Lack Of Orgasm Research Articles

Penile Rehabilitation after Prostate Cancer Treatment: Which Is the Right Program?

The management of sexual complications after treatment of localized prostate cancer, such as erectile dysfunction, changes in the length of the penis, pain during sexual intercourse, and lack of orgasm, is still an unsolved problem with an important impact on patients’ quality of life. In this review, we summarize the current scientific literature about the rehabilitation of erectile dysfunction after prostate cancer treatment. The therapy for penile rehabilitation includes different types of treatments: the combination of phosphodiesterase type 5 inhibitors (PDE5-I) and the vacuum erectile device (VED) are considered first-line treatment options. When therapy begins, the duration of treatment, the dosage and the drug used all play very important roles in the treatment outcome. Intracavernous injection (ICI) therapy represents the second-line option for patients ineligible for PDE5-I therapy. Technological development has led to the emergence of devices for the stimulation of the penis without the use of drugs, such as penile vibratory stimulation (PVS) for stimulation of ejaculation in spinal cord injury and low-intensity extracorporeal shockwave therapy (LIESWT). The rapid diffusion of the latter, thanks to its easy use, attains good results without side effects. The panorama of penile rehabilitation after PC treatments is vast and many studies are needed, especially on new technologies, to find the best therapeutic regimen possible, personalized to the patient’s characteristics and the type of treatment for PC.

Sexual disorders in the men treated in a psychiatric ward.

An attempt to assess the impact of dual diagnosis - mental illness and addiction on the occurrence of sexual dysfunctions, and evaluation of problems with sexual functioning in men treated in a psychiatric ward. 140 psychiatrically hospitalized men (mean age 40.4 ± 12.7 years) with the diagnosis of schizophrenia, affective disorders, anxiety disorders, addiction and double diagnosis (schizophrenia and addiction) took part in the study. The Sexological Questionnaire, developed by Professor Andrzej Kokoszka, and the International Index of Erectile Function IIEF-5 were used in the study. The occurrence of sexual dysfunctions in the study group was reported in 83.6% of patients. The most common was reduction in sexual needs (53.6%) and orgasm delay (40%). Depending on the research tool used, erectile dysfunction appeared in 38.6% of respondents (according to Kokoszka's Questionnaire) and 61.4% of patients (IIEF-5). Severe erectile dysfunction was more common in the group of patients without a partner (12.4% vs. 0; p = 0.000) compared to people in relationships and in the group with anxiety disorders (p = 0.028) compared to groups with other mental disorders. In the group of people with dual diagnosis (DD), sexual dysfunctions were observed more frequently in comparison to patients with schizophrenia (p = 0.034). Treatment lasting over 5 years was more often associated with sexual dysfunctions (p = 0.007). In the DD group, lack of orgasm and excessive sexual needs were more frequent in comparison to people with one diagnosis (p = 0.0145; p = 0.035). Sexual dysfunctions are more common in patients with DD in comparison to patients diagnosed with schizophrenia. Lack of a partner and the duration of psychiatric treatment over 5 years is associated with more frequent occurrence of sexual dysfunctions.

