History Of Sexual Dysfunction Research Articles

(051) Gut Microbiota and Sexual Desire Disorder in Women

Abstract Introduction Hyposexual desire disorder (HSDD) is a common female sexual health problem. HSDD mainly refers to women's continuous lack of sexual fantasy or desire for sexual activities, accompanied by obvious personal pain or affecting the partnership. In humans, sexual desire is regulated by a variety of neurotransmitters in key areas of the brain. Norepinephrine, dopamine, melanocortin, oxytocin and vasopressin mediate excitability, while serotonin, opioids, prolactin and endogenous cannabinoid system mediate inhibition. HSDD may be related to neuropsychological state of increased inhibition or decreased excitation, or both. There is a close relationship between gut microbiota and a variety of mental and neurological diseases. The changes of gut microbiota richness and diversity affect the functions of 5-hydroxytryptamine, norepinephrine and dopaminergic nervous systems in the brain, and these pathways and molecules have been proved to be closely related to the level of human sexual desire. At present, the understanding of the role of gut microbiota in the regulation of sexual desire and the mechanism of HSDD is limited. Objective In order to study the composition of gut microbiota and fecal metabolites in HSDD women, and increase the understanding of the possible relationship between low sexual desire and intestinal microbiota, this study hypothesized that the composition of intestinal microorganisms and fecal metabolites in HSDD patients was different from that in normal people. Methods We recruited and diagnosed HSDD women through Case-Control study, and performed the 16S rRNA sequencing, non targeted LC-MS metabonomics detection and targeted SCFAs quantitative detection of intestinal microorganisms to explore and evaluate the differences of gut microbiota and fecal metabolites composition between HSDD women and control group. Results In this study, 24 women with HSDD and 22 women without history of sexual dysfunction (NHSD) were included. The 16S rRNA gene sequencing of 46 fecal samples showed that the richness and diversity of intestinal flora in HSDD women were higher than those in NHSD women, and there were significant differences in the composition of gut microbiota between the two groups. At the genus level, Bifidobacterium, Lactobacillus, Sphingomonas, Phenylbacillus, Corynebacterium and some unclassified actinomycetes were enriched in the feces of HSDD women, while Ruminococcus were enriched in the feces of NHSD women. The results of non-targeted metabonomics of fecal samples showed that there were significant differences between HSDD and NHSD women in fecal metabolic phenotype. The main metabolites included histamine, deoxycorticosterone, tryptamine, tyramine, 6-methylquinoline, etc. The results of targeted SCFAs quantitative analysis showed that the content of butyric acid in feces of HSDD group was significantly higher than that of NHSD group. Spearman correlation analysis showed that the difference of gut microbiota and fecal metabolites between the two groups were associated with clinical characteristics including FSFI-D score. Conclusions The composition of gut microbiota and metabolites in HSDD women is different from that in NHSD women. The effect of characteristic bacteria and metabolites on the function of neurotransmitter system may be part of the pathogenesis of HSDD. Further studies may bring new theories of the gut microbiota brain sexual desire axis. Disclosure No

\u201cNear-TME\u201d: proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis

BackgroundThe aim of the present study was to describe in detail an approach to proctectomy in ulcerative colitis (UC), which can be standardized; near-total mesorectal excision (near-TME), to prevent injuries to autonomic pelvic nerves and subsequent sexual dysfunction.MethodsWe demonstrate the technique ex vivo on a cadaver from a male patient in lithotomy position and on a sagittal section of a male pelvis. We also demonstrate the technique in vivo in two male patients diagnosed with UC, with no history of sexual dysfunction or bowel neoplasia. The study was performed at the Human Embryology and Anatomy Department. University of Valencia, Spain.ResultsThe posterolateral dissection during a near-TME is similar to that of an oncologic TME, whereas the anterolateral is similar to that of a close rectal dissection. The near-TME technique preserves the superior hypogastric plexus, the hypogastric nerves, the nervi erigentes, the inferior hypogastric plexus, the pelvic plexus and the cavernous nerves.ConclusionThe near-TME technique is the standardisation of the technique for proctectomy in male patients with ulcerative colitis. Near-TME requires experience in pelvic surgery and an exhaustive knowledge of the embryological development and of the surgical anatomy of the pelvis.

