DOCSLIB.ORG

Seksuele Stoornissen En Genderidentiteitsstoornissen

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Seksuele Stoornissen En Genderidentiteitsstoornissen Annual Meeting 2015 anatomy & physiology of female sexual dysfunctions Nice, France, 10 June 2015 Bary Berghmans PhD MSc RPT clinical epidemiologist, health scientist, pelvic physiotherapist Pelvic care Center Maastricht Maastricht University Medical Center The Netherlands Netter-Anatomy Atlas-2009 ovary fallopian tube bladder abdomen uterus cervix pubic bone vagina urethra rectum clitoris Labium minus Labium majus anus vaginal orifice external urethra orifice G-spot female pelvic anatomy understanding essential to treat FSD internal and external genitalia internal: vagina, uterus, fallopian tubes, ovaries external: vulva consists of labia, interlabial space, clitoris, vestibular bulbs female pelvic anatomy: vagina wall vagina 3 layers: – inner aglandular mucous membrane epithelium . mucous type, squamous cell epithelium, cyclic changes – intermediary vascular muscularis layer . smooth muscle & extensive tree blood vessels, engorge during sexual arousal – outer adventitial supportive mesh . fibrosa layer providing structural support to vagina female pelvic anatomy: vagina vagina many ruggae needed for distensibility more prominent in lower third vagina (frictional tension during intercourse) abundance of nerve fibers anterior distal vagina compared to proximal vagina female pelvic anatomy: vagina during sexual arousal genital vasocongestion due to ↑ blood flow vaginal canal lubricated secretions uterine glands, and transudation subepithelial vascular bed by intercellular channels engorgement vaginal wall ↑ pressure inside capillaries and ↑ transudation plasma through vaginal epithelium Levin 1980 female pelvic anatomy: clitoris ‘small knob tissue located below symphysis pubis’ Kaplan 1974 erectile organ similar to penis, arising from genital tubercle. 3 parts: glans (emerging from labia minora), corpus (2-4 cm), crura (9-11cm) fused midline erectile bodies (corpora cavernosa) rising bilateral crura labia minora bifurcate to form upper prepuce anteriorly and lower frenulum posteriorly sexual stimulation → clitoral engorgement not erection female pelvic anatomy: uterus secretion mucous during sexual arousal→ lubrication vagina innervation uterus closely proximate bladder and vagina. surgical procedures great impact pelvic dissection → ↓ sexual health hysterectomy → sexual dysfunctions: – ↓ desire, arousal, genital sensation, orgasmic dysfunction – result nerve and/or vascular injuries, loss ovarian estrogens and androgens – atrophy ovaries, fibrosis vaginal wall and clitoral cavernosal smooth muscle → ↓ genital arousal and orgasm female sexual dysfunctions (FSD) anorgasmia dysorgasmia dyspareunia vaginismus anaphrodisia relational anorgasmia female sexual dysfunctions age-related progressive highly prevalent, 30-50% US females Laumann 1999 risk factors: aging, hypertension, smoking, hypercholesterolemia Hsuch 1998 etiologic factors organic causes - perineal laceration - episiotomy - forceps vacuum - surgery psychological causes - alteration body image - fear of intercourse - fear of infection Graziotin,2007 female sexual response Masters & Johnson 1966 desire excitation resolution desire, arousal, orgasm Kaplan 1979 basis for DSM-IV definitions female sexual response during sexual arousal: clitoris, labia minora engorged with blood increase length and diameter vagina and clitoris labia minora increase in diameter 2-3 x → everted → exposing inner surface Berman 2002 increase in stem diameter of the clitoris removal of the clitoris increase in under the cap volume of the clitoris darkening and thickening of the swelling and opening of labia minora the labia minora activation the the glands of Bartholin expansion and flattening of the labia majora B shelf A excitation cap shortens no marked change of labia majora volume the clitoris decrease and close maximum congestion labia minora and coloration of the thinning and labia minora close C orgasm D resolution (rest) beginning of the elevation of the the uterus is high formation of the uterus seminal lake removal of the clitoris under the cap darkening of the labias increase in volume of the clitoris formation of the orgasmic vaginal lubrication by swelling and opening of expansion of the two platform