Pathophysiology Of Sexual Dysfunction Research Articles

Iatrogenic risk of genital injury with retrograde anterior column screws: CT analysis

Genitourinary injuries are identified acutely in less than 5% of patients sustaining pelvic fractures [1]. However, 31–67% of women and 14–72% of men report sexual dysfunction after blunt pelvic ring injury [2–5]. The pathophysiology of sexual dysfunction after pelvic ring injury may be multifactorial, with contributions from neurologic and vascular trauma, symptomatic mechanical skeletal instability or deformity, and psychological components [6]. Little is known about the possible contribution of iatrogenic surgical insult of skeletal stabilization of the pelvic ring to sexual dysfunction reported by patients with these injuries.

Biology of iatrogenic sexual dysfunction in men and women survivors of cancer.

Sexual dysfunction (SD) is widely reported by cancer survivors. However, this is an issue underestimated by doctors and the contribution of anticancer therapies for the development of SD in cancer survivors is understudied and poorly understood. Sexual function involves the activation of a neurovascular system that leads to penile erection in males and clitoral engorgement in females. Anticancer therapies can cause damage to the neurovascular circuit responsible for normal sexual function and thus, individual or combined therapies could play a role in the development of SD in all types of cancer survivors and not only those affected by genital cancers. In this review, the pathophysiology of SD and possible mechanisms underlying SD induced by anticancer therapies will be discussed. The effects of chemotherapy, radiotherapy and surgical interventions on the vasculature and nerves as well as their effects on sex hormones and inflammatory processes could link the biological effects of these interventions with SD. In conclusion, this review reports evidence that, despite psychological aspects and the disease itself, anticancer therapies are able to induce direct and indirect effects in males and females that could lead to SD in cancer survivors even after the end of the treatment.

The pathophysiology of sexual dysfunction in Parkinson's disease: An overview.

Sexual dysfunction is a common, poorly recognized, poorly discussed (often because of cultural perceptions and sensitivities), bothersome and neglected aspect of the range of non-motor symptoms of Parkinson's disease (PD). The spectrum of sexual dysfunction in PD ranges from hyposexuality-based disturbances to hypersexuality-dominated behaviors in the context of drug-induced impulse control disorder. The pathophysiological mechanisms underlying PD-related sexual dysfunction, specifically for hyposexual disorders, are thus heterogeneous and still not fully understood. However, central and peripheral neural mechanisms secondary to the hallmark pathological alterations of the disease (alpha-synuclein deposition and nigrostriatal degeneration) and to the associated network and neurotransmitter dysfunctions, together with the effects of dopaminergic therapies, seem to play an important role in the development of sexual disturbances. In this chapter, we therefore review the neuroanatomical and neurophysiological basis of sexual function in humans, and we provide insights on the pathophysiological mechanisms of hyposexuality and hypersexuality in PD.

Reproductive Dysfunctions in Males with Type 2 Diabetes Mellitus: An Updated Review

Deterioration in reproductive functions is one of the most serious complications of Type 2 diabetes mellitus (T2DM). Neuropathy, angiopathy, oxidative stress, and psychological deviation are the important causative factors in developing reproductive dysfunctions in diabetes. In males, the principal complications are erectile dysfunction (ED), ejaculatory disorders, and functional hypogonadism. Low serum testosterone is frequently observed in males with T2DM but the neuroendocrine pathophysiology is yet to be defined; this reduction in testosterone levels decreases libido. Evaluation of testosterone levels of male diabetic patients with hypogonadism symptoms is recommended. Hypogonadal males with diabetes might benefit from testosterone replacement therapy. However, there is a need for adequately powered long-term studies in this context. Impairment in sexual function is a common complication in males with diabetes. The pathophysiology of sexual dysfunction in diabetes is multifactorial. Males with diabetes have a >3-fold increase in the risk of ED compared to their nondiabetic counterparts. Phosphodiesterase type 5 inhibitors should be considered as first-line therapy in males with T2DM and ED. Nearly 50% of male diabetic patients presented some degree of subfertility or infertility. Alterations in sperm parameters and hormone levels can contribute to diabetes-related male infertility. Endocrinologists, diabetologists, and physicians should address sexual complaints of their patients since these problems can significantly impair their quality of life.

Does Alcoholism Influence Sexual Functioning?