The Effectiveness of Counseling using PLISSIT Model on Depression, Anxiety and Stress, among Postpartum Women with Sexual Dysfunction: A Randomized Trial

Background & aim: Sexual dysfunction is common among women after childbirth, which could be associated with depression, anxiety and stress. The majority of these problems can be treated in early stages with different counseling approaches. The aim of this study was to assess the effect of counselling based on the PLISSIT model on depression, anxiety and stress among postpartum women with sexual dysfunction. Methods: This clinical trial was carried out on 80 women referred to urban healthcare centers of Mashhad, Iran in 2017, who had a score ≤ 28 based on the female sexual function index, with no history of sexual dysfunction before and during the pregnancy. They were randomly assigned to two groups of PLISSIT and control group. The subjects in the PLISSIT group attended two counseling sessions in two consecutive weeks and those in the control group received routine care. A demographic questionnaire, FSFI, as well as DASS-21 were used to measure female sexual function as well as depression, anxiety and stress before and 4 weeks after the last session in both groups. Data was analyzed using independent t-test, analysis of covariance, and Mann-Whitney U test. Results: The mean scores of DASS-21 total score were 9.6±7.5 and 3.3±2.9 in the PLISSIT group and 9.2±9.5 and 8.7±4.3 in the control group at the baseline and 4 weeks after the last session, respectively. The difference between means in two groups was significant (P=0.026). By controlling the intervening variables, the DASS-21 score in the intervention group decreased, compared to that in the control group. Conclusion: The PLISSIT model decreases the DASS-21 total score in women with sexual dysfunction after childbirth.

Comparison of citalopram and fluoxetine sexual side-effects in male patients referred to psychiatric clinic

Introduction: Selective serotonin reuptake inhibitors (SSRIs) are among the selected medication to treat depression, panic disorder and many other psychiatric disorders. The most common undesirable effects of SSRIs are sexual dysfunctions that may lead to discontinuation of treatment in some patients. This study was conducted to compare sexual side-effects of two common drugs, citalopram and fluoxetine in male patients. Methods: This cross-sectional study was carried out on 60 male patients referred to the psychiatric clinics of Tabriz University of Medical Sciences, Iran, in 2013. They were candidates for SSRIs treatment and the clinic physicians prescribed citalopram or fluoxetine for them. The patients were examined in two groups after taking written informed consent and initial completion of the International Index of Erectile Function (IIEF) questionnaire and no history of sexual dysfunction, considering the inclusion and exclusion criteria. Both citalopram and fluoxetine groups completed IIEF questionnaire again at the end of the first and second months after treatment and statistical analysis was done using SPSS. Results: Sexual dysfunction was observed in both groups in the all sexual function indices and its components. Although there was no significant difference in terms of sexual function components between the two groups, general sexual dysfunction was significantly higher in the fluoxetine group. In both groups, age was inversely related to the general sexual function index. Conclusion: Unlike many other studies suggesting no difference on SSRI sexual side-effects, the present study showed a reduction in sexual function of men taking citalopram and fluoxetine and the reduction was more prominent with fluoxetine.

Prevalence of Sexual Dysfunction and Associations with Psychiatric Disorders Among Women Aged 50 and Older.

This study investigated the prevalence of sexual problems and associated factors, focusing particularly on comorbid psychiatric disorders, among older Korean women. A nationally representative sample of women aged 50-74 years (n=3828) responded to in-person interviews using the Korean version of the Composite International Diagnostic Interview to assess psychiatric disorders and four symptoms of sexual dysfunction: (1) lack of sexual interest/sexual aversion, (2) dyspareunia, (3) loss of pleasure, and (4) other organic dysfunction (e.g., inability of sexual arousal). We examined the likelihood of sexual dysfunction by sociodemographic and clinical variables, including specific psychiatric disorders, and compared the characteristics of sexual dysfunction among women with and without a comorbid psychiatric disorder. A total of 334 (8.7%) women reported one or more symptoms of sexual dysfunction during the year preceding the interview: lack of sexual interest/sexual aversion was most prevalent (7.7%), followed by loss of pleasure (4.2%), dyspareunia (2.4%), and other organic dysfunction (0.4%). Having a psychiatric disorder was associated with a 2.7-fold increase in the probability of sexual dysfunction. Among women with sexual dysfunction, having comorbid mental disorder was associated with being unmarried status, a symptom of loss of pleasure, and a history of sexual dysfunction before 50 years of age. The present study suggests a relatively lower prevalence of sexual dysfunction than previously reported, but supports its strong association with psychiatric disorders among postmenopausal women. We should evaluate comorbid mental disorder with sexual dysfunction, especially among those having some characteristics.