at the first third of transudation the labias posterior thirds of the vagina the vagina (tightening) B shelf A excitation uterus contraction return of the uterus to its original position return of the vagina to its original shape rhythmic contractions anal sphincter of the orgasmic disappearance of the contraction platform orgasmic platform C orgasm D resolution (rest) female sexual response cycle female sexual response cycle initiated by neurotransmitter–mediated vascular and nonvascular smooth muscle relaxation → – increased pelvic blood flow – vaginal lubrication – clitoral and labial engorgement Berman 2000 female sexual response cycle vasculogenic clitoral & vaginal insufficiency – ↓ genital blood flow related to atherosclerosis iliohypogastric/pudendal arterial bed Goldstein 1998 ↓ pelvic blood flow due to aortailiac disease → – clitoral & vaginal wall smooth muscle fibrosis → vaginal dryness, dyspareunia Berman 1999 female sexual response cycle vasculogenic 1. atherosclerosis → clitoral cavernosal artery wall tickening, loss corporal smooth muscle & replacement fibrous connective tissue. possibly atherosclerotic changes in smooth muscle interfere with normal relaxation and dilitation responses to sexual stimulation 2. alterations circulating estrogen levels (menopause) → smooth muscle changes 3. traumata iliohypogastric/pudendal arterial bed and chronic perineal pressure (biking) → ↓ vaginal and clitoral blood flow → vasculogenic FSD Berman 2000 female sexual response cycle neurogenic spinal cord injury more difficult orgasm (Viagra) diseases central/peripheral nervous system (diabetis) incomplete: regain capacity psychogenic arousal and vaginal lubrication Sipsky 1995 female sexual response cycle hormonal dysfunction hypothalamic/pituitary axis, castration, premature ovarian failure, ↑ age, chronic birth control → hormonal FSD ↓ estrogen & testosteron → ↓ libido, vaginal dryness, lack sexual arousal, emotional lability, sleep disturbances estrogen = ok → ↑ integrity vaginal mucosal tissue, ↑ vaginal sensation, vasocongestion, secretion → ↑ arousal Berman 2000 female sexual response cycle hormonal estrogen ≠ ok → ↓ clitoral intracavernosal, vaginal and urethral blood flow estrogen ≠ ok → clitoral fibrosis, thinner vaginal tissue, ↓vaginal submucosal vasculature thus: ↓ estrogen → ↓ vaginal & clitoral tissue → hormonal FSD Berman 2000 female sexual response cycle hormonal testosterone = ok → central & peripheral effects also in vagina vaginal epithelium responds to testosterone replacement like estrogen replacement androgens role in regulating vaginal smooth muscle relaxation and blood flow ↓ androgen receptor expression noted in vaginal sub-epithelium in women having estrogen replacement → persistent symptoms vaginal atrophy and dryness in menopausal women (impaired androgen responsiveness) → hormonal FSD Berman 2000 female sexual response cycle musculogenic pelvic floor muscles: levator ani, bulbocavernosus, ischiocavernosus (perineal membrane) voluntary contraction intensifies sexual arousal and orgasm perineal membrane involuntary rythmic contractions during orgasm levator ani modulates motor responses during orgasm and vaginal receptivity musculogenic FSD – overactive → vaginismus, dyspareunia, sexual pain – underactive → vaginal hypoanesthesia, coital anorgasmia, urinary incontinence during intercourse or orgasm Berman 2000 female sexual response cycle musculogenic levator ani fixes vaginal neck, anorectal junction, vaginal fornices to sidewall pelvis (like a sling) during intercourse vaginal distension by erect penis evokes vaginolevator and vaginopuborectalis reflexes → levator ani contraction levator ani contracts also upon stimulation clitoris or cervix uteri → ↑ sexual response modulates motor responses during orgasm and vaginal receptivity levator ani subluxation and sagging → dysfunction, pelvic pain, dyspareunia, ↓ vaginal sensation, ↓ intensity orgasm Berman 2000 female sexual response cycle psychogenic emotional and relational issues affect sexual arousal self-esteem, body image, quality relationship depression, mood disorders ↔ sexual response medication (serotinin re-uptake inhibitors) ↓ desire, arousal, genital sensation, difficulty achieving orgasm → psychogenic FSD Berman 2000 pleasure orgasm intensity shelf excitation resolution cycle duration conclusion rehabilitation techniques .