Evaluation of ejaculation function using a simple questionnaire

ABSTRACT Introduction There is a wide range of problems associated with ejaculation, including decreased semen volume, vaginal ejaculation problems, premature ejaculation, delayed ejaculation, hematospermia, and pain associated with ejaculation. However, there is no simple questionnaire that can comprehensively evaluate these ejaculatory functions. Objective In this study, we evaluated the overall ejaculation function of the patients in question using an originally developed ejaculation function score (Kimura and Shoji's Ejaculation Function Score). Methods We examined 20 patients who visited our sexual function outpatient clinic with a chief complaint of ejaculation. As a control group, we also examined 20 patients who had undergone vasectomy using the same score. The questionnaire consisted of the following five items (1) Awareness of sufficient momentum, (2) Pleasant sensation during ejaculation, (3) Presence of pain associated with ejaculation, (4) Presence of blood in semen, and (5) Perception of decreased semen volume. The total score was also evaluated. In addition, satisfaction with the current ejaculation was assessed. Results The mean age of the ejaculation disorder group was 43.5±15.1 years. The main complaints were decreased semen volume in 7 cases (35%), vaginal ejaculation disorder in 6 cases (30%), delayed ejaculation in 2 cases (10%), premature ejaculation in 2 cases (10%), lack of orgasm in 1 case (5%), and pain associated with ejaculation in 1 case (5%). The mean scores for each item were 1.5 for item 1, 1.8 for item 2, 3.0 for item 3, 3.0 for item 4, and 2.0 for item 5, resulting in a mean total score of 11.2. On the other hand, the mean age of the vasectomy group was 42.0±9.4 years, item 1 was 2.8, item 2 was 2.9, item 3 was 3.0, item 4 was 3.0, item 5 was 2.9, and the mean total score was 14.6. When the two groups were compared, significant differences were found except for items 3 and 4. There was also a significant difference in satisfaction of present ejaculation with mean scores of 1.3 and 2.9. As a result of examining the clinical severity and the total score, the total score of 5-6 was considered severe, 7-9 moderate, 10-13 mild ejaculation disorder, and 14-15 within the normal range. Conclusion Although our ejaculation function score is still in the developmental stage, we believe that it can be a screening tool for ejaculation function in practical medical care and self-assessment. Disclosure Work supported by industry: no.

FEMALE SEXUAL DYSFUNCTION. UNSPOKEN TRUTH? HYDERABAD SINDH BASED STUDY

Background: Sexual cycle is complex and have so many phases. There are desires that initiates sex , which occur with or without stimulus. Sexual dysfunction is a problem that occurs during the sexual response cycle that inhibits person from sexual satisfaction .It is difficult to estimate the prevalence of sexual dysfunction in women because of religious grounds, natural shyness, illiteracy, and unawareness of sexual education.Objective: To determine female sexual dysfunction in non-diabetic young female of Hyderabad, and to enhance awareness of this taboo problem in women.Material and methods: This cross-sectional questionnaire based study includes 276 married non diabetic females, enrolled by non-probability convenience sampling from OPD of private clinics of sadder Hyderabad. Study was conducted in l accordance with the guidelines for Declaration of Helsinki and data was collected after obtaining participants consents. All women were interviewed according to questionnaire designed in local aspects by modifying female sexual scale which contained 19 different questions, most of them having score from 1 to 5 or -1 to -5. This scale has been modified in local languages in Urdu and Sindhi. All data was entered and analyzed using statistical package for social sciences version 22.0.Results: The mean age was 23±9.5 years, mean BMI was 24±5.5, mean duration of marriage was5.6±4.3 years, (24%) didn’t conceived after 2 years of marriage.(55%) had 2 or more children, Contraceptives user were 24±5.6 Pain was experienced during coitus by (15%), decreased desire in (20%),decreased secretion during foreplay in (15%) lack of orgasm in (30%) and arousal failure in (10% )and only (10%) had mixed disorder.(30%) had orgasm failure score of 25 and p value adjusted with age 0.03, arousal failure was in 10% but score was very low -10, p value was0.04.Conclusion: Awareness and decreasing shyness barriers of sexuality are increasing among the women. Women are seeking a sexual solution, which is the first step toward proper treatment plan.

