Genital Congestion Research Articles

Flibanserin for Low Sexual Desire in Women: A Molecule From Bench to Bed?

Flibanserin for Low Sexual Desire in Women: A Molecule From Bench to Bed?

Chapter 13 - Sexual dysfunction in patients with spinal cord lesions

Many aspects of sexuality can be disrupted following a spinal cord lesion (SCL). It can alter an individual's self-esteem and body image, interfere with positioning and mobility, introduce unexpected problems with incontinence and spasticity, decrease pleasure, and delay orgasm. Sexual concerns in men can involve erectile function, essential for intercourse, ejaculation function, necessary for fertility, and the ability to reach orgasm. In women they can involve concerns with vaginal lubrication, genital congestion, and vaginal infections, which can all go unnoticed, and orgasm, which may be lost. All of these concerns must be addressed during rehabilitation as individuals with SCL continue to live an active sexual life, and consider sexuality among their top priority for quality of life. This chapter describes the impact of SCL on various phases of men's and women's sexual responses and on various aspects of sexuality. Treatments are described in terms of what is currently available and what is specific to the SCL population. New approaches in particular for women are described, along with tips from sexual counseling which consider an overall approach, taking into account the primary, secondary, and tertiary consequences of the SCL on the individual's sexuality. Throughout the chapter, attempts are made to integrate neurophysiologic knowledge, findings from the literature on SCL, and clinical experience in sexual rehabilitation.

Troubles de l’excitation chez la femme

To evaluate the clinical presentation of women's arousal disorders (AD) and therapeutic options, suggested in the literature. Review of articles published on this subject in the Medline database, selected according to their scientific relevance, of consensus conferences and published guidelines. Women's AD form three clinical entities. The most well known is a lack of lubrication and genital congestion in response to a sexual stimulus corresponding to an objective AD. More recently, subjective AD has been identified, with decrease of perception of arousal. In practice these two cases are frequently associated. The prevalence of objective AD varies from 9to 38%, with a peak after the menopause. The prevalence of the subjective AD, much less studied, is among 17%. All clinical studies have reported an absence of correlation between physiological response, genital arousal, and the subjective response, which makes it difficult to clinically assess and manage these disorders. After the menopause, a lack of estrogen is a major factor in decrease in lubrication and poor vaginal trophicity. Clinical examination is essential for the assessment of these symptoms. Subjective AD and sexual desire disorders both have etiological psychological and contextual factors very similar. They mutually sustained and are grouped together in the new classification of DSM-V in one definition. Anxiety and a lack of harmony with the partner are among the factors, which affect adversely women's sexual desire and also subjective arousal. For this reason a sexo/psychotherapy is often necessary even for menopausal women. For them local hormonal therapy with estrogen is also recommended in case of lubrication or vaginal trophicity problem.

Pharmacotherapy for women's sexual dysfunction

Background: Women's sexual function is known to be strongly influenced by mental health and relationship factors. Biological factors interrupting sexual function that might potentially be remedied by pharmacological agents are less clear. Objectives: To examine the role of medications for women's sexual dysfunction. Methods: Searches were done using Medline, Embase, Lilacs and Pubmed databases. Conclusions: Although drugs designed to boost initial sexual desire have been trialed, amelioration of reduced sexual arousability may be a more appropriate target. There is limited evidence of pharmacological benefit to arousability so far. Local oestrogen therapy benefits reduced genital vasocongestion from vulvar vaginal atrophy. Drugs acting to enhance the actions of nitric oxide or vasoactive intestinal polypeptide can only benefit reduced genital congestion: most women complaining of low arousal have normal genital vasocongestion in response to sexual stimulation. In the context of autonomic neuropathies, phosphodiesterase inhibitors may be indicated. Early results of sexual benefit from local administration of dihydroepiandrosterone allowing intracellular production of oestrogen and testosterone in genital tissues post menopause seem promising.

