DOCSLIB.ORG

Changes in Sexual Behavior After Orthopedic Replacement of Hip Or Knee in Elderly Males Ð a Prospective Study

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Changes in Sexual Behavior After Orthopedic Replacement of Hip Or Knee in Elderly Males Ð a Prospective Study International Journal of Impotence Research (2000) 12, 143±146 ß 2000 Macmillan Publishers Ltd All rights reserved 0955-9930/00 $15.00 www.nature.com/ijir Changes in sexual behavior after orthopedic replacement of hip or knee in elderly males Ð a prospective study T Nordentoft1*, J Schou2 and J Carstensen3 1Department of Orthopedic Surgery, Herlev Hospital, University of Copenhagen, Denmark; 2Urology, Herlev Hospital, University of Copenhagen, Denmark; and 3Department of Orthopedic Surgery, Koege Hospital, Denmark The aim of this study was to investigate two questions: Does arthroplastic surgery affect the patient's status as being sexually active; and if patients are sexually active, does surgery affect their erectile function? The study was designed prospectively and the patients ®lled in a questionnaire concerning sexuality and erectile function before and 6 months after alloplastic hip- or knee surgery. Ninety-nine males were included, mean age 70.6 y. The results demonstrate that 17% of patients lost a sexual activity that they had preoperatively, and no one regained sexual activity after surgery. A correlation between increasing age and risk of losing sexual activity was demonstrated. 26.1% lost a normal erectile function they had preoperatively, while 6.7% regained normal erections. A similar correlation between increasing age and increased risk was demonstrated. From this study of elderly males undergoing orthopaedic alloplastic surgery it is concluded that the risk of losing sexual activity and erectile capability is increased after surgery, and especially in the group where sexual functions are already impaired. International Journal of Impotence Research (2000) 12, 143±146. Keywords: sexual activity; erectile dysfunction; arthroplasty; surgery; age Introduction After informed consent, all patients ®lled in a questionnaire before and 6 months after surgery. Patients suffering from osteoarthrosis in hip or knee experience a decrease in all aspects of quality of life Questionnaire including sexual function.1±5 There has been little investigation of the in¯uence of arthroplasty on the sexual function as a whole and no studies have been At the time of the study, there was no international made to evaluate the in¯uence of arthroplasty on validated and accepted questionnaire such as The erectile function. Only a few publications exist on International Index for Erectile Function.6 Further- the in¯uence of general surgery on sexual activity or more, no questionnaire in Danish existed. Therefore, erectile function. The purpose of this investigation a questionnaire was devised for this study. On the was prospectively to estimate changes in sexual front page of the questionnaire the patient could behavior in elderly males undergoing total hip or state either if they had no sexual activity at all knee replacement because of osteoarthrosis. (including any libido, erection, masturbation or coitus), or if they did not want to participate in the study. If the patient agreed to participate, and still Patients and study design had remaining sexual activity, he ®lled in the questionnaire which consisted of the following questions concerning erectile function. Study population A. `Do you experience dif®culties in obtaining full erection when you want it', and B. `Do you experience dif®culties in maintaining an erection Patients suffering from osteoarthrosis in hip or knee until orgasm during sexual intercourse' (Possible scheduled for elective total hip or knee replacement. answers: 1. Never; 2. Occasionally (less than 25% of the times); 3. Approximately 50% of the times; 4. Often (75% of the times); 5. Always). Before using the questionnaire in the study, it was *Correspondence: T Nordentoft, Department of Surgery, Glostrup Hospital, University of Copenhagen, Ndr. Ringvej, tested on 10 elderly patients to see if anything was 2600 Glostrup, Denmark. unclear. After some corrections it was re-tested and Received 3 September 1999; accepted 2 February 2000 found to be satisfactory. Orthopedic replacement of hip or knee T Nordentoft et al 144 Patients Table 2 Sexual activity pre- and postoperatively Sexual 7 Sexual During a one year period 99 consecutive patients Pre=postoperative activity postop. activity postop. Total were recruited from four departments of orthopedic sexual activity preop. 30 (56.6%) 9 (17.0%) 39 surgery in the Copenhagen area. Exclusion criteria: 7 sexual activity preop. 