Abstract: Two hundred and fifty women, randomly selected from the patients of Maternal and Childhood Centers in Ismailia, were examined gynecologically and interviewed to investigate their psychosexual activity. Results showed that the 80% who were circumcised, complained more significantly of dysmenorrhea (80.5%), vaginal dryness during intercourse (48.5%), lack of sexual desire (45%), less frequency of sexual desire per week (28%), less initiative during sex (11%), being less pleased by sex (49%), being less orgasmic (39%), and less frequency of orgasm (25%), and having difficulty reaching orgasm (60.5%) than the uncircumcised women. However, other psychosexual problems, such as loss of interest in foreplay and dyspareunia, did not reach statistical significance. The study suggests that circumcision has a negative impact on a woman's psychosexual life.

Abstract: Sexual dysfunction and dissatisfaction are common symptoms associated with depression. Optimal antidepressant treatment should result in remission of the symptoms of the underlying illness and minimize the potential for short- and long-term adverse effects, including sexual dysfunction. Sexual dysfunction and dissatisfaction are frequently persistent or worsen with the use of some antidepressant medications; this sexual dysfunction and dissatisfaction can have negative impact on adherence to treatment, quality of life, and the possibility of relapse. Successful management of sexual complaints during antidepressant treatment should begin with a systematic approach to determine the type of sexual dysfunction, potential contributing factors, and finally management strategies that should be tailored to the individual patient. The basic physiologic mechanisms of the normal sexual phases of libido, arousal, and orgasm and how these mechanisms may be interrupted by some antidepressants provide a framework for the clinician to utilize in order to minimize sexual complaints when initiating and continuing antidepressant treatment. This article provides guidelines, based upon this type of model, for the assessment, management, and prevention of sexual side effects associated with antidepressant treatment.

Abstract: The purpose of this study was to prospectively examine the occurrence and severity of sexual dysfunction symptoms in depressed patients before and after 6 months of treatment with selective serotonin reuptake inhibitors. The study was part of a randomized, double-blind, controlled trial of sertraline or citalopram in patients with a DSM-III-R major depressive disorder treated by general practitioners. Three hundred eight patients (221 women and 87 men) were assessed at baseline and after 6 months of treatment by means of the Montgomery-Asberg Depression Rating Scale and five items from the Utvalg for Kliniske Undersogelser (UKU) Side Effect Scale covering different aspects of sexual functioning. As measured by the UKU Side Effect Scale, sexual desire and mean total score significantly improved in women, and sexual desire improved in men. Men reported no change in orgasmic dysfunction, erectile dysfunction, or mean total score, but there was a trend toward worsening of ejaculatory dysfunction. However, in the subgroup of women who reported no sexual problems at baseline, 11.8% reported decreased sexual desire, and 14.3% reported orgasmic dysfunction at week 24. The corresponding figures in the same subgroup of men were 16.7% and 18.9%, respectively, and as many as 25% experienced ejaculatory dysfunction after 24 weeks. There were no statistically significant differences between sertraline and citalopram in the magnitude or frequency of adverse sexual side effects.