Women's sexual function and dysfunction: current uncertainties, future directions

There is increasing evidence that women at the outset of sexual activity do not need to have sexual desire, as in 'drive', and that many do not distinguish desire from arousal. Multiple modes of investigation confirm poor correlation between women's subjective arousal and measured genital congestion. Suggested revisions to the DSM-IV definitions of sexual disorder have been published: there is now need to align interview assessments and screening questionnaires with contemporary understanding of women's sexual response. Whereas the psychological factors associated with women's sexual function and resilience to biological insults and external stressors are well documented, the role of biological factors is less clear. Variations in the rate of decline of adrenal and ovarian pro-hormones, activity of converting enzymes in peripheral cells, sensitivity of androgen and estrogen receptors and cerebral production of sex steroids may all be involved. Thus there is great complexity underlying the question of sex hormone supplementation, and in particular, little clarity as to which women have decreased brain and/or peripheral androgen activity. When psychosexual etiological factors appear to be minimal and investigational testosterone supplementation is considered, it would be appropriate to target women with disordered arousal and desire in keeping with the recently recommended revised definitions.

ORIGINAL RESEARCH—WOMEN'S SEXUAL DYSFUNCTIONS: Assessment and Management of Women's Sexual Dysfunctions: Problematic Desire and Arousal

ABSTRACT Introduction Women frequently report low sexual desire or interest. An associated lack of subjective arousal during sexual activity is clinically highly apparent but has not been the focus of traditional sexual inquiry, definitions of dysfunction, or management. The frequent poor correlation of women's subjective sexual arousal and observable increases in genital congestion in response to sexual stimulation has not been reflected in assessment, diagnosis, or management. Aim To provide recommendations/guidelines for the assessment and management of women's sexual dysfunctions focusing on low desire, low interest, and lack of arousal. Methods An international consultation, in collaboration with major sexual medicine associations, assembled over 200 multidisciplinary experts from 60 countries into 17 committees. One subcommittee of five members focused on women's sexual desire and arousal, developing over a 2-year period various recommendations. Main Outcome Measure Expert opinion was based on grading of evidence-based scientific literature, widespread internal committee discussion, public presentation, and debate. Results Women's sexual response in health can be reconceptualized as a circular model of overlapping phases of variable order influenced by psychological, societal, and biological factors. Subsequent revisions to definitions of arousal and desire disorder are given. Recommendations regarding assessment and management focus on factors reducing arousability and satisfaction. These include women's mental health and feelings for their partner, generally and at the time of sexual activity. Recommendations reflect the poor correlation of subjective arousal and increases in genital vasocongestion. Conclusion Further outcome research of management based on new conceptualization of sexual response and revised definitions of dysfunction is needed. The basis of the variable correlation between genital vasocongestion and subjective arousal needs clarification as do the biological underpinnings of sexual response and their changes with age and life cycle.

Genital vascular responsiveness and sexual feelings in midlife women: psychophysiologic, brain, and genital imaging studies

The incidence of women's experiences of lack of sexual arousal increases in the years around the natural menopause transition. This raises the questions to what extent are sexual complaints in postmenopausal women related to hormonal changes, and what is the contribution of psychologic and contextual factors to sexual function in this transitional phase of life. This article reviews all published evidence regarding (1) the relation between menopausal status and sexual arousal symptoms, (2) the extent to which these sexual symptoms relate to measured genital vascular responses to sexual stimuli, and (3) the correlation between women's genital vascular response and their experience of subjective sexual arousal. Psychophysiologic and preliminary functional magnetic resonance imaging (MRI) studies of increases in genital congestion in response to erotic stimulation fail to identify differences between premenopausal and postmenopausal women. This suggests that although urogenital aging results in changes in anatomy and physiology of the genitals, postmenopausal women preserve their genital responsivity when sufficiently sexually stimulated. The vaginal dryness and dyspareunia experienced by some postmenopausal women may result from longstanding lack of sexual arousal and protection from pain previously afforded by estrogen-related relatively high blood flow in the unaroused state. Psychophysiologic studies confirm similar increases in genital vasocongestion from erotic stimuli in women with and without chronically low sexual arousal, even in those women focusing specifically on their perceived lack of genital response. Moreover, studies repeatedly confirm highly variable correlations between subjective sexual arousal and measured increases in genital congestion.