Background: Alcohol and alcohol use disorder are known to cause sexual dysfunctions. In turn it may aggravate frequency and amount of alcohol consumed. We assessed the prevalence and the correlates of sexual dysfunction in men with Alcohol Dependence Syndrome (ADS) in a tertiary care hospital. Methods: A total fifty Consecutive male subjects were selected on the 3rd day of inpatient care from general hospital psychiatry with a diagnosis of Alcohol Dependence Syndrome with Simple withdrawal Symptoms as per ICD-10 criteria. Co-morbid psychiatric diagnosis was ruled out using SCID – 1. They were assessed for sexual dysfunction using International Index of Erectile Function (IIEF), a 15 item questionnaire. Data analyzed using descriptive and chi square test. Results: The mean age of the study sample was 39.26 (±8) years; The mean age of onset of drinking was 19.1(±6.2) years, and that of dependence was 24(± 6.7) years, duration of alcohol dependence was 15 (±7.7) years, with an average daily consumption of 462 (± 330) ml. Out of 50 patients, 38 (76%) reported to have one or more sexual dysfunction. Sexual desire (78.94%), low intercourse satisfaction (76.31%), followed by low overall satisfaction (57.89%), erectile dysfunction (55.26%) and orgasmic function (31.57%) were reported in that order. Co morbid nicotine dependence was found in 31(62%) of those having sexual dysfunction, and was statistically significant in those with erectile dysfunction and overall satisfaction domain with a p value less than 0.05. however other domains did not correlate. Conclusion: Sexual dysfunction is more prevalent in male patients with ADS. The prevalence of co-morbid nicotine dependence was high among patients with alcohol dependence syndrome. The findings of the current study indicate that it is necessary to routinely evaluate sexual dysfunction in patients with ADS and research should focus on the pathophysiology of sexual dysfunction among ADS.

Sexual dysfunction in male patients with multiple sclerosis: a need for counseling!

Sexuality and sexual health are significant factors in determining the quality of life (QoL). Multiple sclerosis (MS) is one of the most serious causes of neurological disability in young adults, therefore it can considerably reduce sexuality. Physical and cognitive symptoms of MS as well as mental and psycho-social issues can directly affect sexual life and body representation, causing reduced libido and self-esteem. Male patients with MS frequently develop sexual dysfunction (SD) as a result of their neurological impairment: in fact physical, psychological and neuropsychological changes indirectly interfere in the sexual response. Thus, MS physicians’ greater concern on SD has led to the enhancement of diagnostic and therapeutic diagnoses on neurogenic SD. Given the increasing number of people coping with MS, a more effective focus on MS-related problems, including SD, is absolutely essential to provide the patients and their partner with the necessary information to achieve a better sexual health and consequently improve their QoL. This review aims to investigate the epidemiology and pathophysiology of SD in male patients, provide an insight into multidisciplinary diagnostic and therapeutic approaches, and focus on the need of proper counseling.

Sexual Dysfunctions of HIV-Positive Men: Associated Factors, Pathophysiology Issues, and Clinical Management

Sexual dysfunctions in HIV-positive men are associated with an increase in risky sexual behavior and decreased adherence to antiretroviral drug regimens. Because of these important public health issues, we reviewed the literature on the pathophysiology, associated factors and clinical management of sexual dysfunction in HIV-positive men. The goal was to investigate the current research on these issues. Literature searches were performed in June 2011 on PubMed, Web of Science, and PsycInfo databases with the keywords “AIDS” and “sexual dysfunction” and “HIV” and “sexual dysfunction”, resulting in 54 papers. Several researchers have investigated the factors associated with sexual dysfunction in HIV-positive men. The association between sexual dysfunction and antiretroviral drugs, particularly protease inhibitors, has been reported in many studies. The lack of standardized measures in many studies and the varying study designs are the main reasons that explain the controversial results. Despite some important findings, the pathophysiology of sexual dysfunction in the HAART era still not completely understood. Clinical trials of testosterone replacement therapy have shown the treatment to be beneficial to the improvement of sexual dysfunctions related to hypogonadism. However, there are not enough psychological intervention studies to make conclusions regarding the therapeutic effects of psychotherapy.

Sexual Function in Chronic Illness

Direct and indirect effects of chronic disease on sexual health are frequent and complex, but guidelines for their optimal management are lacking. With improved surgical and medical treatment of the underlying disease, the numbers of men and women needing assessment and management of associated sexual dysfunction are increasing. To provide recommendations/guidelines for the clinical management of sexual dysfunction within the context of chronic illness. An international consultation in collaboration with the major sexual medicine associations assembled 186 multidisciplinary experts from 33 countries into 25 committees. Nine experts from four countries compiled the recommendations of sexual dysfunction in chronic illness and cancer with four focusing on neurological, renal, and psychiatric disease and lower urinary tract symptoms (LUTS). Searches were conducted using Medline, Embase, Lilacs, and Pubmed databases. Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Some conclusions concerning prevalence and pathophysiology of sexual dysfunction in the context of neurological disorders, end-stage renal failure, LUTS, and psychiatric disease were made. Optimal assessment of the multiple factors affecting sexuality when one or both partners are chronically ill is outlined. Evidence-based recommendations for management are presented. Comorbid depression is frequent and independently determines prevalence of sexual dysfunction in many conditions. There is need for more research and scientific reporting on prevalence, pathophysiology, and optimal treatment of sexual dysfunction associated with chronic illness. Screening for and managing comorbid depression is strongly recommended.