Abstract: Sexuality is a major aspect of intimacy and includes components such as sexual desire, activity, attitudes, body image, and gender-role identity. Sexuality is integral to most marital or romantic relationships and is central to one's self-concept, self-esteem, and mental and physical health. The centrality and complexity of sexuality continue throughout the lifespan. This review examines the following issues of sexuality in older adults: normal physical changes associated with aging and strategies to compensate for those changes, patterns of change in sexual behavior psychosocial and cultural aspects of sexuality, sexual dysfunction, and some of the unique concerns in working with cognitively impaired and physically disabled older adults. Assessment of sexual function and treatment of dysfunction are beyond the scope of this review. For a review of these issues, see Zeiss, Zeiss, and Davies (1999) and McConaghy (1996). Throughout this article, we attempt to frame information in ways that are relevant to heterosexual and gay, lesbian, and bisexual individuals. While it can be easy to slip into assumptions that all older adults are heterosexual and in coupies, this clearly is not the reality. It is important to recognize the needs and interests of older gay, lesbian, and bisexual adults, as well as those of heterosexual individuals. Unfortunately, little research on sexuality and aging has been conducted on self-identified gay, lesbian, and bisexual adults. PHYSICAL CHANGES WITH AGING A reasonable place to start examining the effects of aging on sexuality is to consider the physical response to sexual stimulation in older adults as compared to younger adults. The organized pattern of response to sexual stimulation is called the "sexual response cycle." Characteristic physiological changes during the sexual response cycle do occur with aging (Masters and Johnson, 1966; see Meston, 1997, for a recent review), but there also are great individual differences in the extent and timing of these changes. Some of the individual differences are accounted for by general health factors, but in addition, continued sexual activity lessens changes; that is, the more sexually active the older person, the fewer physical changes the person is likely to experience in her or his pattern of sexual response. Among postmenopausal women, age is associated with a reduction in estrogen, progesterone, and androgen levels. Loss of estrogen results in a thinning of the vaginal walls and decreased or delayed vaginal lubrication in response to sexual stimulation. Both of these changes can result in pain during intercourse or any vaginal penetration. Vaginal penetration also may be more difficult, given that the labia no longer fully elevate during sexual arousal to create the funnel-like entrance toward the vagina. Additionally, the vaginal barrel shortens and narrows, and the cervix may descend into the vagina, increasing the chance of cervical bumping during intercourse, which can be painful. Orgasmic (and multiorgasmic) response remains, but vaginal contractions are fewer and weaker, and general body involvement is reduced. Once a sexual interaction is completed, older women also return to the pre-aroused state more rapidly than when they were younger. Among older men, age is associated with decreased testosterone levels. However, loss of testosterone seems to have limited impact on sexual functioning, as only a minimal level of testosterone is necessary for adequate sexual functioning (Meston, 1997). Older men require more direct stimulation of the penis, and for a longer duration, to experience erection. The maximum level of erection may be less than too percent (e.g., 80-go percent). Orgasmic response remains but, as with women, orgasm consists of fewer and weaker contractions and reduced general body response. Both the force and amount of ejaculation may be reduced. The refractory period, or the time during which a man cannot be restimulated to erection, can lengthen, to hours or days, from a few minutes in younger men. …

Abstract: OBJECTIVE The aim of this study was to determine the effect of the Eros-Clitoral Therapy Device (Eros-CTD) on the sexual function of women with and without symptoms of female sexual arousal disorder (FSAD). DESIGN Periodic survey of sexual function in women using the Eros-CTD over a six-week period. SUBJECTS A total of 19 women participated in the study--10 with symptoms of FSAD and nine without symptoms of FSAD--ranging in age from 28 to 65 years, with a mean age of 45.2 years. METHODS Ten patients with symptoms of FSAD and 10 without symptoms were instructed in the use of the small, portable vacuum device, Eros-CTD. One woman without symptoms of FSAD withdrew early in the study for personal reasons. The patients were instructed in the correct use of the device and were asked to complete one Female Intervention Efficacy Index (FIEI) each week. The patients also kept diaries of their use of the device, noting the frequency, length, and strength of vacuum. RESULTS There was a significant improvement in all symptoms of FSAD (P < .05), including increased sensation, improved vaginal lubrication, enhanced ability to orgasm, and greater overall satisfaction. Patients without FSAD also reported similar changes in sensation, lubrication, ability to orgasm, and overall satisfaction. LIMITATIONS This study was done on a small sample of self-selected patients, was of limited duration, and had no long-term follow-up. All of these factors should be considered in interpreting the data. CONCLUSION The Eros-CTD was safe and effective in improving symptoms of FSAD in this group of women. Further studies on the efficacy of the Eros-CTD are indicated.

Abstract: This current study examined the effect of a 3-week period of sexual abstinence on the neuroendocrine response to masturbation-induced orgasm. Hormonal and cardiovascular parameters were examined in ten healthy adult men during sexual arousal and masturbation-induced orgasm. Blood was drawn continuously and cardiovascular parameters were constantly monitored. This procedure was conducted for each participant twice, both before and after a 3-week period of sexual abstinence. Plasma was subsequently analysed for concentrations of adrenaline, noradrenaline, cortisol, prolactin, luteinizing hormone and testosterone concentrations. Orgasm increased blood pressure, heart rate, plasma catecholamines and prolactin. These effects were observed both before and after sexual abstinence. In contrast, although plasma testosterone was unaltered by orgasm, higher testosterone concentrations were observed following the period of abstinence. These data demonstrate that acute abstinence does not change the neuroendocrine response to orgasm but does produce elevated levels of testosterone in males.

