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doi 10.15296/ijwhr.2016.13 http://www.ijwhr.net doi 10.15296/ijwhr.2015.27 OpenOpen Access Review Review

InternationalInternational Journal Journal of Women’s of Women’s Health and Reproduction and Reproduction Sciences Sciences Vol.Vol. 3, No.4, No. 3, July 2, April 2015, 2016, 126–131 52–58 ISSNISSN 2330- 4456 2330- 4456

HormoneWomen on Profile the Other in SideHypersexuality of War and Poverty: Women Its Effect on the Health of Reproduction Ahmed Al Awlaqi1, Khalid Alkhayat1, Guvan Akrawi1, Nasser Al Awlaqi1, Mohamed E Hammadeh1* Ayse Cevirme1, Yasemin Hamlaci2*, Kevser Ozdemir2 Abstract HypersexualityAbstract refers to a clinical diagnosis used by providers and researchers to describe a suddenly increased or extremelyWar and poverty frequent are sexual ‘extraordinary activity orconditions sexual urges. created The by literaturehuman intervention’ defines and ‘preventable as a public condition health where problems.’ affected War persons and exhibit excessivepoverty have or manyunusual negative indulgence effects onor humanconcern health, with especially sexual activity. women’s Sexologists health. Health have problems reported arising that due hypersexuality to war and poverty can beare a primary condition,being observed or a assymptom of the and underlying , all kinds medical of violence sexual and condition, subsequent such gynecologic as a bipolar and obstetricsdisorder, problemsParkinson with disease, physiological damaged kidney orand impaired psychological adrenal courses, functions. and The objective as the of resultthe current of undesired review but is forcedto explore or obliged the hypersexual and behavior even . in females Certainly, and examine theunjust role treatment of sexual such as being secretion unable into proliferatinggain footing on the the condition. land it is Specificlived (asylum focus seeker,is to discuss refugee, how etc.) a hormonaland being deprivedimbalance of in females couldsocial leadsecurity, to hypersexuality citizenship rights if major and humanglands rightsin the bringsbody become about the impaired, deprivation including of access the to adrenal health cortex,services the and thyroid of provision glands, of pancreatic glands,service intendedand how for medical gynecology conditions and obstetrics. like The purposein these oforgans this article can alsois to triggeraddress hypersexualeffects of war behavior.and poverty The on studythe health will ofalso seek to verifyreproduction if there of is women a link andbetween to offer medical scientific conditions contribution on andthe abovesolutions. organs and the normal secretion of sex , which when triggeredKeywords: can Poverty, cause Reproductive an imbalance health, in hormone War secretion resulting in excessive sexual urge and fantasies. Keywords: , Adrenal glands, , Hypersexuality sex hormones

