative of Lower Egypt. Data were collected by personal interview using a questionnaire. RESULTS: The response rate was 93.6%. The most commonly reported frequency of sexual intercourse was 2 to 4 times per week. More than one-third of the women (36.2%) thought this was too frequent, and 11.5% reported being sexually abused in addition to other sexual problems. The educational level of the women; the presence of genital mutilation; parity, especially for those who had more than 5 deliveries; number of gynecologic visits; and history of gynecologic interventions were significantly or highly significantly associated with SA. The husbands' educational level and age were highly significantly correlated with their wives reporting SA, particularly when the men were illiterate or were smokers or drug users. CONCLUSION: The study's findings demonstrate an immediate need for the prevention of SA in Lower Egypt.     

The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples

Introduction

Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress.

Sexual and Relationship Satisfaction in Young,Heterosexual Couples: The Role of Sexual Frequency and Sexual Communication

BackgroundAlthough their individual contributions to sexual and relational outcomes are well-established, there has been a lack of research on the importance of sexual frequency and sexual communication to sexual and relationship satisfaction.AimTo examine the contribution of sexual frequency and sexual communication to sexual and relationship satisfaction in the early stages of couple relationships.MethodsA sample of 126 young, heterosexual couples (mean age = 23.3 years, SD = 2.4; average relationship duration = 1.9 years, SD = 0.9) filled out questionnaires about sexual frequency, sexual communication, and sexual and relationship satisfaction. Analyses were guided by the actor-partner interdependence model.OutcomesMain outcome variables were sexual satisfaction and relationship satisfaction, measured by the Quality of Sex Inventory and the Couple Satisfaction Index, respectively.ResultsAnalyses revealed a significant actor effect of both sexual communication and sexual frequency for sexual satisfaction. Only sexual communication, not sexual frequency, predicted relationship satisfaction. No significant partner or gender effects were found.Clinical TranslationThese findings lend support to the notion that couples could benefit from focusing on non-behavioral processes (eg, sexual communication), rather than sexual behavior per se, when pursuing a fulfilling partnership.Strengths & LimitationsStrengths of the study include the dyadic nature of the data and analyses, allowing for the evaluation of both individual- and couple-level processes. Also, to our knowledge, this is the first study to specifically examine the importance of sexual frequency and sexual communication to both sexual and relationship satisfaction. Limitations include the reliance on self-report measures and a relatively homogeneous sample.ConclusionAlthough both sexual frequency and sexual communication were relevant to the prediction of sexual satisfaction, only sexual communication predicted relationship satisfaction in this sample of young, heterosexual couples.Roels R, Janssen E. Sexual and Relationship Satisfaction in Young, Heterosexual Couples: The Role of Sexual Frequency and Sexual Communication. J Sex Med 2020;17:1643–1652.     

Visual Attention to Sexual Stimuli in Women With Clinical,Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study

BackgroundVisual attention to sexual stimuli is an important means to facilitate sexual arousal and is thereby relevant for healthy sexual functioning. Experimental studies suggest that sexual dysfunction is associated with less attention toward sexual stimuli.AimThe goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women in the clinical range of sexual function attend to a genital area in visual sexual stimuli differently than women with subclinical sexual function or those with normal sexual functioning.MethodsToward this goal, 69 women (M_age = 27.77, SD = 8.00, range = 19–54) with clinical (n = 30), subclinical (n = 23), and normal (n = 16) levels of sexual functioning watched a series of 10 pictures depicting heterosexual couples during vaginal intercourse while their eye movements were recorded. Each picture was presented twice—once with a distracting object (eg, a to-do list or household appliance) present in the picture and once without—for 8 seconds, each.Outcomes5 eye-tracking measures indicative of different aspects of initial and sustained attention were analyzed.ResultsAs hypothesized, 3 out of 5 eye-tracking measures (ie, first fixation duration, number of first fixations, and total fixation duration) indicated that women in the clinical group attended less to the genital area in the pictures than women with normal sexual functioning. For 2 indices (ie, first fixation duration and total fixation duration), women with subclinical (vs normal) sexual functioning also attended less to the genital area. In contrast to our hypothesis, the presence of a distracting object did not influence attention to the genital area in either of the sexual function groups.Clinical ImplicationsThis study provides further evidence of the role of attentional biases in sexual dysfunction in women.Strengths and LimitationsEye-tracking methodology allows for a continuous measurement of visual attention; this is one of the first studies using this methodology to assess differences in visual attention in women with and without sexual dysfunction. However, the cross-sectional nature of this study prevents causal interpretation of findings.ConclusionFuture studies should use experimental paradigms to determine the causal role of visual attention for the development or maintenance of sexual dysfunction.Velten J, Milani S, Margraf J, et al. Visual Attention to Sexual Stimuli in Women With Clinical, Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study. J Sex Med 2021;18:144–155.     

Sexual Distress and Sexual Problems During Pregnancy: Associations With Sexual and Relationship Satisfaction

IntroductionSexual problems are common during pregnancy, but the proportion of pregnant women who experience sexual distress is unknown. In non-pregnant samples, sexual distress is associated with lower sexual and relationship satisfaction.AimTo identify the proportion of women experiencing sexual distress during pregnancy and to compare the sexual and relationship satisfaction of women who report sexual distress during pregnancy with that of women without distress.MethodsTwo-hundred sixty-one pregnant women completed a cross-sectional online survey.Main Outcome MeasuresWomen completed validated measurements of sexual functioning (Female Sexual Function Index; score < 26.55 indicates a sexual problem), sexual distress (Female Sexual Distress Scale; score ≥ 15 indicates clinically significant distress), sexual satisfaction (Global Measure of Sexual Satisfaction), and relationship satisfaction (Couples Satisfaction Index).ResultsOverall, 42% of women met the clinical cutoff for sexual distress. Of sexually active women (n = 230), 26% reported concurrent sexual problems and distress and 14% reported sexual distress in the absence of sexual problems. Sexual distress and/or problems in sexual functioning were linked to lower sexual and relationship satisfaction compared with pregnant women with lower sexual distress and fewer sexual problems.ConclusionSexual distress is common during pregnancy and associated with lower sexual and relationship satisfaction. Health care providers should ask pregnant women about feelings of sexual distress. Identifying pregnant women who experience sexual distress and referring them to appropriate resources could help minimize sexual and relationship problems during pregnancy.Vannier SA, Rosen NO. Sexual Distress and Sexual Problems During Pregnancy: Associations With Sexual and Relationship Satisfaction. J Sex Med 2017;14:387–395.