Abstract: The Toronto Alexithymia Scale (TAS-26) was administered to patients with sexual disorders (n = 112) and to healthy control subjects (n = 94). The clinic sample was divided into three subgroups according to DSM-III-R criteria: patients with hypoactive sexual desire disorder (n = 41), patients with orgasm disorders (n = 51) and patients with male erectile disorder (n = 20). TAS scores were significantly higher for male and female patients with hypoactive sexual desire disorder, and with male erectile disorder than controls. The TAS scores in the orgasm disorder patients were not significantly different from those of controls. These results are interesting because they show an association betweeen alexithymia and some sexual symptoms.

Abstract: Objective To explore the changes perceived by patients in their sexual lives after orchidectomy and radiation therapy of the pelvic and para-aortic nodes for early-stage testicular seminoma (ST). Patients and methods A questionnaire mainly based on two self-completed instruments, previously used to assess the sexual life of patients affected by testicular cancer (the UCLA/RAND sexual module and the Groningen sexual questionnaire) was mailed to a consecutive series of 143 patients treated for ST between 1961 and 1995, and who showed no signs of disease after primary treatment. Results Ninety-eight questionnaires (69%) were returned and were evaluable. The median age of the patients was 48 years (range 26–85) at the time they completed the questionnaire, with the median follow-up of 123 months (range 15–496). Most of the patients (86%) had been sexually active during the month before completing the questionnaire. Of these patients, 25% reported a low libido and 14% defined their sexual capacity as poor; 14% of the patients avoided sexual contact after treatment because of the disease and/or cancer therapies. After therapy, a minority of the patients found it more difficult to achieve and maintain an erection. Similarly, a few patients reached orgasm less intensely and less frequently. During the period after treatment, 24% reported a low semen volume, 14% premature ejaculation, 2% late ejaculation and 2% an absence of ejaculation. Most of the patients considered the information and counselling given by their physician about the sexual sequelae of therapy to be insufficient. However, the amount of information about the disease and treatment was considered to be good by, respectively, 64% and 61% of the patients. The only variable predictive of sexual adjustment was age at the time of the administration of the questionnaire. Conclusion The sexual adjustment of patients treated with orchidectomy and radiation therapy for early-stage ST is generally good, but a few have negative experiences. Although the main predictive factor is age, communication is an important issue and better information tools could lead to better adjustment.

Abstract: The aim of this study was to investigate age, menopausal status, and the male partner's sexual function on the sexual function of the menopausal woman. Sexual functioning of 304 women (120 premenopausal, 76 perimenopausal, 108 post‐menopausal) aged between 35 and 65 years from a community sample was investigated. Multiple regression analyses found that sexual satisfaction within the relationship was better predicted by age group than by menopausal status. Younger women were more likely to be satisfied with their sexual relationship than older women. Age group was also a better predictor than menopausal status of current frequency of intercourse, with younger women being likely to have more frequent intercourse than older women. Whether a female respondent had experienced a sexual dysfunction was better predicted by menopausal status than by age. Women who were menopausal were more likely to report a sexual problem such as lack of sexual interest, poor lubrication, and failure to have an orgasm. However, a...

Abstract: In this review, we briefly discuss recently published data on female sexual desire, arousal, orgasm and pain, and on medical/iatrogenic factors associated with female sexual function. The studies reviewed highlight a number of important methodological and etiological issues in the study of female sexual function. Researchers are urged to use standardized methods for defining sexual disorders and for selecting patient samples. Placebo-controlled studies are essential for examining the pharmacological aspects of female sexual dysfunction. Evidence suggests that free testosterone levels may be associated with sexual desire in women. Sildenafil citrate increases genital blood flow but may not impact on subjective reports of arousal. Past research implicated the serotonin 5-hydroxytryptamine 2 and 5-hydroxytryptamine 1A receptors in female sexual function, while recent data suggest a role for the 5-hydroxytryptamine 3 receptor. Increasing attention is being paid to medical/health conditions that impact sexual function (e.g. neurological conditions, cancer, hysterectomy, and cardiovascular disease).