Load more

Recommended publications
  • Physiology of Female Sexual Function and Dysfunction
    International Journal of Impotence Research (2005) 17, S44–S51 & 2005 Nature Publishing Group All rights reserved 0955-9930/05 $30.00 www.nature.com/ijir Physiology of female sexual function and dysfunction JR Berman1* 1Director Female Urology and Female Sexual Medicine, Rodeo Drive Women’s Health Center, Beverly Hills, California, USA Female sexual dysfunction is age-related, progressive, and highly prevalent, affecting 30–50% of American women. While there are emotional and relational elements to female sexual function and response, female sexual dysfunction can occur secondary to medical problems and have an organic basis. This paper addresses anatomy and physiology of normal female sexual function as well as the pathophysiology of female sexual dysfunction. Although the female sexual response is inherently difficult to evaluate in the clinical setting, a variety of instruments have been developed for assessing subjective measures of sexual arousal and function. Objective measurements used in conjunction with the subjective assessment help diagnose potential physiologic/organic abnormal- ities. Therapeutic options for the treatment of female sexual dysfunction, including hormonal, and pharmacological, are also addressed. International Journal of Impotence Research (2005) 17, S44–S51. doi:10.1038/sj.ijir.3901428 Keywords: female sexual dysfunction; anatomy; physiology; pathophysiology; evaluation; treatment Incidence of female sexual dysfunction updated the definitions and classifications based upon current research and clinical practice.
    [Show full text]
  • Microbiome, Infection and Inflammation in Infertility
    Chapter 8 Microbiome, Infection and Inflammation in Infertility Reza Peymani and Alan DeCherney Additional information is available at the end of the chapter http://dx.doi.org/10.5772/63090 Abstract The implantation mechanism and process are very complex and require a precise interac‐ tion between the embryo and endometrium. The failure to implant is thought to be due to implantation environment factors or embryonic factors. A suitable condition of the uterine cavity is essential for successful reproduction. Inflam‐ mation can be a part of the normal physiologic process during implantation; however, there are also pathologic sources of inflammation that can adversely affect the uterine cavity and endometrial receptivity. Chronic Endometritis is usually asymptomatic and is defined histologically by the pres‐ ence of plasma cells in an endometrial biopsy. It is mostly associated with the gonorrheal or chlamydial also non-sexually transmitted infections including E-coli, streptococcus, staphylococcus, enterococcus faecalis, mycoplasma, urea plasma and yeast. However, of‐ ten a causal organism can not be identified. Available evidence suggests that chronic subclinical endometritis is relatively common in women with symptomatic lower genital tract infections, including cervicitis and recur‐ rent bacterial vaginosis and may not be altogether rare even in asymptomatic infertile women. Mucopurulent cervicitis is highly associated with chlamydial and mycoplasma infections and both organisms, in turn, are associated with chronic endometritis, which likely plays a role in the pathogenesis of tubal factor infertility. There is also a growing interest in the Microbiome of the reproductive tract. The Vaginal and Uterine Microbiome have been partially characterized and shown to be related to ob‐ stetric outcomes.