UROGENITAL DISORDERS IN WOMEN OF REPRODUCTIVE AGE WITH ANDROGEN DEFICIENCY

According to the consensus of An Endocrine Society Clinical Practice in Princeton, USA, worsening well-being and dystrophic mood, permanent weakness and altered sexual function, including libido decline and lack of orgasm, were considered as typical signs of androgen deficiency syndrome. Particular attention is required to study the state of the genitourinary system, which is hormone dependent, so it is obvious that age-associated symptoms of pathological processes of the lower urinary tract are likely to be considered as a "urological mask" of the deficiency of sex hormones. Aim of the work. Identify and describe the most common urogenital disorders in women of reproductive age with androgen deficiency. Materials and methods. The study was conducted at the Ukrainian Scientific and Practical Center of Endocrine Surgery, Endocrine organs and tissues transplantation of the Ministry of Health of Ukraine during 2017–2018 years. A survey was conducted on 80 women of reproductive age who had major complaints of sexual disturbances (decreased libido and lack of orgasm, as well as dyspareunia as the main manifestations of androgen deficiency in women) and 30 healthy reproductive women without complaints of sexual dysfunction. General clinical methods were used (questionnaire of patients with a detailed study of socio-economic status, somatic, gynecological, obstetric and sexual history). The condition of external and internal genital organs was evaluated in the study of cervix and vagina in mirrors and gynecological bimanual study. At the same time, batches of analyzes for bacteriological research and colpocytology studies were conducted. The “HAWK 2102 EXL” (Germany) apparatus was used for ultrasound examination of pelvic organs using transabdominal and transvaginal convection sensors with frequencies of 3.5 and 5 MHz, respectively. Consultation of the urologist in order to exclude organic urological pathology and, if necessary, cystoscopy was also done. In the plasma of venous blood, the following hormonal indices were also determined by solid phase IFA, namely, content: free testosterone, DHEA, androstenedione, prolactin, ACTH, cortisol, FSH, LH, estradiol, progesterone. Results. It was revealed after exclusion of the urologist of the organic pathology of the urinary tract, in 49 % (39) of the main group, there were disturbances of urination associated with atrophic changes in the distal sections of the urinary tract. The revealed signs of vulvovaginal atrophy: pH 6.1±0.7 in women of the main group and pH 4.3±0.5 in women of the control group, in addition reduction of the karyopyknotic index and increase of the ripening index as signs of atrophic changes in the vaginal mucosa and cervical canal, was detected in 70 % (56) women in the main group and not found in the control group. At the same time, the prolapse of the genitalia of mild degree in women of the main group was detected in 32 % (27), and in the control group, this pathology was not found. Conclusions. Detection of these changes, which was considered characteristic of women in perimenopause and postmenopausal, makes it important and valid for the continuation of the study of patients with androgen deficiency, the discovery of clinical and laboratory criteria for diagnosis and the development of methods for correcting androgen deficiency in women of all ages.

Profile of sexual function using Female Sexual Function Index (FSFI) in post-menopausal women in Geriatric Clinic, Dr Soetomo Hospital, Surabaya

Objectives: to describe the profile of sexual function in post-menopausal women at Geriatric Clinic, Dr. Soetomo Hospital, Surabaya in May 2016 and to determine the factors of sexual dysfunction in 6 sexual domains.Materials and Methods: a descriptive study using survey to obtain data on the examined variables. Population in this study was all post-menopausal women at Geriatric Clinic of Dr. Soetomo Hospital, Surabaya, in May 2016. Data were obtained using Female Sexual Function Index (FSFI) questionnaire.Results: Total population in this study was 160 patients. The number of samples who met inclusion criteria were 90 patients, but only 37 were willing to participate. The prevalence of samples who were still active in sexual intercourse was 29.7%. Based on 6 sexual domains, the prevalence of the lack of desire was 48.6%, lack of arousal was 75.7%, lack of lubrication was 73%, lack of orgasm was 73%, lack of satisfaction was 73% and pain was 70.3%. The assessment of sexual function found that 78.4% of the samples were sexually dysfunctional.Conclusion: The high prevalence (78.4%) of sexual dysfunction in post-menopausal woman was caused by dysfunction in sexual domain.

288 Which Female Prefer Longer Penises?

Women's orgasms are four types: 1) Clitoridene, 2) G-spot, 3) Vaginale, 4) All three together. Lack of orgasm is the second most common female sexual problem, affecting more than 20% of woman.The aim of our study was to find if the vaginal orgasm provoke only when penis of her partner is longer than average penis. The study was an online survey and by personal experiences. The samples were 1275 coitally experienced women. The effect of penis size on the likelihood of having an orgasm from penile – vaginal intercourse (PVI), was assessed by the question: “Are you more likely to have an orgasm from PVI with a man who has somewhat longer than average penis”? Answers were: a) More likely to have an orgasm with longer penis; b) No difference – I orgasm equally well with long or average penis lengths; c) Less likely to have an orgasm with a longer penis; d) I do not (or do not often) have an orgasm from PVI; e) I have not had enough PVI partners to make a comparison. Exclusion criteria were being coitally inexperienced and responses suggesting a high risk of misreporting

The Effect of Extract of Oak Gall for Vaginal Tightening and Rejuvenation in Women with Vaginal Relaxation