Reduced Gray Matter Volume and Increased White Matter Fractional Anisotropy in Women with Hypoactive Sexual Desire Disorder

Models of hypoactive sexual desire disorder (HSDD) imply altered central processing of sexual stimuli. Imaging studies have identified areas which show altered processing as compared with controls, but to date, structural neuroanatomical differences have not been described. The aim of this study is to investigate differences in brain structure between women with HSDD and women with no history of sexual dysfunction, and to determine sexual behavioral correlates of identified structural deviations. Sexual functioning and gray matter (GM) and white matter (WM) were assessed in 29 women with HSDD and 16 healthy control subjects of comparable age and socioeconomic status with no history of sexual dysfunction. WM properties were measured using diffusion-weighted imaging and analyzed using fractional anisotropy (FA). GM volume was measured using three-dimensional T1-weighted recordings and analyzed using voxel-based morphometry. Sexual functioning was measured using the Sexual Function Questionnaire. Women with HSDD, as compared with controls, had reduced GM volume in the right insula, bilateral anterior temporal cortices, left occipitotemporal cortex, anterior cingulate gyrus, and right dorsolateral prefrontal cortex. Also, increased WM FA was observed within, amongst others, the bilateral amygdalae. Sexual interest and arousal correlated mostly with GM volume in these regions, whereas orgasm function correlated mostly with WM FA. HSDD coincides with anatomical differences in the central nervous system, in both GM and WM. The findings suggest that decreased salience attribution to sexual stimuli, decreased perception of bodily responses and sexual emotional stimulus perception, and concomitant altered attentional mechanisms associated with sexual response induction.

Gonadal function in young adult males with metabolic syndrome

AimsAim of the study was to assess the gonadal function of young adult males with metabolic syndrome and to compare them with healthy age matched controls. MethodsForty young male subjects of age group 20–40 years who fulfilled the IDF criteria (2005) for diagnosis of metabolic syndrome were included in the study. Thorough evaluation of the subjects was done and history of sexual dysfunction if any was noted. Pooled blood samples were collected from each subject in fasting state for total testosterone, SHBG, FSH, LH, prolactin and insulin levels. All hormonal analyses were done by radio immune assay (RIA). Hypogonadism was defined as total testosterone less than 3ng/ml. Eighteen healthy age matched controls were also taken for the study. ResultsTwenty percent of subjects with metabolic syndrome had eugonadotropic hypogonadism compared to 5.5% controls. Subjects with metabolic syndrome also had significantly lower SHBG level compared to the controls. ConclusionFrom this study it has been observed that eugonadotropic hypogonadism with low total testosterone and normal or low normal gonadotropin levels may be a feature of the metabolic syndrome in young adult males. Significant low SHBG levels as compared to controls could be one of the factors responsible for various biochemical alteration seen in these cases. This study highlights the importance of evaluating gonadal function in young adult males with the metabolic syndrome and has therapeutic implications in the management of such subjects with gonadal dysfunction.

Pyogenic Granuloma of the Vulva: A Rare Presentation

Abstract Objective: Pyogenic granuloma is a relatively common skin growth. The skin of the head, neck, upper trunk, hands, and feet, and the oral mucosa and gingival mucosa are the most common sites, but pyogenic granuloma seldom appears on female genitalia. Case: A-52-year-old woman presented with a solitary lesion on her left labia majora, with a 2 year history of sexual dysfunction, pain, and cosmetic problems. The surface of the lesion was thickened, mimicking a sebaceous cyst. The lesion was excised and histopathology testing revealed features suggestive of a lobular capillary hemangioma (pyogenic granuloma). Results: On follow-up, no recurrence of the lesion was found in this patient. Conclusions: Pyogenic granuloma is considered to be a reactive, hyperproliferative vascular response to trauma or other stimuli. These lesions can undergo spontaneous involution; thus, treatment may be reserved for those lesions of functional or psychologic concern. In this case, surgical correction was used both as a ...