Introduction thought that severe military conflicts in Africa shorten IntroductionThroughout the history of the world, the ones who had the expectedty simply lifetime means for an more excessive than 2increase years. In of general, resulting Androgensconfronted theare bitteresthormones face presentof poverty in andboth war male had and al- fe- WHOfrom had somecalculated medical that conditions269 thousand that people affect had variation died in sex- male.ways beenHowever, the women. they are As commonlyknown poverty found and in war men affects and are in 1999ual due urge. to Thethe effect objective of wars of andthe currentthat loss reviewof 8.44 milis to- examine attributedhuman health to the either cause directly of male or characterindirectly, traitsthe effects and reproof - lion healthythe common years of medical life had occurredcondition (2,3). and the hormone profile ductionthis condition growth. on The health main and androgens status of women are androstenedione in the so- Warsthat negatively has been affect reported the provision to trigger of hypersexualityin health services. women. andciety should not beand ignored. in men, This these study hormones intends areto castpresent HealthIn institutionsthe year 2010, such theas hospitals,American laboratories Psychiatric and Association inlight higher on the levels effects as ofthey war play and apoverty very vital on the part reproductive in shaping the healththat centers defined are direct and gave targets the of symptoms war. Moreover, of hypersexual the wars disor- health of women. For this purpose, the face of war affect- cause the migration of qualified health employees, and masculine traits. Other forms of androgens have also been der released a draft containing a list of five symptoms that ing the women, the problem of immigration, inequalities thus the health services hitches. Assessments made indi- reported,in distribution including of income dehydroepiandrosterone based on gender and the (DHEA), effects di- cate thata person the effect may of experience destruction regardless in the infrastructure of gender of (6). These hydrotestosteroneof all these on the reproductive(DHT), and health DHEA of sulfatewomen (DHEA-S)will be healthsymptoms continues arefor 5-10not dueyears to even some after medication the finalization or manic ep- (1).addressed. In females, the hormones are secreted in ovaries and of conflictsisodes (3).but Duerather to resourcethey are requirementsbecause of thein thedisorder. re- They fat cells (2,3). According to Abramovitz (1), the variation structuringinclude: investments after war, the share allocated to inWar production and Women’s of these Health hormones in either men or women health• hasThe decreased individual (1). is consumed by sexual fantasies and hasFamine, significant synonymous consequences with war inand the poverty, body regardingis clearer for sexu - indulgence in planning for excessive engagement in alwomen; expression. war means Case deepin point, disadvantages hormonal such imbalance as full deresults- Mortalitiessexual and Morbidities behavior[1], instruction, hormonal loss disorder of future thatand uncertaintyaffects the sexualfor women. behavior Wars of a The ones• whoConcurrent are most repetitionsaffected from in wars these are sexual women activities and in re- person.are conflicts that destroy families, societies and cultures children. Whilesponse deaths to dysphoric depending mood on directstate, violence af- Asthat elaborate, negatively the affect importance the health of of the community and hormone cause to fect the• maleRepetitive population, engagement the indirect in deaths sexual kill fantasies, children, behavior, violation of rights. According to the data of World women and elders more. In Iraq between 1990-1994, in- the female body cannot be underestimated. As noted by and urges in response to stressful events in his/her Health Organization (WHO) and World Bank, in 2002 fant deaths had shown this reality in its more bare form Alkhalilwars had et been al (2), among the theregular first tensexual reasons behavior which in killed women with an increasedaily life, of 600% (4). The war taking five years • highlythe most depends and caused on disabilities.the normal Civil production losses are atof the this rate hor - increases theUnsuccessful child deaths efforts under ageto ofcontrol 5 by 13%. this Also repetitive 47% sexual mone.of 90% Inwithin agreement all losses with (1). these views, Allen et al (3) note of all the refugeesengagement in the or world even and reduce 50% ofit, asylumand seekers thatWar inhas adult many females, negative androgen effects on hormones human health. regulate One sexualof and displaced• Irresponsible people are of women sexual and engagement and 44% disregarding ref- the behavior,these is its as effect they ofare shortening responsible the foraverage human synthesis. life. ugees andrisks asylum posed seekers for emotional are children and under physical the ageharm of to them- Also,According Yazici to (4) the has data added of WHO, that theandrogen average hormoneshuman life playis a 18 (5). selves or the others. significant68.1 years for role males in sexual and 72.7 satisfaction. years for females. Hence, whatIt is being remains As theThe result above of underlyingwars and armed medical conflicts, conditions, women as are Higgins et clear from the literature is the fact that the alteration in the al (7) explain, cause excessive production of libido hor- levelReceived of 12production December 2014, of Accepted these 25 hormones April 2015, Available will have online a 1 Julydirect 2015 mones in women, thus causing them to have that urge for effect on the sexual of the and may lead to excessive sexual indulgence. The current review presents 1Department of Nursing, Sakarya University, Sakarya, Turkey. 2Department of Midwifery, Sakarya University, Sakarya, Turkey. the*Corresponding hypersexual author: condition. Yasemin Hamlaci, Department of Midwifery, Sakarya University,and Sakarya, discusses Turkey. Tel:the +905556080628, common reasons for the alteration in AccordingEmail: [email protected] to Bertherat and Bertagna (5), hypersexuali- normal secretion of this hormone that is responsible for

Received 28 September 2015, Accepted 14 January 2016, Available online 7 February 2016