Background and Objectives: The Quercus (oak) fruit and especially the internal layer of the fruit (jaft) is rich in tannin (polyphenolic compound) and due to its astringent effects on the smooth muscles, we decided to evaluate this effect of extract of Oak Gall for vaginal tightening and rejuvenation in women with vaginal relaxation. Methods: This double blind clinical trial was performed on women with vaginal relaxation at Asali Hospital in Khorramabad from May to October 2012 and was candidate for colporrhaphy due to different types of pelvic organ prolapse. Sampling method was done on nonprobability basis according to the number of patients referred to clinic. Using blocked random allocation method, the participants were divided into 4 groups of 30 patients (three intervention group and one control group) who were age-matched. Then, an extract of Oak Gall in specified concentrations (10 - 15 and 20 grams in 1.5%, 2% and 2.5% jells) were administered to each intervention group. Finally, the obtained data were analyzed with Chi-square, Pearson, Fisher’s exact test and ANOVA using SPSS software version 19. Results: A total of 120 patients entered into the study with mean age of 36 ± 5.4 years. The evaluation of mean scores showed that sense of sexual satisfaction and orgasm, sense of vaginal tightness during intercourse, sense of vaginal lubrication and loss of vaginal dryness was significantly improved in patients in intervention group. Also other parameters including urinary incontinence, sense of vaginal mass exit, lack of orgasm, sense of air outflow during intercourse, sense of calmness after sex and loss of libido were significantly reduced in the group of patients who received jell 2.5% compared to other groups (P < 0.0001). Conclusion: Our findings show that using topical jell of Oak Gall not only is associated with contracting effects, but also improves vaginal lubrication and reduces its dryness. Regarding the lack of previous studies in this field and considering some limitations of this study, we suggest that Oak Gall to be used for management of women with vaginal relaxation.

Antihypertensive Drugs and Male Sexual Dysfunction

Published clinical practice guidelines have addressed antihypertensive therapy and sexual dysfunction (SD) in many different ways. In this systematic review, we evaluated guidelines that address antihypertensive drug-associated SD, guideline recommendations, and recent guideline trends. Thirty sets of guidelines for hypertension management in adults that had been published in the English language since 2000 were reviewed. The primary outcome measure was antihypertensive-associated SD potential, which was independently evaluated using specific questions by 2 authors in a nonblinded standardized manner. Sexual dysfunctions associated with thiazide-class diuretics, β-blockers, and centrally acting sympathoplegics were addressed by half of the guidelines reviewed. There is no clarity on β-blockers and thiazide-class diuretics because one-third of the guidelines are vague about individual β-blockers and diuretics, and there is no statement on third-generation β-blockers and thiazide-like diuretics that can improve erectile function. The revised guidelines never use terms such as loss of libido, ejaculatory dysfunction, lack of orgasm, and priapism. Summary versions of guidelines are inadequate to reflect the key interpretation of the primary guidelines on SD associated with antihypertensives, even in the major guidelines that were updated recently. Therapeutic issues such as exploring SD in clinical history, assessing SD prior to and during treatment with antihypertensives, substituting the offending agents with alternatives that possess a better safety profile, intervening with phosphodiesterase-5 inhibitors, and avoiding the concomitant use of nitrovasodilators are superficially addressed by most guidelines, with the exception of 2013 European Society of Hypertension/European Society of Cardiology and Seventh Joint National Committee recommendations. Future guideline revisions, including both full and summary reports, should provide a balanced perspective on antihypertensive-related SD issues to improve the impact of hypertension treatment guidelines on patient care and quality of life.

Sexual Function in Female Patients with Spinal Cord Injury

Objective: To determine the perception of sexuality, sexual function disorders and the effects of quality of life of sexual problems in female patients with spinal cord injury (SCI) in a Turkish population. Material and Methods: This study group was between the ages of 18-58 years; female SCI patients, sexually active before the spinal cord injury, were included. The control group consisted of healthy women. Neurological levels T10 and above, T11-L2, conus, and cauda were classified in three sub-groups. SCI and healthy women were evaluated with the TAF Rehabilitation Center Sexual Rehabilitation Evaluation Form in Women with SCI, Female Sexual Function Index, and Satisfaction With Life Scale. Results: Fifty SCI and 50 healthy women were included into the study; 46 patients before the injury and 40 patients after the injury had sexual intercourse experience, respectively. The decrease in sexual arousal and sexual intercourse was statistically significant (p=0.000) in the after-injury group than before the injury. Sexual interest and importance given to sexuality were significantly lower before the injury than in the control group (p<0.05). After SCI, based on the need to share intimacy, sexual activity ratio was 84%. In patients with a sense of the genitals, level of arousal was greater than those without (p=0.002). Lack of orgasm and sexual desire after the injury was the major problem experienced in sexual intercourse and was significantly increased after the SCI (p<0.05). Conslusion: In this study, we found that female SCI patients have a significant deterioration in sexual function, and it also impairs quality of life.