    [Show full text]
  • Sexual Reproduction & the Reproductive System Visual
    Biology 202: Sexual Reproduction & the Reproductive System 1) Label the diagram below. Some terms may be used more than once. Spermatozoa (N) Mitosis Spermatogonium (2N) Spermatids (N) Primary Oocyte (2N) Polar bodies (N) Ootid (N) Second polar body (N) Meiosis I Primary spermatocyte (2N) Oogonium (2N) Secondary oocyte (2N) Ovum (N) Secondary spermatocytes (2N) First polar body Meiosis II Source Lesson: Gametogenesis & Meiosis: Process & Differences 2) Label the diagram of the male reproductive system below. Seminal vesicle Testis Scrotum Pubic bone Penis Prostate gland Urethra Epididymis Vas deferens Bladder Source Lesson: Male Reproductive System: Structures, Functions & Regulation 3) Label the image below. Rectum Testis Ureter Bulbourethral gland Urethra Urinary bladder Pubic bone Penis Seminal vesicle Ductus deferens Epididymis Prostate gland Anus Source Lesson: Semen: Composition & Production 4) Label the structures below. Inner and outer lips of the vagina Mons pubis Vaginal opening Clitoris Anus Urethral opening Perineum Vulva Source Lesson: Female Reproductive System: Structures & Functions 5) Label the diagram below. Some terms may be used more than once. Clitoris Vulva Labia majora Labia minora Perineum Clitoral hood Vaginal opening Source Lesson: Female Reproductive System: Structures & Functions 6) Label the internal organs that make up the female reproductive system. Uterus Fallopian tubes Ovaries Cervix Vagina Endometrium Source Lesson: Female Reproductive System: Structures & Functions 7) Label the diagram below. LH Follicular
    [Show full text]
  • Chapter 28 *Lecture Powepoint
    Chapter 28 *Lecture PowePoint The Female Reproductive System *See separate FlexArt PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Introduction • The female reproductive system is more complex than the male system because it serves more purposes – Produces and delivers gametes – Provides nutrition and safe harbor for fetal development – Gives birth – Nourishes infant • Female system is more cyclic, and the hormones are secreted in a more complex sequence than the relatively steady secretion in the male 28-2 Sexual Differentiation • The two sexes indistinguishable for first 8 to 10 weeks of development • Female reproductive tract develops from the paramesonephric ducts – Not because of the positive action of any hormone – Because of the absence of testosterone and müllerian-inhibiting factor (MIF) 28-3 Reproductive Anatomy • Expected Learning Outcomes – Describe the structure of the ovary – Trace the female reproductive tract and describe the gross anatomy and histology of each organ – Identify the ligaments that support the female reproductive organs – Describe the blood supply to the female reproductive tract – Identify the external genitalia of the female – Describe the structure of the nonlactating breast 28-4 Sexual Differentiation • Without testosterone: – Causes mesonephric ducts to degenerate – Genital tubercle becomes the glans clitoris – Urogenital folds become the labia minora – Labioscrotal folds
    [Show full text]
  • The Cyclist's Vulva
    The Cyclist’s Vulva Dr. Chimsom T. Oleka, MD FACOG Board Certified OBGYN Fellowship Trained Pediatric and Adolescent Gynecologist National Medical Network –USOPC Houston, TX DEPARTMENT NAME DISCLOSURES None [email protected] DEPARTMENT NAME PRONOUNS The use of “female” and “woman” in this talk, as well as in the highlighted studies refer to cis gender females with vulvas DEPARTMENT NAME GOALS To highlight an issue To discuss why this issue matters To inspire future research and exploration To normalize the conversation DEPARTMENT NAME The consensus is that when you first start cycling on your good‐as‐new, unbruised foof, it is going to hurt. After a “breaking‐in” period, the pain‐to‐numbness ratio becomes favourable. As long as you protect against infection, wear padded shorts with a generous layer of chamois cream, no underwear and make regular offerings to the ingrown hair goddess, things are manageable. This is wrong. Hannah Dines British T2 trike rider who competed at the 2016 Summer Paralympics DEPARTMENT NAME MY INTRODUCTION TO CYCLING Childhood Adolescence Adult Life DEPARTMENT NAME THE CYCLIST’S VULVA The Issue Vulva Anatomy Vulva Trauma Prevention DEPARTMENT NAME CYCLING HAS POSITIVE BENEFITS Popular Means of Exercise Has gained popularity among Ideal nonimpact women in the past aerobic exercise decade Increases Lowers all cause cardiorespiratory mortality risks fitness DEPARTMENT NAME Hermans TJN, Wijn RPWF, Winkens B, et al. Urogenital and Sexual complaints in female club cyclists‐a cross‐sectional study. J Sex Med 2016 CYCLING ALSO PREDISPOSES TO VULVAR TRAUMA • Significant decreases in pudendal nerve sensory function in women cyclists • Similar to men, women cyclists suffer from compression injuries that compromise normal function of the main neurovascular bundle of the vulva • Buller et al.