Revised Definitions of Women's Sexual Dysfunction

Existing definitions of women's sexual disorders are based mainly on genitally focused events in a linear sequence model (desire, arousal and orgasm). To revise definitions based on an alternative model reflecting women's reasons/incentives for sexual activity beyond any initial awareness of sexual desire. An International Definitions Committee of 13 experts from seven countries repeatedly communicated, proposed new definitions and presented at the 2nd International Consultation on Sexual Medicine in Paris July 2003. Expert opinions/recommendations are based on a process that involved review of evidence-based medical literature, extensive internal committee discussion, informal testing and re-testing of drafted definitions in various clinical settings, public presentation and deliberation. Women have many reasons/incentives for sexual activity. Desire may be experienced once sexual stimuli have triggered arousal. Arousal and desire co-occur and reinforce each other. Women's subjective arousal may be minimally influenced by genital congestion. An absence of desire any time during the sexual experience designates disorder. Arousal disorder subtypes are proposed that separate an absence of subjective arousal from all types of sexual stimulation, from an absence of subjective arousal when the only stimulus is genital. A new arousal disorder has provisionally been suggested, namely that of persistent genital arousal. Orgasm disorder is limited to absence of orgasm despite high subjective arousal. Dyspareunia includes partial painful vaginal entry attempts as well as pain with intercourse. Variable reflex muscle tightening around the vagina and an absence of abnormal physical findings are noted in the definition of vaginismus. Women's sexuality is highly contextual and descriptors are recommended re past psychosexual development, current context, as well as medical status. Diagnosing sexual disorders need not imply intrinsic dysfunction of the woman's own sex response system. The International Definitions Committee has recommended a number of fundamental changes to the existing definitions of women's sexual disorders.

Pharmacotherapy for sexual dysfunction in women

In the setting of multiple studies claiming a high prevalence of sexual problems amongst women, new conceptualisation of the sexual response in women and definitions of sexual dysfunction, which reflect the need for biopsychosocial management, are being developed. The biological underpinnings of the sexual response in women may be influenced by environmental factors, as well as by medications, disease processes and normative changes in endogenous hormones. Psychological factors can alter both the physiological processes and the experience of sexual response. The new models clarify the importance of sexual motivations other than desire, sexual arousability and subtypes of arousal disorder. The role of pharmacotherapy to potentially augment desire, arousability, genital congestion and to lessen the pain of chronic dyspareunia must be envisaged within the holistic biopsychosocial model.

Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled trial

Some postmenopausal women lose genital sexual responsivity despite preserved subjective sexual arousal from non-genital stimuli. When oestrogen replacement is without benefit, both the underlying pathophysiology and management of this acquired genital female sexual arousal disorder are unclear. We aimed to study the effect of sildenafil on sexual arousal and orgasmic functioning of such women. Secondly, we aimed to explore the concordance between a detailed historical assessment of genital response in real life, with laboratory vaginal photoplethysmographic assessment of genital vasocongestion. Session one consisted of a semi-structured clinical interview to assess real life sexual arousal. Session two employed vaginal pulse amplitude and self-report questionnaire assessment of erotica-induced sexual arousal. Sessions three and four were a randomised, double-blind, placebo-controlled crossover administration of sildenafil on orgasm latency, intensity, perception of genital congestion and subjective arousal to erotica plus clitoral vibrostimulation. University associated Sexual Medicine Clinic and Psychophysiology Laboratory. Volunteer sample of 34 oestrogenised postmenopausal women with acquired genital female sexual arousal disorder and impaired orgasm. Sildenafil (50 mg) or placebo administered over two laboratory sessions. Orgasm latency and intensity during drug sessions; subjective and psychophysiological sexual arousal during photoplethysmography session. The erotic video significantly increased subjective sexual arousal in all women. Vaginal pulse amplitude responses varied from robust to absent. Although across all women, sildenafil improved neither arousal nor orgasm, subsequent analyses comparing high versus low vaginal pulse amplitude responders revealed significantly reduced latency to orgasm, and increased subjective sexual arousal and perception of genital arousal in the latter group of women. The data suggest that oestrogenised postmenopausal women with genital female sexual arousal disorder and orgasmic impairment based only on clinical assessment do not benefit from sildenafil. However, the photoplethysmograph had predictive value-those women showing low vaginal pulse amplitude response benefited from sildenafil compared with women with a higher response. Thus, oestrogenised women diagnosed with acquired genital female sexual arousal disorder may be a heterogeneous group and the photoplethysmograph might be useful in their further characterisation.

Biopsychosocial models of women's sexual response: applications to management of ‘desire disorders’

The complexities of women's sexual response preclude useful management strategies which are modelled only on the traditional human sex response cycle beginning with sexual desire rather than other motivations. Both biological and psychological parameters affecting women's sexual motivation and arousability can be depicted in alternative models. These reflect that motivations to begin a sexual experience, although varied, are most often intimacy-based in women. The key role of subjective sexual arousal, which often precedes and then accompanies sexual desire, is clarified. A positive outcome emotionally and physically is necessary to achieve the original goal of enhancing emotional closeness, sense of being attracted and attractive, committed, loved—together with the goal (accessed en route) of sexual satisfaction. Innate, spontaneous desire may only occasionally augment the intimacy-based motivation. Thus therapy for ‘desire disorders’ may more profitably focus on the woman's problematic motivation, inadequate sexual stimuli and context, diminished arousability and/or unsatisfactory outcome to an experience. A model of subjective sexual arousal reflects the ongoing affective and cognitive modulation and variable input from physical genital congestion. Awareness of the poor correlation between genital vasocongestion and the subjective experience allows subtyping of arousal problems in order to facilitate their management.

The complexities of female sexual arousal disorder: potential role of pharmacotherapy

Identifying any role for pharmacotherapy in women's sexual arousal disorders requires an understanding of the components of sexual arousal. Furthermore, an analysis of female sexual arousal disorders necessitates distinguishing between the absence of physiological genital responding and lack of attention to, or dislike of, any physiological responding. Pharmacologically enhancing a suboptimal physiological vasocongestive response is possible. Current studies involve both medications that magnify the affects of a natural neurotransmitter of genital sexual arousal (nitric oxide), and those that act independently of the natural mechanism. Enhancing attention to genital engorgement by pharmacological means is at present theoretical. Similarly, non-hormonal pharmacological means of facilitating pleasure from the arousal-associated genital congestion awaits scientific study. When a deficiency of estrogen or androgen is involved in the lack of pleasure from massaging vulval structures and/or involved in their suboptimal engorgement, their replacement can be beneficial. Scientific study of physiological androgen replacement therapy is only just beginning.

A Model of Women's Sexual Arousal

A model of female sexual arousal shows the composite emotion of subjective sexual arousal, which results from conscious appraisal of sexual stimuli and their context in the presence of positive affective and cognitive feedback. Genital feedback augments the subjective arousal to a variable degree. Genital congestion can be triggered by sexual stimuli in the absence of subjective arousal. Then the congestion either is ignored or not interpreted as sexual. An anhedonic or even a dysphoric response to the sensations of genital congestion are further possibilities. This model allows for various subtypes of arousal disorder and thus facilitates a choice of therapeutic intervention.

