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Estimulos Para Aumentar Estimulos Para Aumentar La Respuesta Sexual

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Estimulos Para Aumentar Estimulos Para Aumentar La Respuesta Sexual ESTIMULOS PARA AUMENTAR LA RESPUESTA SEXUAL FEMENINA Dr. Santiago Palacios Instituto Palacios, Salud y Medicina de la Mujer Chairman of CAMS (Council of Affiliated Menopause Societies) President of SIBOMM (Ibero American Society of Osteology and Mineral Metabolism) Antonio Acuña, 9 - 28009 Madrid Teléfono 91 578 05 17 E-mail: [email protected] www.institutopalacios.com www.institutopalacios.com Diapositivas / Slides CONTENIDO • ESTUPEFACTO • QUÉ ES LA RESPUESTA SEXUAL FEMENINA • CONOCER LA RESPUESTA SEXUAL • QUÉ TENEMOS • QUÉ SE ESTÁ HACIENDO PARA EL FUTURO * DOCTOR, ACUDO A USTED YA QUE ES ESPECIALISTA EN ESTE CAMPO, PORQUE DESEO AUMENTAR MI RESPUESTA SEXUAL CONSULTA MÉDICA: ¿QUÉ? ¿QUÉ LE DIGO? ¿QUÉ HAGO? CONTENIDO • ESTUPEFACTO • QUÉ ES LA RESPUESTA SEXUAL FEMENINA • CONOCER LA RESPUESTA SEXUAL • QUÉ TENEMOS • QUÉ SE ESTÁ HACIENDO PARA EL FUTURO * Ciclo de respuesta sexual femenina: Modelo lineal • En 1966, Masters y Johnson introdujeron el primer modelo de la función sexual femenina. Propusieron un modelo lineal de sexualidad para mujeres consistente en cuatro etapas: excitación, meseta, orgasmo y resolución. • Diferentes mujeres diferentes patrones de respuesta • Misma mujer diferente patrón de respuesta en diferentes ocasiones Orgasmo Meseta Excitación Masters WH, Johnson V. (1966) Human Sexual Response. Boston: Little, Brown & Co Ciclo de respuesta sexual femenina: Modelo no lineal • En 2001, Basson construyó un modelo no lineal de la respuesta sexual femenina. • El modelo alternativo de Basson incorpora una motivación basada en la intimidad, los estímulos sexuales, los factores confluyentes biológicos y psicológicos y la satisfacción. Intimidad Buscar y ser emocional receptivo Satisfacción emocional y física Impulso Estímul sexual os espontáneo sexuale s Excitación y deseo sexual Deseo Biológic sexual o PiPsico lóilógico Basson R. Med Aspects Hum Sex. 2001;1:41-42. FUNCIÓN SEXUAL FEMENINA ANDRÓGENOS ESTRÓGENOS DESEO RESPUESTA ( Espon táneo / Reac tivo ) ( Su bjeti va / Fi si oló gi ca ) Estímulos físicos Vasocongestión pélvica Estímulos afectivos Orgasmo Fantasías Respuesta Extragenital Recuerdos SATISFACCIÓN / PLACER MOLESTIA / AVERSION MODELO DE RESPUESTA SEXUAL DESEO SEXUAL •OXIDO NITRICO SINTETASA EXCITACION Resolució •OXIDO NITRICO n lenta K LUBRICACION •FOSFODIESTERASA TIPO 5 K Vasodilatcion de ldlared cap ilililar vaginal ORGASMO(Contraccione s ritmicas de la musculatura vaginal) La Respuesta Sexual Cambios Normales EDAD Deseo La excitación (El flujo sanguíneo .La lubricación) El orgasmo (Contracciones) CONTENIDO • ESTUPEFACTO • QUÉ ES LA RESPUESTA SEXUAL FEMENINA • CONOCER LA RESPUESTA SEXUAL • QUÉ TENEMOS • QUÉ SE ESTÁ HACIENDO PARA EL FUTURO * Entendimiento actual del deseo sexual • El deseo sexual consta de dos componentes fundamentales: el impulso físico y la motivación • El impulso físico está modulado ppprincipalmente p or: • La edad • La salud general • LiithlLos requisitos hormonales • El estado de ánimo • La motivación está modulada ppprincipalmente por: • Las experiencias