Abstract: Objective The goal of this study was to investigate the effects of hormone replacement therapy (HRT) and tibolone on the sexuality and quality of life of Taiwanese postmenopausal women. Methods Forty-eight postmenopausal women were enrolled and prospectively randomized to receive either HRT or tibolone for 3 months. At the end of the 3-month period, quality of life measures were assessed using the Greene Climacteric Scale and attitudes of sexuality were evaluated using the McCoy Sex Scale. Results Based on subjective qualitative scores, tibolone treatment was at least as effective as continuous combined HRT in improving quality of life. It also effectively prevented withdrawal bleeding, which may occur during HRT use. Compared with continuous combined HRT, tibolone treatment was also associated with perceived improvement of sexual performance, including general sexual satisfaction, sexual interest, sexual fantasies, sexual arousal and orgasm, with decreased frequencies of vaginal dryness and painful inter...

Abstract: Sexual dysfunction has been reported as an unwanted effect associated with selective serotonin reuptake inhibitors therapy, but the nature and frequency of such effects have not been characterized systematically. Sexual function was assessed in depressed patients participating in a multicenter trial of acute and continuation fluoxetine therapy using a 4-item self-rated scale. Patients were evaluated at study entry, after 13 weeks of fluoxetine 20 mg daily, and during 25 weeks of continuation therapy with fluoxetine 20 mg daily, fluoxetine 90 mg weekly, or placebo. In a 13-week open-label trial, among 501 patients who met Diagnostic and Statistical Manual of Mental Disorders criteria for depression, 51.6% of women and 40.6% of men reported improvement, 35.0% of women and 41.9% of men reported no change, and 13.4% of women and 17.4% of men reported worsening in overall sexual function. During double-blind continuation therapy, there were no statistically significant differences in change in sexual function between treatments. Worsened sexual function that occurred during continuation treatment was strongly associated with worsened depressive symptoms. Depression is associated with sexual dysfunction, and improvement in sexual functioning related to the antidepressant effects of fluoxetine may be more common than drug-associated deterioration in sexual function. Among patients who report worsening, effects may be most pronounced on orgasm. Deterioration in sexual function does not appear to be a late-onset drug-specific event, but is strongly related to worsening depressive symptoms.

Abstract: Background: Determination of the exact level and degree of a woman’s spinal cord injury (SCI) has allowed researchers to document the aspects of sexual response that are altered with specific patterns of SCI. Based on these findings, recommendations can be made regarding the development and testing of electrical stimulation systems designed to facilitate sexual responses in women with SCI.Design: Literature reviewFindings: Studies of the arousal stages of response indicate that psychogenic vaginal lubrication is maintained with pinprick sensation in T11 -T12 dermatomes, and that reflex lubrication occurs in women with upper motor neuron injuries affecting the sacral segments. Studies of the orgasmic stage support the hypothesis that orgasm is a reflex response of the autonomic nervous system that appears to depend on an intact sacral arc.Conclusions: Laboratory studies of arousal and orgasm among women with different types of SCI, and comparisons with ablebodied controls, provide valuable informat...

Abstract: Sexual dysfunction is a recognized side effect of hypertension and antihypertensive medications in men, but is not established as a side effect in women, due to the lack of established methodology. An ambulatory medical record-based, case-control study was designed to study sexual function in treated and untreated hypertensive women and healthy controls. The research was performed in a teaching hospital with satellite clinics in upstate New York. There were 3312 medical records reviewed, 640 premenopausal Caucasian women in heterosexual relationships subjects were eligible for participatic diagnosis of mild hypertension (BP > or =140/90 mmHg and < 160/100 mmHg) for cases; no other significant medical history. A total of 241 women agreed to participate, 224 (35%) completed both a self-administered questionnaire and a telephone interview (112 healthy, 112 hypertensive). There was an initial 74% response rate among those eligible to participate, with 35% completing the entire study. Age and average blood pressure were not significant between 224 participants and 416 nonparticipants by 2-tailed t-test analysis. Seven composite variables were formed from a 47-item sexual response questionnaire. Initial unadjusted chi2 results reported women with hypertension had more difficulty than did healthy controls achieving lubrication and orgasm. Seven questions, each with the highest correlation to its respective composite variable (by Spearman's correlation), formed an abbreviated questionnaire. Quality of female sexual function was quantified in an ambulatory outpatient setting. A method was described to address hypertension, pharmacotherapy, and sexual functioning by employing self-administered questionnaires and telephone interviews. Initial analysis suggested that hypertensive women may have an impaired physiological sexual response. The abbreviated questionnaire generated from questions with the highest correlation to their respective composite variables may be useful in further evaluating this issue.