副睾丸結核500例

This authors have observed statistically 500 cases of epididymitis tuberculosa from 1920 to 1934. Results are as follows:1) Frequency:This is 2.6% of the total cases the clinic.2) Age:The percentage of age of 500 cases:1-10 years old 0.2% 11-20 years old 8.8%21-30 years old 49.6% 31-40 years old 25.2%41-50 years old 12.4% 51-60 years old 2.8%61- years old 1.0The youngest is 3 years old, and the oldest 65.3) Afflicted side:right side 130 cases 26.0 left side 148 cases 29.6%both sides 222 cases 44.4%There is no remarkable difference on the percentage of right and left side. The number of cases which are attacked coincidentaly is 11 (2.2%), How many days will it take to make the pathological change of the opposite side when not treated with operation? The shortest is 4 days and 11 years at the most. The percentage is as follows;within 1 month 12 cases 17.6%within half year 23 cases 33.8%4) Proximate cause:As the approximate cause there is the general condition of the body, trauma, gonorrhoea, genital congestion and tuberculosis.a) Trauma: The contusion is very frequently observed, but here the authors find only 10 cases owing to the lack of previous history. Among them one case of falling from a horse is seen. The pathological change of epididymis by these contusions will take place after 2 months to 20 years.b) Gonorrhoea: Gonorrhoea is recognised on the previous history only in 6%. The tuberculous change is seen atter 1-25 years when the patient is attacked by gonococcus on epididymis. The side of the pathological change on both diseases is almost the same.The 500 tuberculous changes of epididymis are seen among 5127 cases of urethritis (15.9%) and 957 cases of epididymitis gonorrhoica (2.98%).c) Tuberculosis of the urinary tract: Among 500 cases of this disease 173 cases of tuberculosis of urinary tract especially kidney and bladder is seen (34.6%) 798 cases of nephrophthisis are acampanied by tuberculous epididymitis at the percentage of 28.7 (321 cases).Among 500 cases of this disease 53 cases are treated by nephrectomy(10.6%) and after this operation 28 cases are attacked by tuberculosis on epididymis. The shortest is 7 days and the longest 6 years and 9 months after nephrectomy.The side of the singular epididymitis with that of nephrophthisis is not just crossing, but the direct may is more numerous:The statistics on the tuberculous prostatitis are uncertain.e) Other tuberculosis: Pleuritis is seen on 127 cases (25.4%). The tuberculosis of epididymis is seen after a month to 23 years when the case is attacked by pleuritis.Peritonitis (1%), Phthisis (3.4%), Caries (1.7%), Lymphadenitis colli tuberculosa (1%), Arthritis tuberculosa (0.4%) and Tuberclid (0.2%) are seen in previous. history.In short 164 cases (32.8%) are attacked by Tuberculosis on the other side of the urinary tract.5) Complaint:The complaint is as follows;Swelling of epididymis 366 cases 73.2%Pain an epididymis 104. cases 20.8%Fistula 48 cases 9.6%Pain of lain 7 cases 1.4%Pain by pression upon epididymis 7 cases 1.4%Redness of scrotal skin 6 cases 1.2%Strain of inguinal region 5 cases 1.0%Pain in the perineum 5 cases 1.0%Swelling of abdominal region 4 cases 0.8%Swelling of inguinal region 3 cases 0.6%Abdominal pain 2 cases 0.4%Pain in the thigh 2 cases 0.4%Ejaculatio praecox 2 cases 0.4%Sensitinenes to pressure of epididymis 1 cases 0.2%Sterility 1 cases 0.2%Complaint of disease of the urinary tract 200 cases 40.0% 6) Clinical change of epididymis and vas deferens:Size of tumor is from the size of a pea to a fist.Surface is almost rough.Condition is elastic solid.The tuberculous change on the epididymis:on the tail section 228 case 45.6%on the head section 49 case 9.8%on the head and tail 22 case 4.4%on the total 65 case 13.0%uncertain 358 case 2