1Department of Obstetrics & Gynecology, University of Saarland, Homburg/Saar, Germany. *Corresponding author: Mohamed E Hammadeh, Department of Obstetrics & Gynecology, University of Saarland, Homburg/Saar, Germany. Tel: +49 68411628117, Email: [email protected] Al Awlaqi et al women’s sex drive, rendering them hypersexual or rather mones include androgenic steroids, corticosteroids, and have an excessive desire to have sex. aldosterone. Excessive secretion of androgenic steroids causes hypersexuality due to increases libido (11). These Androgen Production tumors are found by chance when there is a body scan for In agreement with the views of the above authors, Beck- unrelated conditions. According to Clark et al (12), the mann (6) documents that in females, androgens are fash- majority of these tumors though are non-functional. ioned in the adrenal glands, adipose tissue and the ovaries. In elaboration, it is in these organs that there appears to be Adrenalin Cancer the extra-glandular production of testosterone. Excessive In explaining about the adrenalin cancer (Figure 2), production of androgen may cause adrenal disorders, tes- Bertherat and Bertagna (5) states that it is a rare disease tosterone secretion tumors, which, as studies shows, may that usually originates from the adrenalin glands. The trigger hypersexuality causing hormones (6-8). Figure 1 adrenalin glands are situated at the topmost part of the and Table 1 below show the major site of androgen pro- kidneys and usually consist of two parts: the medulla (the duction. inner layer) and the cortex (the outer layer) that usually function separately (11). The outer layer is responsible for Adrenal Adenoma, Familial the production of three major hormones. These hormones Adrenal adenoma is a noncancerous (benign) tumor that are cortisol (a glucocorticoid), DHEA and aldosterone. is in the adrenalin gland. According to Alkhalil et al (2), The inside layer (medulla) produces , norepi- adrenalin tumor arises because of , in particular, nephrine and epinephrine. that are not known yet. That is why it is hypothe- In agreement with the above views, Lesser et al (14) note sized that it is inherited in the family and this is further that this cancer usually occurs in young adults and caus- exhibited that it is found together with some common in- es overproduction of adrenal hormones and is certainly herited diseases such as Carny . believed to be hereditary. The increases libido is due to In cases where the adrenal adenomas produce hormones, excess secretion of androgenic steroids. According to Co- it is referred to as functioning. However, this term maybe mandone (15), about one out of a million people develops confused to mean normal, but in fact, in such instances, adrenal cancer yearly worldwide. The symptoms for this Khazaal and Zullino (8) state that adrenal hormones pro- cancer vary, but the most common are; moderate hyper- duces an excessive amount of steroid hormones resulting tension, constipation, excessive urination, headache, ex- in increased sexual behavior. On the other , if the ad- cessive thirst and frequent personality changes. The symp- renal adenomas do not produce any hormones it is known toms mentioned above are, but just a list of few symptoms as non-functioning (10). However, in the case where the but others are depending on the most secreted hormone tumor is referred to as functioning, Series and Dégano by the gland (14,16). (10) state that it secretes different hormones and, there- fore, different symptoms may be exhibited. These hor- Adrenal Cortex Diseases Haussermann et al (17) state that these diseases normal- ly occur when the adrenalin gland seems not to produce enough hormones that they are expected. Figure 3 shows the functions of adrenal cortex in hormone secretion. This condition is alternatively known as chronic adreno- cortical insufficiency, primary adrenal insufficiency, or- adrenonic adrenocortical hypofunction. Examples of this disease are Addison disease, adrenal , and Cush- ing syndrome. According to Jameson and Degroot (18), Addison disease is caused as a result of damaged adrenal

Figure 1. A Photo Showing Adrenalin Glands. Adapted from Linos and Van Heerden (9).

Table 1. Sites of Androgen Productiona DHEA-S Androstenedione Testosterone Site (%) (%) (%) Adrenal glands 90 50 25 Ovaries 10 50 25 Extraglandular 0 0 50 Figure 2. A Photo Is Showing Anexample of the Adrenal Tumor. Abbreviation: DHEA-S, dehydroepiandrosterone sulfate. Adapted from Fowler et al (13). a Adapted from Beckmann.6

International Journal of Women’s Health and Reproduction Sciences, Vol. 4, No. 2, April 2016 53 Al Awlaqi et al