0 (0%) 14 (26.4%) 14 age < 45 y, active malignant disease, incapacity to Total 30 23 53 ®ll in the form (blindness, dementia). Preoperatively only one patient had to be excluded increased, 7 decreased sexual activity. (concomitant malignant disease). Of the remaining 98 patients, 27 did not want to participate. activity revealed how many patients regarded Six months later similar questionnaires were themselves as being sexually active at all (including mailed to 71 patients and 59 replies were obtained any libido, erection, masturbation or coitus) pre- (answering percent: 81.9%). Six patients had to be and postoperatively, and if any changes for the excluded (two deaths, two would not ®ll in second individual patient were registered. This calculation form and two for other reasons), but 53 answered the was based on the patient's statement on the front second time. For demographic data see Table 1. page of the questionnaire. The patients' erectile function were categorized pre- and postoperatively to see if there was any Control group change. This was based on the questions concerning erectile function. Since there was no generally accepted de®nition of normal erection it was No control group was included, but in a study of de®ned as `the ability to obtain and maintain an elderly men in Copenhagen it was found that 3% erection until orgasm in at least 75% of the times spontaneously developed erectile dysfunction dur- desired'.7 This means that to be classi®ed as having ing a period of 6 months.6 a normal erectile function, the patients had to answer 1 or 2 in both questions (see questionnaire in study design). Statistics Students t-test were used for comparison of groups. Sexual activity The data show that 17.0% lost a sexual activity they Ethics had preoperatively, while no patients being sexually inactive preoperatively regained any activity. A total The study design was approved by the local ethics of 83% were unchanged in that 56.6% still had a committees. sexual activity postoperatively while 26.4% re- mained inactive. The group of patients without any sexual activity (n 14) was signi®cantly older Results than the patients with a sexual activity pre- and postoperatively (n 30) (P < 0.01). The group who lost their sexual activity (n 9) was also signi®- The data were analysed regarding sexual activity as cantly older than the group who remained sexually well as erectile function. The analysis of the sexual active (n 30) (P < 0.01). See Table 3. Table 1 Demographic data: age of the subpopulations in the study Erectile function First questionnaire Mean age (y) The results above outline two interesting subpopu- Did you want to participate (n 27) 69.9 Excluded, ®rst questionnaire (n 1) 79.1 lations for further study, namely the nine patients Included (n 72) 70.0 Included, no sexual function (n 21) 73.8 Table 3 Mean age (range) related to sexual activity pre- and Included, preserved sexual function (n 51) 68.3 postoperatively Second questionnaire Sexual ± Sexual Lost to follow-up (n 13) 67.1 activity postop. activity postop. Returned questionnaire (n 59) 70.6 Excluded, second questionnaire (n 6) 74.3 Sexual activity preop. 67.0 (48 ± 84) 75.2 (70 ± 79) From these no sexual function (n 23) 74.4 7 Sexual activity preop. ± 74.0 (64 ± 85) From these preserved sexual function (n 30) 67.0 increased, 7 decreased sexual activity. International Journal of Impotence Research Orthopedic replacement of hip or knee T Nordentoft et al 145 losing their sexual activity and the 30 patients and women (average age 65 y, range 20 ± 79 y) remaining sexually active. It was calculated how suffering from arthrosis of the hip joint Wiklund many of these patients who had normal erections and Romanus showed that total hip arthroplasty had pre- and postoperatively according to the de®nition bene®cial effect on all functions concerning quality (see Table 4). of life including sexual function.13 After this classi®cation, the data show that 26.1% To our knowledge the in¯uence of hip or knee lost a normal erectile function they had preopera- replacement speci®cally on erectile function has tively, while 6.7% (one patient) regained normal never been investigated. erections. The patients with unchanged abnormal Some surgical procedures on the pelvic organs erections (n 15) were signi®cantly older than the have been demonstrated to increase the risk of patients with normal erections pre- or=and post- erectile dysfunction (ie TURP, operation for rectal operatively (n=24) (P < 0.001). Again, the group of cancer)14 ± 17 probably due to neurovascular damage patients who lost their normal erectile function and various studies show that increasing age (n 6) were signi®cantly older than the patients enlarges this risk: Burniham et al 16 found in a who continued with normal erectile function group of males who had undergone rectal excision, (n 17) (P < 0.02) (see Table 5). that the risk of developing erectile dysfunction after the operation was much higher among older patients (more than 45 y-old) than among the younger patients. Libman et al 18 demonstrated that the Discussion negative impact of TURP on sexual function and erectile function was more pronounced in a group older than 65 y compared with a group less than It is well-known that patients suffering from osteo- 65 y-old. Linder et al 19 have found similar results. arthrosis in hip or knee experience a decreases in Whether any major surgery unrelated to the quality of life.5,8 Total hip or knee replacement pelvic organs in¯uences the erectile function has increases quality of life for these patients.8,9 ± 13 only been scarcely investigated.