IIEF-15: Unsuitable for Assessing Erectile Function of Young Men?

The prevalence of erectile dysfunction (ED) is mainly studied in older males, whereas we measured prevalence of ED in young healthy males using a validated questionnaire. Assessing the prevalence of ED in young adult men using the International Index of Erectile Function (IIEF-15) and creating a benchmark for ED in this young age group for further research. Male students were randomly asked to participate. Men with history of sexual dysfunction or urologic disease were excluded. Age, having a relationship and the IIEF-15 were filled out anonymously and in private. Outcomes of all domains were separately analysed based on relationship and intercourse frequency. ED measured by the IIEF-15. One hundred and fifty-one students, aged 21.8 years (17-35, SD 2.98) participated and 14 were excluded. Of 137 students, 81% reported to have an intimate relationship. ED appeared to be present in 46 students (33.6%). The answer "no sexual activity," resulting in a 0-score, was given inconsistently. Outcomes were analysed for students who gave this answer at least once compared with those who never did. Nobody had ED in the group "without 0-scores" (n = 91). All students in the group "with (inconsistent) 0-scores" (n = 46) had ED. Students with a relationship had ED in 24.3% compared with 73.1% in those without a relationship (P < 0.001). When men with inconsistently answered IIEF-15 questionnaires are excluded, a 0% prevalence of ED is found in this age-group. The current scoring method however does not state that these questionnaires should be excluded, and results in a prevalence of ED of 34%. Possibly, the scoring method of the IIEF-15 needs to be reviewed when this questionnaire is used in young, healthy men in order to accurately measure the prevalence of ED.

Women with hypoactive sexual desire disorder compared to normal females: A functional magnetic resonance imaging study

Lack of sexual interest is the most common sexual complaint among women. However, factors affecting sexual desire in women have rarely been studied. While the role of the brain in integrating the sensory, attentional, motivational, and motor aspects of sexual response is commonly acknowledged as important, little is known about specific patterns of brain activation and sexual interest or response, particularly among women. We compared 20 females with no history of sexual dysfunction (NHSD) to 16 women with hypoactive sexual desire disorder (HSDD) in a functional magnetic resonance imaging (fMRI) study that included assessment of subjective sexual arousal, peripheral sexual response using a vaginal photoplethysmograph (VPP), as well as brain activation across three time points. Video stimuli included erotic, sports, and relaxing segments. Subjective arousal to erotic stimuli was significantly greater in NHSD participants compared with HSDD. In the erotic–sports contrast, NHSD women showed significantly greater activation in the bilateral entorhinal cortex than HSDD women. In the same contrast, HSDD females demonstrated higher activation than NHSD females in the medial frontal gyrus (Brodmann area (BA) 10), right inferior frontal gyrus (BA 47) and bilateral putamen. There were no between group differences in VPP-correlated brain activation and peripheral sexual response was not significantly associated with either subjective sexual response or brain activation patterns. Findings were consistent across the three experimental sessions. The results suggest differences between women with NHSD and HSDD in encoding arousing stimuli, retrieval of past erotic experiences, or both. The findings of greater activation in BA 10 and BA 47 among women with HSDD suggest that this group allocated significantly more attention to monitoring and/or evaluating their responses than NHSD participants, which may interfere with normal sexual response.

NITRIC OXIDE, ERECTILE DYSFUNCTION AND BETA‐BLOCKER TREATMENT (MR NOED STUDY): BENEFIT OF NEBIVOLOL VERSUS METOPROLOL IN HYPERTENSIVE MEN