    [Show full text]
  • Selectively Increases Vaginal Blood Flow in Anesthetized Rats
    International Journal of Impotence Research (2003) 15, 461–464 & 2003 Nature Publishing Group All rights reserved 0955-9930/03 $25.00 www.nature.com/ijir Short communication Topical administration of a novel nitric oxide donor, linear polyethylenimine-nitric oxide/nucleophile adduct (DS1), selectively increases vaginal blood flow in anesthetized rats P Pacher1,2*, JG Mabley1, L Liaudet1, OV Evgenov1, GJ Southan1, GE Abdelkarim1, C Szabo´ 1 and AL Salzman1 1Inotek Pharmaceuticals Corporation, Beverly, Massachusetts, USA The aim of the present study was to test the effects of a topical administration of a novel nitric oxide donor, linear polyethylenimine-nitric oxide/nucleophile adduct (DS1), on vaginal blood flow and hemodynamics in rats. Laser Doppler flowmetry was used to measure blood flow changes following topical application of DS1 (0.3 or 1.5 mg in 0.15 ml saline) into the vagina of anesthetized Wistar rats. In vivo hemodynamic parameters were measured with Millar-tip-catheter placed in the left ventricle. DS1 (1.5 mg) increased vaginal blood flow by 191 7 24, 226 7 22 and 166 7 23% of the baseline value (at 5, 15 and 30 min, respectively, after application) without affecting systemic blood pressure, heart rate and cardiac function. The increased vaginal blood flow following DS1 application returned to baseline between 45 and 60 min. Thus, topical application of nitric oxide donors such as DS1 may be useful for the treatment of female sexual dysfunction that develops due to an impairment of local blood flow supply to the vaginal tissue. International Journal of Impotence Research (2003) 15, 461–464.
    [Show full text]
  • Psychosocial and Sexual Aspects of Female Circumcision
    African Journal of Urology (2013) 19, 141–142 Pan African Urological Surgeons’ Association African Journal of Urology www.ees.elsevier.com/afju www.sciencedirect.com Opinion article Psychosocial and sexual aspects of female circumcision ∗ S. Abdel-Azim Psychiatry Department, Cairo University, Egypt Received 17 November 2012; received in revised form 3 December 2012; accepted 3 December 2012 KEYWORDS Abstract Female circumcision; Sexual behavior is a result of interaction of biology and psychology. Sexual excitement of the female can Psychological; be triggered by stimulation of erotogenic areas; part of which is the clitoris. Female circumcision is done Sexual to minimize sexual desire and to preserve virginity. This procedure can lead to psychological trauma to the child; with anxiety, panic attacks and sense of humiliation. Cultural traditions and social pressures can affect as well the unexcised girl. Female circumcision can reduce female sexual response, and may lead to anorgasmia and even frigidity. This procedure is now prohibited by law in Egypt. © 2013 Pan African Urological Surgeons’ Association. Production and hosting by Elsevier B.V. All rights reserved. Introduction human sexual response including excitement, orgasm and resolution phases. Later Kaplan [3] added the desire phase. The desire phase Sex is one of the basic drives. Impairment of this drive/sexual reflects motivations, drives and personality and is characterized by functioning can have a profound effect on the persons’ quality of sexual fantasies and the desire to have sexual activity, and in the life and other aspects of functioning. Sexual behavior represents a female is controlled mainly by androgens particularly testosterone very complex and interesting interaction of biology and psychology.