Figure 4. Showing the cortex and medulla of the adrenal glands where hormones are manufactured. Adapted from Fowler et al (13). Figure 3. Depicting the Function of Adrenaline Glands in Hormone Secretion. Adapted from Fowler et al (13). show symptoms according to the secretion of the hor- glands, which are known to produce the hormones that mones secreted. As Houck (25) further acknowledges, control the body’s response to and aid in balancing the hormones secreted by the gland includes androgenic the body salt and water. Because of the damage to adren- steroids aldosterone, corticosteroids, and aline glands, there is reduced endurance and therefore, epinephrine. The tumor may cause increased activity of the patient, even though suffers from lower aldosterone this adrenal gland. Gullette and Lyons (26) reveal that secretion, lacks general self-control and therefore, may sometimes there can be cases of excessive stimulation of portray some symptoms of hypersexuality (19). Fong (20) the glands and therefore, causing the increase of activity also states that some of the symptoms of this disease in- in the gland. Pituitary hormones are also responsible for clude severe fatigue, loss of weight, weakness, increased simulation of adrenal gland activity. The increased libido pigmentation of the skin, nausea, salt cravings, low that causes hypersexuality in women is because, during pressure, painful muscles and . Because this sickness the excess activity of adrenaline gland, there may occur is not apparent until almost 90% of the cortex is destroyed, a scenario where excess androgenic steroids are secreted some of the symptoms are ignored. and therefore the behavioral change of the patient is re- alized (26). Adrenal Cortex Neoplasms This tumor usually develops in the adrenal gland. Just as Adrenal Incidentaloma adrenal adenoma, the tumor may secrete hormones or While performing an imaging examination, a tumor can may not. In explaining this further, Fowler et al (13) re- be incidentally discovered in the adrenalin gland (27). The veal that while secreting these hormones, the process may tumor may cause excessive secretion of adrenal hormones be excessive and, therefore, exhibit several symptoms de- and therefore, causes the resulting symptoms or may also pending on what hormones secreted most. The hormones be asymptomatic. The discovered tumor may be benign or that show these variations are made in the cortex and are malignant. Benign tumors are tumors that lack the ability the ones responsible for the increase variation of symp- to spread since they do not attack neighboring cells (28). toms (21). The presentation of adrenal cortical neoplasm These tumors are non-cancerous in nature and according usually varies depending on the tumor size, and the status to Haussermann et al (17), part of the symptoms of adre- of tumor secretion. To Pollock (22), 20% of the patients nal incidentaloma is that there are excessive fat deposits at usually experience excessive androgen secretion. the back of the patient. The deposits are as a result of the The hormones that are affected because of these secre- excess release of corticosteroids, increased libido because tions are aldosterone, androgenic steroids and corticoste- of excess secretion of androgenic steroids and sometimes roids, which are manufactured in the cortex, the outside increased body hair due to excess corticosteroids. Accord- part of the adrenal gland (Figure 4). According to Moore ing to Garcia-Falgueras and Swaab, hypersexuality occurs and Puri (23), excessive secretion of androgenic hormones when there is excess secretion of androgenic steroid hor- cause the increase of sexual urge and the patient finds her- mones, which is responsible for the increase in libido. In- self indulging in excessive sexual activity and fantasy, thus crease in libido causes the patient to have an excess urge being hypersexual. Other symptoms go with this medical to sexual indulgence and sometimes lack control over the condition such as loss of scalp hair due to excess cortico- condition (9). steroids secretion and increased body hair due to excess corticosteroids (24). This disease is sometimes referred to as cancer of the ad- Adrenal Gland Hyperfunction renal cortex. This tumor, just as the previous ones, may There are times where there is the excessive activity of the be making more hormones than required (functioning) adrenaline gland. This activity causes excessive produc- or making no hormones at all (nonfunctioning). Coman- tion of adrenal hormones. One or two of the hormones done (15) states that these hormones are made in large may be produced in excess, and therefore, the patient will quantities, which may cause certain symptoms or signs of