Abstract: The effect of various spinal lesions on female sexual response has recently been investigated in detail. Studies of women with neurologic disabilities and studies of animal models have provided substantial information regarding the spinal control of sexual responses. In this report, the authors explore findings regarding the neurologic pathways underlying the spinal control of sexual arousal and orgasm. Information available about the effects of multiple sclerosis and various cerebral disorders on female sexual function will also be reviewed, with special attention to areas where further research is needed. Lastly, the current status and techniques available to improve the sexual functioning of women with neurologic disabilities affecting the central nervous system will be reviewed.

Abstract: CLINICAL HISTORIES Patient 1.— A 41-year-old woman was seen with a 20-year history of similar recurring headaches. Approximately 50% of the time, she will see squiggly lines in both visual fields for a few minutes and then develop a nonthrobbing pain in the back of her head associated with nausea, and light and noise sensitivity lasting up to 3 days. The headaches have been occurring about once every 1 to 2 weeks. Triggers have included menses, chocolate, margaritas, stress, and letdown after stress. For about the last 5 years, about 90% of the time when she has an orgasm, she immediately develops a typical headache without aura which can last up to 3 days. Her internist had tried metoprolol which was not effective as a preventative medication. A magnetic resonance imaging scan of the brain about 5 years ago was normal. Neurological examination was normal. Questions.— How often are orgasms a trigger for migraine? What treatment would you recommend for this patient’s orgasmic migraines? Are there other physical activities which can be triggers for migraine? Is benign orgasmic cephalgia in patients without other headaches a form of migraine? Patient 2.— This 52-year-old man has a 25-year history of migraine without aura. The headaches can last all day and are dulled by over-the-counter medications. If he has an orgasm, the headache goes away within minutes. Questions.— Is it common for orgasm to relieve an acute migraine? Are there physical activities which relieve migraine for some people?

Abstract: Measurement approaches for male and female sexual dysfunction have proliferated in recent years, spurred in large part by the development of new treatments for male and female dysfunction. In the past, physiologic measures of penile tumescence and rigidity in males, and vaginal blood flow in females, played an important role in clinical and research studies. More recently, a variety of brief, self-report measures have been developed for assessing male and female function across a variety of sexual domains (eg, desire, arousal, orgasm, satisfaction). These self-report measures have been shown to have a high degree of reliability and validity, and are sensitive to treatment interventions. Accordingly, they are widely employed in clinical trials. Daily diary or sexual event logs have similarly been developed for this purpose. Selfreport measures have been used for clinical screening purposes and for diagnostic assessment of sexual function in a number of studies. Finally, several disease-specific quality of life and treatment satisfaction measures have been developed, which are currently in widespread use in clinical trials of sexual dysfunction.

Abstract: Until recently, erectile dysfunction (ED) was one of the most neglected complications of diabetes. In the past, physicians and patients were led to believe that declining sexual function was an inevitable consequence of advancing age or was brought on by emotional problems. This misconception, combined with men’s natural reluctance to discuss their sexual problems and physicians’ inexperience and unease with sexual issues, resulted in failure to directly address this problem with the majority of patients experiencing it. Luckily, awareness of ED as a significant and common complication of diabetes has increased in recent years, mainly because of increasing knowledge of male sexual function and the rapidly expanding armamentarium of novel treatments being developed for impotence. Studies of ED suggest that its prevalence in men with diabetes ranges from 35–75% versus 26% in general population. The onset of ED also occurs 10–15 years earlier in men with diabetes than it does in sex-matched counterparts without diabetes. A sexually competent male must have a series of events occur and multiple mechanisms intact for normal erectile function. He must 1 ) have desire for his sexual partner (libido), 2 ) be able to divert blood from the iliac artery into the corpora cavernosae to achieve penile tumescence and rigidity (erection) adequate for penetration, 3 ) discharge sperm and prostatic/seminal fluid through his urethra (ejaculation), and 4 ) experience a sense of pleasure (orgasm). A man is considered to have ED if he cannot achieve or sustain an erection of sufficient rigidity for sexual intercourse. Most men, at one time or another during their life, experience periodic or isolated sexual failures. However, the term “impotent” is reserved for those men who experience erectile failure during attempted intercourse more than 75% of the time. Normal male sexual function requires a complex interaction of vascular, neurological, hormonal, and psychological systems. …