1. Hypertensive men treated with beta-blockers frequently complain of erectile dysfunction. The present study investigated the effects of two beta(1)-adrenoceptor-selective antagonists, namely nebivolol and metoprolol, on erectile function in hypertensive men. 2. Male out-patients (age range 40-55 years) with newly diagnosed or existing stage 1 essential hypertension (mean seated systolic blood pressure 140-159 mmHg; diastolic blood pressure 90-99 mmHg) were enrolled in the study. All patients lived in a stable, heterosexual partnership and had no history of sexual dysfunction. After a 2-week placebo run-in period, patients were randomized double-blind to either Treatment group A (comprising nebivolol 5 mg once daily for 12 weeks, followed by placebo for 2 weeks and then metoprolol succinate 95 mg once daily for 12 weeks) or Treatment group B (comprising metoprolol succinate 95 mg for 12 weeks, placebo for 2 weeks and then nebivolol 5 mg for 12 weeks). An international index of erectile function (IIEF) questionnaire and a diary documented patients' sexual function and activity. 3. Nebivolol and metoprolol lowered blood pressure to a similar extent. Metoprolol, but not nebivolol, significantly decreased the IIEF erectile function subscore by 0.92 in the first 8 weeks after onset of beta-blocker treatment. In contrast with metoprolol, nebivolol improved secondary sexual activity scores and other IIEF subscores. 4. Despite similar antihypertensive efficacy of the cardioselective beta(1)-adrenoceptor antagonists nebivolol and metoprolol, nebivolol may offer additional benefits by avoiding erectile dysfunction in male hypertensive patients on long-term beta-adrenoceptor antagonist therapy.

Incidence and severity of sexual adverse experiences in finasteride and placebo-treated men with benign prostatic hyperplasia

Objectives To evaluate the incidence and resolution of sexual adverse experiences (AEs) in men with benign prostatic hyperplasia treated with finasteride 5 mg compared with placebo. Methods The Proscar Long-term Efficacy and Safety Study (PLESS) was a 4-year, randomized, double-blind, placebo-controlled trial assessing the efficacy and safety of finasteride 5 mg in 3040 men, aged 45 to 78 years, with symptomatic benign prostatic hyperplasia, enlarged prostates, and no evidence of prostate cancer. Patients completed a questionnaire at screening regarding their history of sexual dysfunction. During treatment, spontaneously self-reported sexual AEs were recorded. Results At screening, 46% of patients in each treatment group reported some history of sexual dysfunction. During year 1 of the study, 15% of finasteride-treated patients and 7% of placebo-treated patients had sexual AEs that were considered drug related by the investigator ( P <0.001). During years 2 to 4, no between-group difference was noted in the incidence of new sexual AEs (7% in each group). The drug-related sexual AE profile for finasteride was similar for men with or without a history of sexual dysfunction. Sexual AEs resolved while continuing therapy in 12% of finasteride patients and 19% of placebo patients. Only 4% of finasteride and 2% of placebo patients discontinued the study because of sexual AEs. In men who discontinued with a sexual AE, 50% and 41% experienced resolution of their sexual AE after discontinuing finasteride or placebo therapy, respectively. Conclusions Compared with placebo, men treated with finasteride experienced new drug-related sexual AEs with an increased incidence only during the first year of therapy.

Sexual function in hypertensive males treated with lisinopril or atenolol: A cross-over study

To evaluate the effect of antihypertensive treatment on sexual activity, 90 hypertensive men, aged 40 to 49 years, all married and without history of sexual dysfunction were treated with 100 mg of atenolol or 20 mg of lisinopril for 16 weeks, according to a double-blind, randomized, cross-over design. During the first month of therapy, sexual activity, assessed as number of sexual intercourse episodes per month, significantly declined with both atenolol (from 7.8 ± 4.3 to 4.5 ± 2.8, P < .01 v placebo) and lisinopril (from 7.1 ± 4.0 to 5.0 ± 2.5, P < .05 v placebo). Ongoing with the treatment, sexual activity tended toward recovery in the lisinopril (7.7 ± 4.0 sexual intercourse episodes per month, P = NS v placebo), but not in the atenolol group (4.2 ± 2.8, P < .01 v placebo), with a statistically significant difference between the two drugs ( P < .01). The percentage of patients who complained of sexual dysfunction symptoms was significantly higher in the atenolol- than in the lisinopril-treated group (17% v 3%, P < .05). These findings suggest that atenolol induces a chronic worsening of sexual activity, whereas lisinopril causes only a temporary decline.