54 International Journal of Women’s Health and Reproduction Sciences, Vol. 4, No. 2, April 2016 Al Awlaqi et al disorder in the patient’s overall behavior. Linos and Van oversleeping, sluggishness, among other Heerden (9) also state that excessive secretion of hor- negative thoughts. On the other hand, Hayat (35) notes mones differentiates the symptoms portrayed by a patient. that in case of the patient will exhibit these signs: Symptoms that are exhibited in the early stage include spending spree, physical agitation, excessive involvement increased body hair attributed to the fact that there was in goal-directed activities, distractibility, racing thoughts, an increase secretion of corticosteroids, which also causes fast-talking, excessive talking, decreased sleep need, un- excess fats deposits at the back and sometimes loss of hair. realistic idea, grandiosity, over-inflated self-esteem, rebel- When there is excess secretion of androgenic steroids, the liousness, irritability, inappropriately elevated mood and patient will exhibit an increase in libido and therefore, de- hypersexuality that is increased sex drive (36). During velop hypersexuality (29). this period, the patient’s estrogen hormones interact with many hormones and therefore, cause an imbalance that Bipolar Disorder might be characterized to hypersexuality (37). Sometimes known as manic-depressive illness, bipolar disorder is a condition that causes the mood of the patient HAIR-AN Syndrome to have no proper direction. The mood keeps on chang- Pal (38) states that Hair-An syndrome affects females and ing back and forth between two distinct emotional states insulin resistance and overproduction of male hormones (30). In , the patient is sad, inactive and in a in female characterize it. When the body produces insulin, withdrawn state (31). On the other side, the mood of the and the body does not use it very well, that condition is patient may be extremely elevated and there are very high the one referred to as insulin resistance. Due to this re- levels during this period, high alertness and a lot of sistance, the pancreas is forced to produce more insulin excitement. However, according to Quinn (32), the patient and therefore, high level of insulin causes the ovaries to may show some sign of endless talking or the rapid rush of produce excessive androgen that in this case causes acne, ideas. These lead to the development of and de- excessive hair growth, irregular periods and higher libido. lirium. This state can result in increased hormone release The increased libido can cause the patient to be hypersex- as depicted in Figure 5. ual and develop other complications later in life, such as Most patients with bipolar disorder alternate between , heart disease, excessive growth and high blood these moods and sometimes it can confuse the people pressure (39). who live with the patient. The depressed person may have thought of contemplating suicide attempts. Often the pa- Hyperadrenalism tient may not realize they are suffering from this disor- Hyperadrenalism refers to a condition where the body der because the symptoms may be ignored as a normal produces an excessive level of adrenal hormones (40,41). way of life for these individuals (33,34). There are sever- The symptoms depend on which hormone is involved and al symptoms associated with this sickness. They include; the degree levels in which is released. These hormones in persistent sad mood, appetite loss, overeating, weight the discussion are aldosterone, androgenic steroids, corti- gain, agitation, lack of energy, feeling of worthlessness, costeroids, norepinephrine and epinephrine (42). In cases inappropriate guilt, difficulty in thinking, difficulty in where the excessive secretion of hormones involved is an concentrating, thought of suicide and death, chronic androgenic steroid, the patient’s libido level increases and eventually will exhibit signs of hypersexuality.

Hyperandrogenism is a condition where the body in- creases the body’s male sex hormones. A woman secreting these hormones will exhibit male features such as break- ing of voice, the growth of air changes in menstrual cycles and sometimes hypersexuality (43). Hyperandrogenism is a condition whereby the body makes an excessive amount of androgens, a hormone responsible for increased libido. Therefore, as Mushlin and Greene (44) state, the female patient will start showing signs of hypersexual tendencies.

Hypertryptophanemia Hypertryptophanemia is a rare disease, but some of the symptoms include hypersexuality that is characterized by the presence of high levels of blood . Some of the symptoms include; aggressive behavior, , development delay, adducted , limited ex- tension, loose joints, , absent femur bone, flat Figure 5. How Stress Can Cause Adrenalin to Release Hormone. In this case, is cortisol. Adapted from Quinn (32). foot, absent ulnar bone, mood swings, impaired vision,