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]
  • Arousing Imaginations
    Evolutionary Psychology www.epjournal.net – 2007. 5(4): 778-785 ¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯ Book Review Arousing Imaginations A review of Michael R. Kauth, (Ed.), Handbook of the Evolution of Human Sexuality, Haworth Press, Binghamton, NY, 2006, 395 pp., $50.00 (softbound), $130.00 (hardbound) Reviewed by David Puts, Ph.D. Department of Anthropology, 424 Carpenter Building, Pennsylvania State University, University Park, PA 16802. Email: [email protected] In the quarter century since Donald Symons (1979) wrote The Evolution of Human Sexuality, research in this area has flourished. Michael Kauth’s edited volume Handbook of the Evolution of Human Sexuality (co-published as Volume 18, Numbers 2/3 and 4 2006 of the Journal of Psychology & Human Sexuality) is therefore a welcome addition. Kauth assembles researchers in diverse areas of human sexuality, including heterosexual mate choice, sexual arousal and olfactory preferences, but the focus is heavily upon the evolution and development of homosexuality, with five of the book’s ten chapters centering on this topic. Given that only 2-3% of men and 1-2% of women report predominantly homosexual preferences, this focus may seem disproportionate. However, the volume is intended not to cover all aspects of human sexuality but to serve as a springboard for future research, a mission that it will undoubtedly accomplish. The scholarship in the Handbook is variable but generally good. The content is often heavy on speculation and light on evidence, which would be less concerning if authors acknowledged this more openly. Instead, the chapters of the Handbook often reify “facts” that are still quite theoretical—for example, Kauth’s statement that “physical symmetry and extravagant sexual ornamentation are ‘honest’ signals of health and genetic quality” (p.
    [Show full text]
  • Drug-Induced Sexual Dysfunction in Men and Women
    VOLUME 36 : NUMBER 2 : APRIL 2013 ARTICLE Drug-induced sexual dysfunction in men and women Helen M Conaglen whether the clinician is willing to ask about sexual Clinical psychologist and SUMMARY issues and does so in a sensitive way.7,8 Senior research fellow Many medical conditions and their treatments Patients on long-term medications may not be John V Conaglen aware that their sexual problems have developed Endocrinologist and contribute to sexual dysfunction. as a result of their treatment. Conversely some may Associate professor in Commonly implicated drugs include Medicine blame their drugs for sexual problems which are due Sexual Health Research Unit antihypertensives, antidepressants, to relationship difficulties or other stressors. Some Waikato Clinical School antipsychotics and antiandrogens. doctors consider that asking patients if they had Faculty of Medical and Understanding the potential for drug-induced noticed any sexual adverse effects from their drugs Health Sciences University of Auckland sexual problems and their negative impact may ‘suggest’ them to the patient, and possibly result on adherence to treatment will enable the in non-adherence. Patients attributing their sexual clinician to tailor treatments for the patient problems to their drugs are less likely to continue the Key words treatment even when necessary for their health.9 The antidepressants, and his or her partner. consultation should include discussion of the patient’s antihypertensives, Encouraging a discussion with the patient sexual issues so these can be considered in treatment antipsychotics, arousal, about sexual function and providing erectile dysfunction, decisions. hypoactive sexual desire strategies to manage the problem are critical disorder, male impotence, to good clinical care.
    [Show full text]
  • The Effect of Contraceptive Implants on Sexual Desire in Women Zoë Tessier and Katrina Armstrong | Faculty of Health Science | University of Ottawa
    Are contraceptives causing the bedroom blues? The effect of contraceptive implants on sexual desire in women Zoë Tessier and Katrina Armstrong | Faculty of Health Science | University of Ottawa ABSTRACT METHODS DISCUSSION Background: In the United States, an estimated 51% of pregnancies are unwanted (Sanders et. al., 2014). High rates of unwanted • The main finding of the structured literature review was a decrease in sexual desire in women using contraceptive implants. pregnancy can be reduced by the use of various contraceptives. Hormonal contraceptives are a popular choice among fertile women PubMed, Medline, and Scopus were searched for relevant However the studies did not provide satisfactory evidence to draw a confident conclusion. and have been shown to effectively prevent pregnancy. Contraceptive implants are a type of progestogen-only birth control. The articles. “Contraceptive implants” and “libido” were initially • The Di Carlo and Sanders articles used the “Female Sexual Function Index” (FSFI) and the “Short Form-36” (SF-36) as a tool to implant is a single rod that is inserted subdermally into the upper arm. It has 68 mg of active compound and is effective in searched under the PubMed database. “Contraception” and measure sexual desire. All other articles failed to explicitly indicate the controls and measures used to determine libido. preventing pregnancy for up to 3 years (Gezginc et. al., 2007). Objective: Examine if contraceptive implants decrease a woman’s “drug implants” combined with “sexual dysfunction” or “libido” • Two articles described an increase in sexual desire while the remaining four reported a decrease. The increases were believed to sexual desire via a literature review.