Abstract: Sexuality is a complex entity involving several aspects, including desire, libido, pleasure, sexual life, intercourse, erection, ejaculation, orgasm, happiness and bother. Sexuality can be assessed through patient-doctor interviews as well as through self-completing questionnaires. A number of these have been validated and translated into several languages. It is important that such questionnaires are simple and easy for the patient to complete. One commonly used instrument is the International Index of Erectile Function (IIEF), which involves 15 questions on five domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction. This has recently been simplified to five questions (IIEF-5). A number of questionnaires, such as the modified Danish Prostatic Symptom Score (DAN-PSS) and International Continence Society sex (ICSsex), take into account the bother caused by sexual dysfunction. There is expected to be an increasing number of sexually active men consulting with lower urinary tract symptoms (LUTS) as the population ages. Evidence suggests that the severity of LUTS is linked with sexual dysfunction and consequently this significant aspect of life for men of all ages should be taken into consideration in the management of LUTS associated with benign prostatic hyperplasia (BPH).Prostate Cancer and Prostatic Diseases (2001) 4, S7-S11

Abstract: In sexology the existing questionnaires do not sufficiently consider the experiencing of sexuality and the extent of sexual satisfaction. That is why a questionnaire was developed which includes, besides the frequency and duration of sexual activities, the satisfaction with frequency and duration of these activities and the desired sexual behaviour. A first study with this questionnaire was carried out on 112 women with heterosexual behaviour, aged 20 to 48 years. The frequent desire with regard to coital orgasm as one result of our investigation confirms the centering of orgasm in other studies. But half of the women do not describe orgasm as the favoured feeling during sexual intercourse. For 37% of the women the emotional and physical closeness to the partner is explicitly more important than experiencing an orgasm. According to the comparison of extreme groups sexual satisfaction particularly correlates with self-determination realized in partnership and with satisfaction of communicational desires and need for tenderness within the partnership.

Abstract: Part 1 principles of psychosexual medicine: physical aspects of the sexual response psychological aspects of sexual response interaction of physical and psychological factors presentation and management the skills of psychosexual medicine the relevance of past history. Part 2 psychosexual Problems: vaginismus and non-consummation lack of sexual desire erectile dysfunction problems with ejaculation problems with orgasm painful intercourse problems with life events paraphilias and related problems. Part 3 psychosexual medicine in clinical practice: general practice the contraceptive clinic the genito-urinary clinic the gynaecology clinic the psychosexual clinic.

Abstract: Background: Sexuality is an important part of health, quality of life, and general well-being, yet studies suggest that less than half of patients' sexual concerns are known by their physicians and that physicians are unaware of how common sexual concerns are among patients. The objective of this study was to determine the type and prevalence of sexual concerns among a randomly selected sample of women enrolled for health care at a military community hospital. Methods: A randomized mail survey was used. Of 593 eligible participants, 232 responded (39%). Main outcome measures were self-reported sexual concerns and sociodemographic data. Results: A total of 90.9% of women reported one or more sexual concerns. Most frequently reported sexual concerns were lack of interest (88.6%), difficulty with orgasm (81.2%), body image concerns (80.4%), inadequate lubrication (76.1%), dyspareunia (75.1%), needing information about sexual issues (75.1%), and unmet sexual needs (63.4%). More than half (65.2%) reported concerns of physical or sexual abuse, and more than half (53.1%) reported sexual coercion at some point in their lives. Conclusions: The results demonstrate a high prevalence of sexual health concerns for women enrolled for health care in a military community hospital. The implication for clinical practice is that sexual health inquiry should be a regular and important part of health care maintenance.