International Journal of Women’s Health and Reproduction Sciences, Vol. 4, No. 2, April 2016 55 Al Awlaqi et al , , weak eye muscles, speech problems, whereby the patient exhibits signs of being consumed by behavioral problems, excessive sweating and hypersexu- sexual fantasies and indulgence in planning for excessive ality (45). engagement in sexual behavior concurrent repetitions in these sexual activities in response to dysphoric mood Kluver-Bucy Syndrome state. Also, as Reiser and Thomson (48) reveal, other signs This rare behavioral impairment is characterized by in- include repetitive engagement in sexual fantasies, behav- appropriate behaviors that are sexually related. Some of ior, and urges in response to stressful events in his/her these patients turn to exhibit some abnormal characters daily life, unsuccessful efforts in to control this repetitive like mouthing of objects and . Other signs sexual engagement or even reduce it without much suc- include loss of anger and normal fear traits, distractibility, cess. The irresponsibility of sexual engagement disregard- , memory loss, lack of ability to identify object ing the risks posed for emotional and physical harm to visually and hypersexuality (46,47). This disorder is asso- themselves or the others (4). ciated with anterior temporal lobes damage of the This, as Souhami and Tobias (37) explain, may be because and (42) in his text shows that he causes of this disorder of medical condition such as, adrenal adenoma, adrenalin have been connected to head trauma, maybe caused by an cancer, adrenal cortex diseases, adrenal cancer, adrenal accident or herpes encephalitis. gland hyperfunction, adrenocortical carcinoma, bipolar disorder, HAIR-AN syndrome, functioning pancreatic Mania endocrine tumor, hypertryptophanemia, hyperadrenal- Mania is the feeling of being high and euphoric. People ism, hyperandrogenism, Kluver-Bucy syndrome, mania, with this disorder are overexcited, hyperactive or frantic. and sertoli. All of the above can be treated if early Their thought and speech are often fast and are fragment- detected in the life of a patient. The biggest challenge is ed because of frequent tumbling against itself caused by that most of these symptoms are ignored and the patient overall crisscrossing of ideas and thoughts. Cycling be- may not feel free to share them having the fear of stigma- tween this condition and abrupt depression is an indica- tization and self-ego. Some of the above conditions can tion of the bipolar disorder. Some of the symptoms ac- result inthe loss of life and other chronic sicknesses. cording to Noggle et al (46) include, grandiosity, physical agitation, spending spree, distractibility, racing thoughts, Ethical Issues fast talking, excessive talking, decreased sleep need, un- Not applicable. realistic idea, grandiosity, recklessness, fast moving, in- creased appetite, increased use of alcohol, over-inflated Conflict of Interests self-esteem, rebelliousness, irritability, inappropriate ele- The authors declare no conflict of interests. vated mood and hypersexuality (47). Financial Support Puberty The researchers received no financial support or grant Puberty is the physical and sexual maturation in adoles- from any funding agency in the public and commercial cent (1,35,48). The signs and symptoms of puberty include sectors. growth spurts, acne and maturation of the internal organs, increased appetite and menarche. Some of the mental and Acknowledgments emotional changes include moodiness, emotional chang- None to be declared. es, anxiety, clumsiness, irritability and increased libido. The increased libido may cause hypersexuality behavior Endnote (49,50). Those sexual activity, may be , sexual involvements that is not normal but in its excess. Psych Sertoli-Leydig Cell Tumors Central.com. 2013. Symptoms of Hypersexual Disorder Sertoli-Leydig cell tumors is a form of ovarian cancer (Sex ) - Psych Central. [online]. where there are excess male hormones produced by the cancerous cells. The symptoms that come with this disor- References der include painful sex, fatigue, enlarged , acne, in- 1. Abramovitz M. Diseases and Disorder. In: Abramovitz frequent menstrual periods, pelvic pain and pelvic mass, M. Bipolar Disorder. Detroit: Lucent Books; 2005:93- reduced size, and increased libido. The increased 95. libido is due to excessive androgenic hormones (42,50). 2. Alkhalil C, Tanvir F, Alkhalil B, Lowenthal DT. Treatment of sexual disinhibition in dementia: Case Conclusion reports and review of the literature. Am J Thera- In conclusion, a woman’s sexual are altered when peutics. 2004;11(3):231-235. doi:10.1097/00045391- there is an alteration of androgens produced in the wom- 200405000-0001. an’s body. Excessive reproduction of this hormone causes 3. Allen A, King A, Hollander E. Obsessive-compulsive an increase in woman’s libido and, therefore, causes her to spectrum disorders. Dialogues Clin Neurosci urge for sexual indulgence. Hypersexuality is a condition 2003;5(3):259-71. doi:10.1159/000321070.