    [Show full text]
  • Post-Orgasmic Illness Syndrome: a Closer Look
    Indonesian Andrology and Biomedical Journal Vol. 1 No. 2 December 2020 Post-orgasmic Illness Syndrome: A Closer Look William1,2, Cennikon Pakpahan2,3, Raditya Ibrahim2 1 Department of Medical Biology, Faculty of Medicine and Health Sciences, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia 2 Andrology Specialist Program, Department of Medical Biology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo Hospital, Surabaya, Indonesia 3 Ferina Hospital – Center for Reproductive Medicine, Surabaya, Indonesia Received date: Sep 19, 2020; Revised date: Oct 6, 2020; Accepted date: Oct 7, 2020 ABSTRACT Background: Post-orgasmic illness syndrome (POIS) is a rare condition in which someone experiences flu- like symptoms, such as feverish, myalgia, fatigue, irritabilty and/or allergic manifestation after having an orgasm. POIS can occur either after intercourse or masturbation, starting seconds to hours after having an orgasm, and can be lasted to 2 - 7 days. The prevalence and incidence of POIS itself are not certainly known. Reviews: Waldinger and colleagues were the first to report cases of POIS and later in establishing the diagnosis, they proposed 5 preliminary diagnostic criteria, also known as Waldinger's Preliminary Diagnostic Criteria (WPDC). Symptoms can vary from somatic to psychological complaints. The mechanism underlying this disease are not clear. Immune modulated mechanism is one of the hypothesis that is widely believed to be the cause of this syndrome apart from opioid withdrawal and disordered cytokine or neuroendocrine responses. POIS treatment is also not standardized. Treatments includeintra lymphatic hyposensitization of autologous semen, non-steroid anti-inflamation drugs (NSAIDs), steroids such as Prednisone, antihistamines, benzodiazepines, hormones (hCG and Testosterone), alpha-blockers, and other adjuvant medications.
    [Show full text]
  • Sexual Dysfunction in Men and in Women
    888-387-7218 @PharmXhealthOne @PharmXhealthOne Schedule your appointment today with a friendly sta member or book online today: LOW-INTENSITY EXTRACORPOREAL Toll-free 888-387-7218 SHOCK WAVE THERAPY Phone 561-847-4654 Fax 561-847-4956 Both men and women go through the same phases of sexual reactions cycle: sexual desire, sexual arousal, and, as a result, orgasm and reso- Email health@pharmxheal- lution phase. During the phase of sexual arousal, in both men and women, the blood flow to pelvic organs increases, but in the event of erectile dysfunction in men and frigidity in women, this process weak- ens or does not occur at all. Furthermore, the innervation of genital organs in male and female organisms is identical. Activation, which enables genital innervation, launches the activation of blood circula- PharmXhealthOne wellness center has tion in the target organs. three convenient locations: Therefore, in case of ED in men, and in case of female sexual arousal disorder in women, along with other specific treatment methods, it is 1054 Gateway Blvd, Suite 103 useful to perform non-invasive stimulation of insuciently active physiological mechanisms of sexual arousal. However, for the treat- Boynton Beach, FL 33426 ment of ED in men, such stimulation has already been successfully (561) 847-4654 used for a long time – that is the low-intensity extracorporeal shock (561) 847-4956 fax wave therapy, which allows to restore the erection mechanism itself. [email protected] SEXUAL Studies from throughout the world, including those conducted by Ukrainian scientists, have established that low-intensity extracorpore- al shock wave therapy induces neovascularization and therefore 808 SW Glenview Ct, Suite 818 improves blood circulation.