Complete Penile Corporeal Septation

In man the penile corpora cavernosa have vascular continuity via channels passing through the penile septum. To our knowledge we report the first case of a complete penile septum resulting in corporeal vascular dissociation. The patient presented with primary sexual dysfunction. CASE REPORT A 38-year-old white man presented with a lifelong history of sexual dysfunction described as erections that were never fully rigid. Sexual intercourse was suboptimal because of buckling of the erection. Medical history and physical examination were unremarkable. A Rigiscan* evaluation demonstrated 3 or 4 erectile episodes with reasonable tumescence and duration but rigidity was less than 70%. Injection of 15 mcg. prostaglandin El into the right corporeal body resulted in full rigidity of the right corporeal body only and left curvature of the penis while the left corporeal body remained flaccid. The left corporeal body was then injected with prostaglandin El, resulting in a full straight erection that exceeded those previously experienced. Duplex ultrasonography demonstrated unilateral tumescence of the corpora after injection of prostaglandin El (fig. 1 ). Cavernosal -arterial flow velocity -was normal and increased only on the injected side. Cavernosography revealed unilateral corporeal opacification when contrast medium was

Kleptomania: making sense of the nonsensical

Kleptomania, or the irresistible impulse to steal unneeded objects, is a poorly understood disorder. The objectives of this paper are to critically review and integrate existing data and to make suggestions for further research. Information was gathered by reviewing the English-language literature on kleptomania. Cases were chosen for review that approximated the diagnosis as defined in DSM-III-R. These cases were analyzed in terms of their relationship to previous theories about the disorder, and larger relevant studies were examined. Using the data organized into a table, the author explores areas of convergence and disagreement and discusses the methodological difficulties of the different studies. Kleptomania is more common than previously thought. The "typical" individual with kleptomania is a 35-year-old woman who began to steal when she was 20 years old. Her thefts bring both relief and guilt. She probably has not sought treatment on her own but suffers from a necessary, pervasive, repetitive, and self-destructive act. She may have a history of sexual dysfunction or sexual preoccupation and may be unhappily married to an emotionally unsupportive husband. She has been labile and dysphoric for many years and may have a personality disorder. She has probably had a tumultuous, stressful childhood and may dissociate. The author proposes a biopsychosocial model of the etiology of kleptomania based on data from the literature. This model emphasizes possible childhood abuse as a precipitating factor in later development of kleptomania. More complete research is needed in the study of kleptomania.

Pituitary Infarction and Apoplexy: The Need for Early Recognition in Intensive Care Units

Pituitary infarction can occur after prolonged shock, usually from peripartum hemorrhage. With good obstetrical care and prompt transfusion therapy, it is largely preventable. Spontaneous pituitary infarction is much less common. It can be recognized in diabetic patients by the sudden appearance of a severe, usually retroorbital, headache and frequent episodes of hypoglycemia from an abrupt decrease in insulin requirement. When hemorrhage occurs with a pituitary tumor of sufficient expansion to produce acute parasellar manifestations, it is called pituitary apoplexy. Many patients, particularly men, are unaware of a preexisting pituitary tumor, but some will have features of acromegaly and others will have a history of sexual dysfunction. In the more severe cases, early diagnosis is imperative so that prompt neurosurgical evacuation can be undertaken.

The natural history of sexual dysfunction in diabetic women. A 6-year follow-up study.

The natural history of sexual dysfunction in diabetic women was evaluated in a 6-year prospective study. Fifty type I, insulin-treated diabetic women, aged 26-45 years, were assessed and re-evaluated 6 years later. Measures included psychological, physiological and social parameters. The frequency of sexual dysfunction was similar in 1977 and 1983. Diabetic women did not differ in sexual function from their healthy controls. None of the physiologic measures studied were predictive of sexual function. Six out of 14 women who were sexually dysfunctional in 1977 recovered normal function, some of them in spite of objective evidence of neuropathy. None of the women had been on psychotherapy for their sexual problem. The most important factor in the spontaneous remission rate seemed to be improvement in the overall marital and social situation. The women's acceptance of illness, as judged by the interviewer, and data from the questionnaires concerning psychological distress, were strong predictors of sexual function. Sexual dysfunction in diabetic women is thus an index of psychological adjustment to chronic illness. Family and marital counseling should be routinely offered as part of the medical care of the diabetic patient.