    [Show full text]
  • Vagina – Inflammation
    Vagina – Inflammation 1 Vagina – Inflammation Figure Legend: Figure 1 Vagina - Inflammation, Acute in a female F344/N rat from a chronic study. The lumen of the vagina is filled with copious eosinophilic material. Figure 2 Vagina - Inflammation, Acute in a female F344/N rat from a chronic study. The lumen of the vagina is filled with copious eosinophilic material and neutrophils, and there is mucification of the vaginal epithelium. Figure 3 Vagina - Inflammation, Suppurative in a female F344/N rat from a chronic study. An area of suppurative inflammation is present in the vaginal wall. Figure 4 Vagina - Inflammation, Suppurative in a female F344/N rat from a chronic study (higher magnification of Figure 3). There is a lack of epithelial lining demarcating the inflammatory cells from the adjacent vagina. Figures 5 Vagina - Inflammation, Chronic active in a female B6C3F1/N mouse from a chronic study. Chronic active inflammation is present in a focal area of epithelial erosion. Figure 6 Vagina - Inflammation, Chronic active in a female B6C3F1/N mouse from a chronic study (higher magnification of Figure 1). A focal area of inflammation is associated with erosion of epithelium. Comment: In NTP studies, there are five standard categories of inflammation: acute, suppurative, chronic, chronic active, and granulomatous. In acute inflammation (Figure 1 and Figure 2), the predominant infiltrating cell is the neutrophil, though fewer macrophages and lymphocytes may also be present. There may also be evidence of edema or hyperemia. The neutrophil is also the predominant infiltrating cell type in suppurative inflammation (Figure 3 and Figure 4), but they are aggregated, and many of them are degenerate (suppurative exudate).
    [Show full text]
  • MR Imaging of Vaginal Morphology, Paravaginal Attachments and Ligaments
    MR imaging of vaginal morph:ingynious 05/06/15 10:09 Pagina 53 Original article MR imaging of vaginal morphology, paravaginal attachments and ligaments. Normal features VITTORIO PILONI Iniziativa Medica, Diagnostic Imaging Centre, Monselice (Padova), Italy Abstract: Aim: To define the MR appearance of the intact vaginal and paravaginal anatomy. Method: the pelvic MR examinations achieved with external coil of 25 nulliparous women (group A), mean age 31.3 range 28-35 years without pelvic floor dysfunctions, were compared with those of 8 women who had cesarean delivery (group B), mean age 34.1 range 31-40 years, for evidence of (a) vaginal morphology, length and axis inclination; (b) perineal body’s position with respect to the hymen plane; and (c) visibility of paravaginal attachments and lig- aments. Results: in both groups, axial MR images showed that the upper vagina had an horizontal, linear shape in over 91%; the middle vagi- na an H-shape or W-shape in 74% and 26%, respectively; and the lower vagina a U-shape in 82% of cases. Vaginal length, axis inclination and distance of perineal body to the hymen were not significantly different between the two groups (mean ± SD 77.3 ± 3.2 mm vs 74.3 ± 5.2 mm; 70.1 ± 4.8 degrees vs 74.04 ± 1.6 degrees; and +3.2 ± 2.4 mm vs + 2.4 ± 1.8 mm, in group A and B, respectively, P > 0.05). Overall, the lower third vaginal morphology was the less easily identifiable structure (visibility score, 2); the uterosacral ligaments and the parau- rethral ligaments were the most frequently depicted attachments (visibility score, 3 and 4, respectively); the distance of the perineal body to the hymen was the most consistent reference landmark (mean +3 mm, range -2 to + 5 mm, visibility score 4).