Sexual Functions of Turkish Women with Gynecologic Cancer during the Chemotherapy Process

The negative effects of gynecologic cancer on women's health is multidimensional. Sexual problems arising after chemotherapy are decreased interest and vaginal lubrication, lack of orgasm and dyspareunia and sense of reduction in sexual attractiveness in general. The purpose of this study was to evaluate changes that patients who receive chemotherapy for a gynecologic oncology disorder experience in their sexual functions. A descriptive/cross-sectional and qualitative study was performed. The Female Sexual Function Index (FSFI) was used in order to collect data on sexual capacity. The quantitative data obtained were evaluated with frequency and percentage calculations while content analysis was performed for the qualitative data. All of the information related to sexuality was provided by the physician. Chemotherapy treatment affected sexuality negatively in 55.9%. Since receiving the diagnosis, 52.9% of women had experienced no sexual intercourse at all. Those who had an FSFI score of 30 and below made up 75% of the women. After the content analysis of data obtained during in in-depth interviewing, we focused on three main themes: desire for sexual intercourse, problems experienced during sexual intercourse, and coping with problems. An integrated system where sexual problems can be handled professionally should be present during gynecological cancer treatment.

Radical cystectomy and urinary diversion in women: Impact on sexual function

The aim of this study was to assess the impact of radical cystectomy and different forms of urinary diversion on female sexual function. Seventy-three consecutive patients were included in the study. The mean age was 52.3 ± 6.5 years. All of them had undergone non-nerve-sparing radical cystectomy and urinary diversion for invasive bladder cancer. Patients were questioned about their current general relations with their husbands in comparison to the preoperative status. The Female Sexual Function Index (FSFI) was used to assess libido, lubrication, orgasm, satisfaction and painful sexual dysfunction. Patients were asked about any urinary complaints during or after sexual intercourse. Twenty-nine patients (39%) reported worsening relations with their husbands. The mean frequency of sexual relations was 2.3 ± 2.3/month; however, sexual relations had ceased completely in 19 patients (26%). Overall satisfaction among sexually active women worsened in 32 (59.2%) and was completely lost in eight patients (14.8%). Absent libido, difficult intromission, dyspareunia, lack of orgasm and sexually related urinary complaints were reported in 89%, 63%, 48%, 63% and 63% of patients, respectively. The mean FSFI score dropped significantly from 18.3 ± 5.1 to 11.3 ± 7.4 postoperatively (p < 0.001). FSFI scores were significantly higher among patients with orthotopic versus non-orthotopic forms of diversion and also higher among patients with no stoma versus those with stomal forms of diversion. Radical cystectomy and urinary diversion have deleterious impacts on all domains of female sexual function. Female patients with orthotopic and non-stomal diversions had better sexual functions than those with stomal diversions.

Sexual Dysfunction before and after Cardiac Rehabilitation

Background. The aim of this study was to assess sexual function before and after cardiac rehabilitation in relation to medical variables. Methods. Analysis of patients participating in a 12-week exercise-based outpatient cardiac rehabilitation program (OCR) between April 1999 and December 2007. Exercise capacity (ExC) and quality of life including sexual function were assessed before and after OCR. Results. Complete data were available in 896 male patients. No sexual activity at all was indicated by 23.1% at baseline and 21.8% after OCR, no problems with sexual activity by 40.8% at baseline and 38.6% after OCR. Patients showed an increase in specific problems (erectile dysfunction and lack of orgasm) from 18% to 23% (P < .0001) during OCR. We found the following independent positive and negative predictors of sexual problems after OCR: hyperlipidemia, age, CABG, baseline ExC and improvement of ExC, subjective physical and mental capacity, and sense of affiliation. Conclusions. Sexual dysfunction is present in over half of the patients undergoing OCR with no overall improvement during OCR. Age, CABG, low exercise capacity are independent predictors of sexual dysfunction after OCR.