Sexual Ramifications of Medical Illness

Medical disease and the methods used to treat disease that can result in sexual problems. The prevalence and pathophysiology of sexual dysfunction have been prominent questions in medicine for more than a decade. Pertinent information related to sexual dysfunction and medical illness, with special emphasis on cardiovascular health, endocrine-related disorders, and malignancy are presented.

Sexual health in women with pelvic floor disorders: measuring the sexual activity and function with questionnaires—a summary

The integration of sexual health into the health care services is important. In women attending urogynecological clinics, the urinary function, anorectal function, and anatomical defects are more often evaluated than those related to sexual activity and function. A group of experts in urogynecology, sexuality, and patient reported outcome development, met in a roundtable with the final objective of reviewing what is currently available and what is needed to accurately evaluate sexual function in women with pelvic floor dysfunction. An article was prepared for each of the issued presented during the roundtable and combined into this supplement. This article is a summary of all articles included in this supplement. The pathophysiology of sexual dysfunction as related to pelvic floor disorders has not been well established. Sexuality questionnaires and scales play an integral role in the diagnosis and treatment of female sexual dysfunction. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is the only validated female sexual function questionnaire specifically developed to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse; however, the PISQ does not screen for sexual activity. The effects of treatments for pelvic floor problems on sexual function have received little attention. There is a need for a validated sexual function measure that evaluates not only the impact of pelvic floor dysfunction on sexual function but also the impact on sexual activity.

Pathophysiology of sexual dysfunction as related to pelvic floor disorders

Female sexual dysfunction must be evaluated in the context of age, marital status, and general health status of the woman. Questionnaires evaluating the four domains of female sexual dysfunction can be used as a screening tool to evaluate the effect of pelvic floor disorders and coital leakage, as well as the effect of surgical methods and medical treatment on sexual function. Sexual problems are seldom volunteered symptoms, and only recording whether the woman has dyspareunia and frequency of sexual activity must be considered end-point parameters of a complex function. These parameters cannot explain the pathophysiological causes of the problem. There is a paucity of validated, easily accessible methods and parameters to objectively assess female sexual function.

Differential brain processing of audiovisual sexual stimuli in men: Comparative positron emission tomography study of the initiation and maintenance of penile erection during sexual arousal

The human male psychosexual cycle consists of four phases: excitation, plateau, orgasm, and resolution. Identification of the specific neural substrates of each phase may provide information regarding the brain’s pathophysiology of sexual dysfunction. We previously analyzed regional cerebral blood flow (rCBF) with H215O-positron emission tomography (PET) during the excitation phase (initiation of penile erection) induced by audiovisual sexual stimuli (AVSS) and identified activation of the cerebellar vermis, the bilateral extrastriate cortex, and right orbitofrontal cortex, suggesting a role of cognition/emotion in the excitement phase. In the present study, we analyzed rCBF of the same six healthy volunteers during the plateau phase (maintenance of penile erection) induced by AVSS and compared the results with those of the excitation phase. Penile rigidity was monitored in real time with RigiScan Plus® during PET scanning. Images were analyzed by statistical parametric mapping (SPM) software, and rCBF in the amygdala, hypothalamus, anterior cingulate, and insula was measured. During the plateau phase, primary subcortical activation was noted in the right ventral putamen, indicating motivational factors in the sexual response via the limbic reward circuit. A significant increase in rCBF in the left hypothalamus was also observed during the plateau phase. The right anterior cingulate and left insula were specifically activated during the excitation phase but not during the plateau phase. These results indicate a significant role of the ventral putamen and the hypothalamus in the plateau phase and confirm that paralimbic and limbic components of the human brain differentially coordinate the sexual response in a psychosexual phase-dependent manner.

Sexual dysfunction in depression.

Sexual dysfunction is a well-known symptom of depression. However, it has received little, if any, attention from clinicians and researchers. A review of published literature suggests that sexual dysfunction occurs in the majority of depressed patients. It has a major impact on the quality of life of the patients. The pathophysiology of sexual dysfunction in depression involves a complex interplay of various neurotransmitters and hormones. Clinicians need to be more proactive in enquiring about sexual dysfunction in depressed patients. More information is needed about the nature, prevalence and pathophysiology of sexual dysfunction in depression. Copyright 2000 John Wiley & Sons, Ltd.

The pathophysiology of sexual dysfunction associated with antipsychotic drug therapy in males: A review

Sexual dysfunction is commonly encountered in men receiving antipsychotic drug therapy. Ejaculatory dysfunction has been most commonly reported, but erectile dysfunction, decreased libido, priapism, and a change in the sensation of orgasm have also been noted. The anticholinergic and antiadrenergic effects of antipsychotics may cause problems with erection and ejaculation. Antipsychotics block dopamine synapses in the central nervous system and may suppress sexual interest because of this. The hyperprolactinemia seen with these compounds may also have adverse consequences on sexual functioning. The effects of antipsychotics on gonadotropins and testosterone are not clear. A variable which confounds much of the research in this area is the possibility of an underlying neuroendocrine abnormality in patients with schizophrenia.