56 International Journal of Women’s Health and Reproduction Sciences, Vol. 4, No. 2, April 2016 Al Awlaqi et al 4. Yazici M. Ovarian Mucinous Cystadenomas in 22. Pollock R. Advanced Therapy in Surgical Oncology. Childhood. In: Bardos AP, editors. Trends in Ovarian Hamilton, Ontario: BC Decker Inc; 2008. Cancer Research. New York: Nova Science Publishers; 23. Moore D, Puri B. Textbook of Clinical Neuropsychiatry 2004:139-162. and Behavioral Neuroscience. London: Hodder 5. Bertherat J, Bertagna X. Pathogenesis of adrenocortical Education; 2012. cancer. Best Practices Res Clin Endocrinol Metab. 24. Lerma EV, Berns JS, Nissenson AR. Current 2009;23(2):261-271. doi:10.1016/j.beem.2008.10.006. Essentials: Nephrology and . New York: 6. Beckmann CR, ed. Obstetrics and Gynecology. 2nd McGraw-Hill Medical; 2012. ed. Philadelphia: Lippincott Williams & Wilkins; 25. Houck JA. Hot and Bothered: Women, Medicine, and 2010. in Modern America. Cambridge, MA: 7. Higgins A, Barker P, Begley CM. Hypersexuality Harvard University Press; 2006. and dementia: dealing with inappropriate sexual 26. Gullette DL, Lyons MA. Sexual sensation seeking, expression. Br J Nurs. 2004;13(1):1330133-4. compulsivity, and HIV risk behaviors in college doi:10.12968/bjon.2004.13.22.17271. students. J Community Health Nurs. 2005;22(1):47- 8. Khazaal Y, Zullino DF. Topiramate in the treatment 60. doi: 10.1207/s15327655jchn2201_5. of compulsive sexual behavior: a case report. BMC 27. Fischer J, Bland K, Callery M. Mastery of Surgery. 2006;6:22. doi:10.1186/1471-244X-6-22. Volume 1. Philadelphia: Lippincott Williams & 9. Linos D, Van Heerden J, editors. Adrenal Glands, Wilkins; 2006. Diagnostic Aspects and Surgical Therapy. Berlin: 28. Fagan PJ. Sexual Disorders: Perspectives on Diagnosis Springer; 2005. and Treatment. Baltimore, Maryland: JHU Press; 10. Series H, Dégano P. Hypersexuality in dementia. Adv 2004. Psychiatr Treat. 2005;19(6):424-431. doi:10.1192/ 29. Gizewski ER, Krause E, Schlamann M, et al. apt.11.6.424. Specific cerebral activation due to visual erotic 11. Clark OH, ed. Endocrine Tumors. London: Hamilton, stimuli in male-to-female transsexuals compared B.C. Decker; 2003. with male and female controls: an fMRI study. J 12. Clark O, Duh Q, Kebebew E. Thyroiditis. In: Clark Sexual Med. 2009;6(2):440-448. doi:10.1111/j.1743- O, Duh Q, Kebebew E, eds. Textbook of Endocrine 6109.2008.00981.x. Surgery. Philadelphia: Elsevier Saunders; 2005. 30. Leonard B, Jovinelly J. Bipolar Disorder. New York: 13. Fowler CJ, Panicker JN, Emmanuel A. Pelvic Organ Rosen Publishers; 2012. Dysfunction in Neurological Disease: Clinical 31. Kiesbye S. Bipolar disorder. Farmington Hills, MI: Management and Rehabilitation. Cambridge: Greenhaven Press/Gale Cengage Learning; 2010. Cambridge University Press; 2010. 32. Quinn B. Mental Health. In: Quinn B, ed. Bipolar 14. Lesser JM , Hughes SV , Jemelka JR , Griffith J. Disorder. Hoboken, NJ: John Wiley & Sons; 2007:11- Sexually inappropriate behaviors. Assessment 37. necessitates careful medical and psychological 33. Garcia-Falgueras A, Swaab DF. A sex difference in evaluation and sensitivity. Geriatrics. 2005;60(1):34. the hypothalamic uncinate nucleus: relationship to doi:10.1037/0735-7028.28.1.58. . Brain. 2008;131(12):3132-3146. 15. Comandone A. Rare Tumors of Male Genital Tract. 34. Garcia-Falgueras A, Pinos H, Collado P, et al. The role In: Comandone A. Chemotherapy Regimens in Rare of the androgen receptor in CNS masculinization. Solid Tumors. Torino: SEEd Srl; 2011:41-54. Brain Res. 2005 Feb 21;1035(1):13-23. doi:10.1016/j. 16. Nosé V. Diagnostic Pathology: Breast. 1st ed. Salt brainres.2004.11.060. Lake City, Utah: Amirsys Publishing; 2012. 35. Hayat M. Cancer Imaging. Amsterdam: Elsevier, 17. Haussermann P, Goecker D, Beier K, Schroeder Academic Press; 2008. S. Low-dose treatment of 36. Sabolch A, Feng M, Griffith K, Hammer G, Doherty sexual acting out in men with dementia. Int G, Ben-Josef E. Adjuvant and definitive radiotherapy Psychogeriatrics. 2003;15(2):181-186. doi:10.1017/ for adrenocortical carcinoma. Int J Radiat Oncol S104161020300886X. Biol Phys. 2011;80(5):1477-1484. doi:10.1016/j. 18. Jameson JL, Degroot L. : Adult and ijrobp.2010.04.030. Pediatric. 7th ed. Philadelphia: Saunders, Elsevier; 37. Souhami R, Tobias J. Cancer and its Management. 2010. 2nd ed. Oxford: Blackwell Science Ltd; 2005. 19. Flück CE, Miller WL. Disorders of the Human 38. Freeman R. The role of the adrenal glands in the Adrenal Cortex. Basel: Karger; 2008. hyperandrogenism associated with polycystic ovarian 20. Fong TW. Understanding and managing compulsive syndrome. In: Pal L, ed. Polycystic Ovary Syndrome: sexual behaviors. Psychiatry (Edgmont). 2006; Nov: Current and Emerging Concept. Dordrecht: Springer; 51-58. 2013. 21. Ellis L, Hellberg J. Fetal exposure to prescription 39. Lederman R. Tarascon Internal Medicine & Critical drugs and adult . Pers Individ Dif. Care Pocket Book. Burlington, MA: Jones & Bartlett 2005;38(1):225-236. doi:10.1016/j.paid.2004.04.004. Learning; 2011.