Neuroanatomy of the Minor Pelvis-Significant Area in the Surgery of Rectal Carcinoma

For centuries, there are attempts to develop a strategy of appropriate rectal carcinoma management. However, surgery remains the essential element of therapy, being proposed by Morgagni in the eighteenth century. The anterior rectal resection method established by Dixon, in addition to Total Mesorectal Excision (TME), supplemented by combined therapy (radiotherapy, chemotherapy) initiated modern rectal carcinoma management techniques, aimed at oncological radicalism with sphincter preservation (Sphincter Saving Procedure – SSP, Sphincter Sparing Surgery – SSS, Sphincter Preserving Surgery – SPS) (1). Surgical intervention is considered as the standard oncological therapeutic method in case of rectal carcinoma patients, supplemented by combined therapy (radiotherapy, chemotherapy), depending on the stage of the disease and biology of the tumor. Surgery consists in the excision of the rectum and tumor (maintained margins free of neoplastic infiltration – R0 resection), as well as mesorectum with its vessels and lymph nodes. In case of tumors localized in the upper part of the rectum, tumor specific mesorectal resection (TSME) is preferred (2). In case of tumors localized in the medial and inferior part of the rectum low anterior resections are performed, in addition to total mesorectal excisions. Intestinal continuity is restored after the anastomosis of the proximal intestinal segment with a fragment of the rectal ampulla or at the level of the anal canal (coloanal anastomosis) (3). The technique proposed by Heald and Enker consisting in the excision of the mesorectum should always be respected, enabling to maintain the undamaged mesorectal (oncological radicalism) and Tolt’s fascia (NerveSparing Technique). Depending on the localization of the tumor rectal sphincters are preserved, and intestinal continuity is restored after the anastomosis of bowel segments free of neoplastic infiltration with all preserved techniques of anastomosis surgery (4). In most cases the reservoir part of the rectum is lost (different fragments of the rectal ampulla are preserved). Intestinal continuity restoration consisting in the simple anastomosis of the colon and rectal stump, and the creation of the neorectum cistern (by means of transverse coloplasty or other intestinal cisterns) do not guarantee normal functioning of the anorectum. Dixon’s (promoter of the anterior resection) suggestion that the procedure had no influence on the functioning of the sphincters proved to be erroneous (5). Combined oncological therapy of rectal carcinoma also exerts a negative effect on the genitourinary system. Urinary bladder and urethral sphincter dysfunction (urine retention and incontinence), as well as sexual disturbances both in male and female patients (impotence, lack of ejaculation, retrograde ejaculation, lack of orgasm) can result from the operation, especially in case of lower rectal carcinomas. The percentage of the above-mentioned postoperative complications ranges between 10 and 60% (6). The described disturbances result from damage to the autonomic innervation of the mentioned organs. The wide range of the above-mentioned disturbances depends on the experience of the surgeon, thus, being dependent of the learning

ORIGINAL RESEARCH—EPIDEMIOLOGY: Sexual Problems Among a Specific Population of Minority Women Aged 40–80 Years Attending a Primary Care Practice