previas • La calidad de la relación • La duración de la relación •En mujjpperes individuales los dos componentes pueden interactuar y variar durante la vida y los distintos contextos EL DESEO EN EL CEREBRO Es el balance entre la actividad excitatoria diriggpida por la DA ( deseo) )y y NE (excitación) y la actividad inhibitoria dirigida por la 5-HT (idd)(saciedad) September 12, 2011 Mean Plasma Hormone Levels: Pre- and Post-Menopausal Reproductive Surgical Menopause Natural Menopause Age (Oophorectomy) Below assay Below assay Oestradiol (pg/ml) 40 ± 3 detection limit detection limit Testosterone (Ð (Ð 400 ± 30 200 ± 20 100 ± 20 (pg/ml) 50%) 75%) 1970 ± (Ð 1260 ± (Ð DHEA (pg /m l) 4200 ± 210 430 53%) 360 70%) 9 Androgens are present at higher circulating levels than oestradiol 9 Androgen levels fall more dramatically after surgical menopause 9 Post menopause, androgen levels decline by 50% compared with pre-menopausal levels Lobo, RA (2001) Obstet Gynecol Surv 56: 361-76 Davison et al JCEM 2005 Davison Total testosterone Free testosterone Free Testosterone, pmol/L Total testosterone, nmol/L 0 20 40 60 0 1 2 3 4 20 20 30 30 40 40 age, years age, years 50 50 60 60 70 70 80 80 Free Testosterone, pmol/L Total testosterone, nmol/L 0 20 40 60 0 1 2 3 4 18-24 25-34 35-44 45-54 55-64 65-75 18-24 25-34 35-44 45-54 55-64 65-75 age group,years age group, years Amygdala activity in middle-aged women restored to that of younger women after a single nasal administration of testosterone. Neuropsychopharmacol. van Wingen et al 2008 EFFECTS OF E/TE ON FUNCTIONAL MRI Androgen Production • Androgens are also produced in specific tissues themselves, either from circulating “precursors” (e.g. DHEA, DHEAS, Androstenedione, T, DHT) or de-novo (just in certain tissues) • The tissue -specific hormone production is called “Intracrinology” Ovaries & Circulation Peripheral Tissues Adrenal Glands Tissue- Tissue- specific specific Precursors conversion to Intra- production of hormones crinology hormones Production Endocrinology Peripheral Hormones Action Adapted from Arlt W (2006) Eur J Endocrinol 154: 1–11 Intracrinology of Androgens • Androgens are produced in the following peripheral tissues: – Adipose Tissue – Mammary Gland – Endometrial Tissue – Skin – Bone – CdiCardiovascu lar StSystem –Brain • Secretion of these androgens into the blood system can be neglected • Serum levels of testosterone may not reflect the availability of testosterone and other androgen metabolites at a local levels Posibilidades para mejorar el deseo sexual • El impulso • La edad……………………………… FILOSOFIA • La salud general………………………CHEQUEO • Los requisitos hormonales………………...ANDROGENOS • El estado de ánimo……………………….. DOPAMINA • La motivación :……………………CUIDADO CON DAR IDEAS •Las e xpe rie nc ias p rev ias • La calidad de la relación • La duración de la relación Cambios psicofisiológicos durante la respuesta sexual femenina Durante la excitación • Cerebro: activación de distintas regiones cerebrales y liberación de neuromediadores que llevan a un sentimiento de excitación mental • Piel: vasodilatación que lleva al sentimiento de calor • Genitales: aumento del flujo de sangre que lleva a la congestión genital/clitorídea y a la lubricación vaginal percibidos como la excitación genital Durante el orgasmo • Liberación de serotonina, oxitocina y otros agentes que producen contracciones • Contracción de los músculos pélvicos (a veces incluyendo los músculos uterinos) que lleva a sentimientos de “liberación” y placer variable Durante la resolución • Los tejidos vuelven al estado no excitado. Female Sexual Health in Midlife and Beyond: Addressing Female Sexual Distress, Health and Sexuality, Publication of the Association of Reproductive Health Professionals July 2005;10,(2) Cambios psicofisiológicos durante la respuesta sexual femenina Durante la excitación • Cerebro: activación de distintas regiones cerebrales y liberación de neuromediadores que llevan a un sentimiento de excitación mental……NORADRENALINA • Piel: vasodilatación que lleva al sentimiento de calor • Genitales: aumento del flujo de sangre que lleva a la congestión genita l/c litoríd ea y a l a l ub ri cació n vagi nal percibid os como l a exciióitación genital TERAPIA DE REEMPLAZO HORMONAL SISTEMICA O LOCAL Durante el orgasmo • Liberación de serotonina, oxitocina y otros agentes que producen contracciones OXITOCINA Female Sexual Health in Midlife and Beyond: Addressing Female Sexual Distress, Health and Sexuality, Publication of the Association of Reproductive Health Professionals July 2005;10,(2) CONTENIDO • ESTUPEFACTO • QUÉ ES LA RESPUESTA SEXUAL FEMENINA • CONOCER LA RESPUESTA SEXUAL • QUÉ TENEMOS • QUÉ SE ESTÁ HACIENDO PARA EL FUTURO * Consejos basicos sobre sexualidad • Dar la oportunidad a la paciente de hablar de su propia sexualidad • Escuchar activamente • Informar acerca de la realidad de la sexualidad humana • Quitar mitos sobre la sexualidad del hombre y mujer QUÉ TENEMOS • DESEO -Testosterona en parches, en gel y en comprimidos. -Tibolona -Flibanserina..historia que …seguirá • EXCITACION Y ORGASMO - TRH -EROS Effects of E+T vs T alone over 2 years on sexual function 5 6 7 8 9 10 Libido E IMPLANTS Sexuality E+T IMPLANTS Scale Activity Satisfaction Pleasure Fantasy Orgasm Relevancy Davis et al Maturitas 1995 Transdermal Testosterone Plus Oestrogen Phase III testosterone patch studies in surgically menopausal women • Two Separate Phase III Clinical Trials: – SilSurgical menopause 1(1 (INTIMAS1ATE SM 1)62), n=562 women – Surgical menopause 2 (INTIMATE SM 2), n=532 women • Objective: – Assess efficacy / safety of transdermal testosterone in surgically menopausal women with Hypoactive Sexual Desire Disorder • Design: – 24-weekdiddblk randomised, double-blind , pl aceb o-controlled , mul ti nati onal tri al – Placebo or transdermal testosterone patch 300 μg/day – All patients on oral or transdermal oestrogen – Inclusion / Exclusion criteria similar • Female testosterone patch: – Alcohol-free, translucent , matrix patch – Twice-a-week application to abdomen – Contains 8.4 mg testosterone – Delivers 300 μg/day testosterone Simon JA, et al. (2005) J Clin Endocrinol Metab 90: 5226–5233 Buster JE et al. (2005) Obstet Gynecol 105: 944–952 Source: FSDeducation.eu APHRODITE (Transdermal Testosterone Patch Only) Increased PFSF Domains at 24 Weeks Placebo Transdermal Testosterone Patch (300μg/day) 30 * * (SEM) 25 * 20 * Baseline * mm 15 * * 10 ange fro hh 5 Mean C 0 Desire ArousalOrgasm Pleasure Reduced Responsive- Self-image
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