International Journal of Women’s Health and Reproduction Sciences, Vol. 4, No. 2, April 2016 57 Al Awlaqi et al

40. Hirneise L. Chemotherapy Heals Cancer & the World 45. Nawar R, Aron D. Adrenal incidentalomas—a is Flat. Germany: Atlasbooks Dist Serv; 2008. continuing management dilemma. Endocr Relat 41. Iemmola F, Ciani AC. New evidence of genetic Cancer. 2005;12(3):585-598. doi:10.1677/erc.1.00951. factors influencing sexual orientation in men: female 46. Noggle C, Dean R, Horton A. The Encyclopedia of fecundity increase in the maternal line. Arch Sex Neuropsychological Disorders. New York: Springer; Behav. 2009;38(3):393-399. doi:10.1007/s10508-008- 2012. 9381-6. 47. Penzias A. Current Reproductive Endocrinology. 42. O’Connell T, Movalia M. Brochert’s Crush Step 2. Philadelphia: WB Saunders; 2000. London: Elsevier Health Sciences; 2012. 48. Reiser R, Thompson L. Bipolar Disorder. Cambridge, 43. Mendez MF, O’Connor SM, Lim GT. Hypersexuality MA: Hogrefe; 2005. after right pallidotomy for Parkinson’s disease. J 49. Savic-Berglund I. Sex Differences in the Human Neuropsychiatry Clin Neurosci. 2004;16(1):37-40. Brain. Salt Lake City, UT: Elsevier; 2010. doi:10.1007/s11194-007-9045-4. 50. Smith R, Netter F, Smith R. Netter’s Obstetrics and 44. Mushlin S, Greene H. Decision-making in Medicine. Gynecology. Philadelphia, PA: Saunders Elsevier; Philadelphia, PA: Mosby Elsevier; 2010. 2008.

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