ABSTRACT Introduction Clinicians are embarrassed about discussing sex with patients and do not know how to ask about sexual problems in a way that will optimize honest and open responses. Learning about inquiry responses and the prevalence of sexual problems among specific groups of women, including minority women, can help identify appropriate inquiry and management pathways. Aim To better understand useful inquiry techniques as well as to describe the prevalence of sexual problems among a specific group of minority women aged 40–80 years. Main Outcome Measures Responses to two styles of sexual problem inquiry, direct vs. ubiquity, were compared among sexually active subjects. Prevalence of sexual problems and interest in discussing problems with personal clinician were determined. Methods Minority women aged 40–80 years receiving care at one of two Family Health Centers in Brooklyn, New York who could speak English met inclusion criteria. A cross-sectional survey of 212 subjects, the majority being Afro-Caribbean, identified those who were sexually active and then randomly asked about sexual problems using one of two inquiry types: (i) a direct question, such as “Do you have a problem during sex,” or (ii) a ubiquity-style question, such as “Many women with diabetes have sexual problems, how about you?” Sexual problems were characterized by recognized phases of female sexual activity. Interest in discussing sexual problems with a personal clinician was determined. Results Of the 212 women surveyed, 108 (50.9%) were sexually active with 37 (34.3%) of these women responding “yes” when asked about sexual problems using one of the two inquiry techniques. Stratified analysis by age group showed significantly higher reporting of sexual problems when a ubiquity-style inquiry was used among older women aged 61–80 years (P = 0.028) but not among younger ones. The prevalence of sexual problems was 14.8% reporting pain, 12.0% lack of interest, 9.2% lack of excitation, 5.5% lack of orgasm, and 6.5%“other.” Forty-three percent of women with problems said they would like to discuss their problem(s) with their clinician. Conclusions In a specific minority group of women aged 40 years and older, especially those over age 60 years, ubiquity-style inquiries may encourage more open and honest responses about sexual problems. The most common sexual problem among this group of women was pain. There is willingness and even interest in talking with clinicians about sexual issues. Recognition of sexual problem prevalences helps clarify the high number of women who could be potentially helped with current and future pharmacologic and psychosocial treatments.

Mental health and lifestyle correlates of sexual problems and sexual satisfaction in heterosexual Hong Kong Chinese population

ObjectivesTo examine the lifestyle, mental health, and stress-related factors associated with various types of sexual problems among sexually active, heterosexual Hong Kong residents aged 18 to 59 years. MethodsAn anonymous, cross-sectional, random telephone survey was conducted using a special, validated, computerized telephone interview method. A total of 1281 men and 2130 women completed the interview (response rate 50.6%). Sexual problems were determined according to the Diagnostic and Statistical Manual (of Mental Disorders) IV definitions. ResultsAmong the men, multivariate analyses indicated that older age, poor spousal relationship, less exercise, high level of family stress, high level of financial-related stress, and past year substance use were significantly associated with sexual problems (odds ratio [OR] 1.41 to 3.83). Among the women, being married or cohabiting with a partner was positively associated with lubrication problems, lack of orgasm, lack of pleasure, lack of interest (OR 1.43 to 1.73) and negatively associated with pain during intercourse (OR 0.66) and anxiety (OR 0.62). A high level of financial stress and neuroses diagnoses were also associated with various female sexual problems (OR 1.40 to 2.66). Sexual satisfaction was associated with being married/cohabitating (OR 1.94) and negatively associated with a poor spousal relationship, low level of exercise, and a high level of work-related stress among men (OR 0.37 to 0.71). Among women, a poor spousal relationship and high levels of family stress and financial stress were associated with not being satisfied sexually (OR 0.24 to 0.71). ConclusionsMental health, stress-related factors, and lifestyle factors contribute to sexual problems among Hong Kong Chinese adults. The factors differed between the two sexes.

Clinical holistic medicine: holistic sexology and treatment of vulvodynia through existential therapy and acceptance through touch.

Sexual problems are found in four major forms: lack of libido, lack of arousal and potency, pain and discomfort during intercourse, and lack of orgasm. It is possible to work with a holistic approach to sexology in the clinic in order to find and repair the negative beliefs, repressions of love, and lack of purpose of life, which are the core to problems like arousal, potency, and pain with repression of gender and sexuality. It is important not to focus only on the gender and genitals in understanding the patient's sexual problems. It is of equal importance not to neglect the body, its parts, and the feelings and emotions connected to them. Shame, guilt, helplessness, fear, disgust, anger, hatred, and other strong feelings are almost always an important part of a sexual problem and these feelings are often “held” by the tissue of the pelvis and sexual organs. The patient with sexual problems can be helped both by healing existence in general and by discharging old painful emotions from the tissues. The later process of local healing is often facilitated by a simple technique: accepting contact via touch. This is a very simple technique, where the self-acceptance of the patient is to be promoted, for example, asking the female patient to put her hand on her stomach (uterus) or vulva, after which the holistic physician puts his hand supportively around hers. When done with care and after obtaining the necessary trust of the patient, this aspect of holding often releases the old negative emotions of shame bound to the touched areas. Afterwards, the emotional problems become a subject for conversational therapy and further holistic processing. Primary vulvodynia seems to be one of the diseases that can be cured after only a few successful sessions of working with acceptance through touch. The technique can be used as an isolated procedure or as a part of a pelvic examination. When touching the genitals with the intention of sexual healing, a written therapeutic contract with the patient is highly recommended and a strict ethical code is necessary to avoid malpractice. As about one woman in three suffers from sexual problems, many of which seemingly can be efficiently alleviated by the simple holistic techniques of “holding and processing”, it is very important that the holistic physician is also trained to work in the sexual sphere in order to be able to support his patients fully.