    [Show full text]
  • Birth Cont R Ol Fact Sheet
    VAGINAL RING FACT SHEET What is the Vaginal Ring (Nuvaring®)? The Vaginal Ring is a clear, flexible, thin, plastic ring that you place in the vagina where it stays for one cycle providing a continuous low dose of 2 hormones (estrogen and progestin). It prevents pregnancy by stopping the release of an egg (ovulation), thickening the cervical fluid, and changing the lining of the uterus. How effective is the Vaginal Ring? The ring is a very effective method of birth control. The ring is about 93% effective at preventing pregnancy in typical use, which means that around 7 out of 100 people who use it as their only form of birth control will get pregnant in one year. With consistent and correct use as described in this fact sheet, it can be over 99% effective. How can I get the Vaginal Ring? You can visit a clinic to get the ring or a prescription for it and talk with a healthcare provider about whether the ring is right for you. Advantages of the Vaginal Ring Disadvantages of the Vaginal Ring Periods may be more predictable/regular and lighter Must remember to remove and replace the ring once a Less period cramping month Decreased symptoms of Premenstrual Syndrome Some users may experience mild side effects such as: (PMS) and perimenopause spotting, nausea, breast tenderness, headaches, or Can be used to skip or shorten your periods dizziness (usually these improve in the first few months Less anemia/iron deficiency caused by heavy periods of use) Does not affect your ability to get pregnant in the Possibility of high blood pressure
    [Show full text]
  • The Effects of Yohimbine Plus L-Arginine Glutamate on Sexual Arousal in Postmenopausal Women with Sexual Arousal Disorder1
    P1: GVG/FZN/GCY P2: GCV Archives of Sexual Behavior pp527-aseb-375624 July 4, 2002 13:29 Style file version July 26, 1999 Archives of Sexual Behavior, Vol. 31, No. 4, August 2002, pp. 323–332 (C 2002) The Effects of Yohimbine Plus L-arginine Glutamate on Sexual Arousal in Postmenopausal Women with Sexual Arousal Disorder1 , Cindy M. Meston, Ph.D.,2 4 and Manuel Worcel, M.D.3 Received August 17, 2001; revision received November 30, 2001; accepted December 31, 2001 This study examined the effects of the nitric oxide-precursor L-arginine combined with the 2-blocker yohimbine on subjective and physiological sexual arousal in postmenopausal women with Female Sex- ual Arousal Disorder. Twenty-four women participated in three treatment sessions in which self-report and physiological (vaginal photoplethysmograph) sexual responses to erotic stimuli were measured following treatment with either L-arginine glutamate (6 g) plus yohimbine HCl (6 mg), yohimbine alone (6 mg), or placebo, using a randomized, double-blind, three-way cross-over design. Sexual responses were measured at approximately 30, 60, and 90 min postdrug administration. The com- bined oral administration of L-arginine glutamate and yohimbine substantially increased vaginal pulse amplitude responses to the erotic film at 60 min postdrug administration compared with placebo. Sub- jective reports of sexual arousal were significantly increased with exposure to the erotic stimuli but did not differ significantly between treatment groups. KEY WORDS: yohimbine; L-arginine; female sexual arousal; photoplethysmography; nitric oxide; adrenergic. INTRODUCTION lubrication-swelling response of sexual excitement” which causes “marked distress or interpersonal difficulty.” Physiological sexual arousal in women involves Prevalence estimates of FSAD vary widely between an increase in pelvic vascular blood flow and resultant studies, likely due to different operational definitions of pelvic vasocongestion, vaginal engorgement, swelling of the disorder.
    [Show full text]
  • Universidade Paulista
    0 UNIVERSIDADE PAULISTA CENTRO DE CONSULTORIA EDUCACIONAL FÁBIO BARBOSA DA MATTA O TABAGISMO E A ONCOGÊNESE DO CÂNCER DE COLO UTERINO RECIFE 2011 1 FÁBIO BARBOSA DA MATTA O TABAGISMO E A ONCOGÊNESE DO CÂNCER DE COLO UTERINO Monografia apresentada à Universidade Paulista e Centro de Consultoria Educacional, para obtenção do título de especialista em Citologia Clínica Orientador: Prof. MSc. Gustavo Santiago Dimech RECIFE 2011 2 FÁBIO BARBOSA DA MATTA O TABAGISMO E A ONCOGÊNESE DO CÂNCER DE COLO UTERINO Monografia para obtenção do grau de Especialista em Citologia Clínica. Recife, 03 de Março de 2011. EXAMINADOR: Nome: _________________________________________________________ Titulação: _______________________________________________________ PARECER FINAL: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ _____________________________________________ 3 AGRADECIMENTO Agradeço primeiramente a Deus, pela força e a minha esposa Ana Priscila pela dedicação. Agradeço aos amigos que fiz durante o curso pelo continuo apoio e incentivo para o termino desta etapa. Aos professores pelos conhecimentos transmitidos e a direção do curso pelo apoio institucional e pelas facilidades oferecidas. 4 DEDICATÓRIA Dedico esta monografia a Deus, por guiar meus passos nesta conquista e também a todos que nutrem pensamentos positivos em relação a mim. 5 RESUMO O câncer de colo uterino é um tumor de natureza multifatorial
    [Show full text]