Women's Sexual Behavior, Body Image and Satisfaction with Surgical Outcomes after Hysterectomy: A Comparison of Vaginal and Abdominal Surgery

The aim of this study was to investigate the impact of vaginal and abdominal hysterectomy on women's sexual behavior, sexual dysfunction, body image and satisfaction with surgery. A prospective study was conducted on 90 women to evaluate the outcomes of hysterectomy. Data were collected prior to surgery, three months and two years after surgery, using self-report questionnaires. The results showed significant differences in women's sexual behavior and sexual dysfunction before and after hysterectomy, independent of the surgical procedure performed. Women in both groups reported improvements in sexual desire, sexual activity and sexual intercourse three months and two years after surgery. Sexual dysfunction such as dyspareunia, vaginismus, lack of orgasm and loss of sexual interest diminished significantly after surgery. Regression analyses revealed that postmenopausal status, severity of gynecological complaints and frequency of sexual intercourse were the most important factors for improved sexual outcomes. Women in the abdominal group were dissatisfied with their body image because of the abdominal scar, experienced more pain and had a longer period of recovery from surgery compared to women in the vaginal group. According to the results, sexual behavior alone is not an important factor in choosing vaginal or abdominal hysterectomy. However, sexual behavior was important in both groups when evaluating outcomes after hysterectomy.

Guilt and Lack of Orgasm During Sexual Intercourse: Myth Versus Reality Among College Women

With increasing emphasis on sexual fulfillment, many women perceive a societal expectation that they should always experience orgasm during sexual intercourse although scientific evidence indicates such a goal to be unrealistic. Failure to attain this expectation evokes guilt feelings in some women. This investigation of 556 never-married college women examined the influence of such guilt feelings on risk-related sexual behaviors and physiological/psychological sexual satisfaction. Significant differences identified included cognitive factors in sexual decision-making, number of lifetime sex partners, and levels of physiological/psychological sexual satisfaction. Given the negative role that guilt and unrealistic orgasmic expectations play in the sexual lives of many women, these findings have substantial implications for sex therapists, sex educators, physicians, and researchers.

Sexual experience and drinking among women in a U.S. national survey.

A 1981 national survey of 917 women provided rates of major sexual experiences and dysfunctions for the entire sample and across alcohol abstention/consumption categories. Most women drinkers (heavier drinkers most often) reported that drinking lessens sexual inhibition and helps them feel close to others; only 8% reported becoming less particular in sexual partner choice, 22% more sexually assertive, but over half (60%) had been targets of other drinkers' sexual aggression. On a sexual dysfunction index combining lifetime lack of sexual interest, lifetime lack or low frequency of orgasm with a partner, and vaginismus, moderate drinkers scored significantly lower than lighter and heavier drinkers. The heaviest drinking women had the highest rates of lifetime sexual disinterest and lack of orgasm with a partner. "Temporary abstainers" (who drank in the past 12 months but not the last 30 days) also had elevated sexual dysfunction rates, particularly those with substantial drinking histories. Several nontraditional sexual behaviors were correlated with heavier drinking, which was also related to morally liberal sexual attitudes. The study's findings may show the effects of a generalized moral value framework in which one large portion of the nation's population, especially females, is subject to pervasive proscriptions of behavioral, including their drinking and sexuality, while others vary in the freedom they find to drink and be sexual. More suppressed traditional sexuality occurs more frequently with lighter drinking and abstention, as is also true of sexual dysfunction. At heavier drinking levels suppressed and dysfunctional sexuality and heavy drinking may be both cause and consequence in a vicious circle, sometimes escaped by temporary or lasting abstention.