    [Show full text]
  • Sexuality and Chronic Pain
    Sexuality and Chronic Pain By Judith Paice, PhD, RN, Research Professor of Medicine, Northwestern University Medical School, Chicago, IL Re-printed with permission from the American Chronic Pain Association Chronicle. Sexuality is a significant part of who we are as individuals, providing intimacy, affection, social interaction, and touch. We are sexual beings from the moment of birth to the end of our lives. Sexual practices and beliefs wary widely, often based upon age, gender, past experiences, as well as religious and cultural values. As a result, each person and partner defines what is considered “normal” sexual behavior. There are four phases involved in the sexual response: desire, excitement, orgasm, and resolution. Desire is interest in sex, also called libido. Excitement is a state of arousal that often occurs as a result of touching and kissing. During excitement the body responds by increasing the heart rate, blood pressure, and respiratory rate. Blood flow will increase to the genitals in both men and women. In men, this results in an erection. The third phase, orgasm, is also called climax. Muscles in the genitalia contract, resulting in waves of pleasure throughout the body. Finally, resolution is the return of the body to its original state. Unfortunately, chronic pain and its treatment can impair our ability to express sexuality by altering any of the four phases. Few studies have evaluated the frequency of changes in sexual desire or function in people with chronic pain. One study of patients enrolled in chronic pain treatment programs in England found that 73 percent had some degree of sexual problems (Ambler et al.
    [Show full text]
  • Sexual and Life Satisfaction of Pregnant Women
    International Journal of Environmental Research and Public Health Article Sexual and Life Satisfaction of Pregnant Women Dorota Branecka-Wo´zniak 1,*, Anna Wójcik 2, Joanna Bła˙zejewska-Ja´skowiak 1 and Rafał Kurzawa 1 1 Department of Gynecology and Reproductive Health, Pomeranian Medical University of Szczecin, 71-210 Szczecin, Poland; [email protected] (J.B.-J.); [email protected] (R.K.) 2 Clinic of Obstetrics and Gynecology, Independent Public Clinical Hospital No. 1, Pomeranian Medical University of Szczecin, 71-252 Szczecin, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-91-480-0920 Received: 30 June 2020; Accepted: 11 August 2020; Published: 13 August 2020 Abstract: The awareness of one’s own sexuality and its expression depend on the stage of an individual’s life. Pregnancy is a period of many, also psychosexual, changes. The sexual needs of pregnant women are rarely discussed, and intercourse during this period seems to be a taboo. The aim of this study was to assess the sexual and life satisfaction of pregnant women. The study involved 181 pregnant women and was conducted from July to November 2018. The participants were patients of the pregnancy pathology ward, Independent Public Clinical Hospital No. 2 in Szczecin, and participants of antenatal classes. The research project was approved by the Bioethics Committee of the Pomeranian Medical University, Szczecin (KB-0012/74/18). This survey-based study was performed using the self-developed questionnaire and standardized tools: the Sexual Satisfaction Questionnaire, and the Satisfaction with Life Scale (SWLS). Statistical analysis was performed using the SPSS Statistics 24.0 statistical package.
    [Show full text]
  • Sexuality Development and Developmental Psychology
    Chapter 6 Sexuality Development and Developmental Psychology While most humans appear to invoke free will regarding their sexual behav- ior, their sexuality in turn often seems to subvert a great deal of this will. That is, our sexual desires, inclinations, and identity greatly influence our decisions and behavior. People tacitly accept this principle when they advocate imprisonment for individuals who commit sex crimes against children. Implicit in this involuntary commitment process is the premise that the offender will not be able to control himself or herself against committing future offenses and thus should be physically prevented from doing so. This generally accepted act of prevention applies to the most extreme and dangerous sexual behaviors. But is the violent pedophile really less in control of his sexual behavior than those individuals who exhibit socially acceptable forms of sexuality? Or, is it that most of the population enacts a sexual- ity that is no more under control but considered a normative part of both nature and society? In essence, the issue is—regardless of the sexual behavior that an individual engages in—whether he or she is ultimately in control of that behavior. Wine connoisseurs often encourage the uninitiated to educate their palates to better appreciate fine wines. In doing so, they are encouraging people to suppress their innate aversion to what is essentially rancid grape juice with a bit of alcohol. With repeated exposure to the initially repellant properties of the wine, and with the guidance of an expert identifying specific hedonic properties, an individual can come to identify what is deemed to be a desirable wine.
    [Show full text]
  • S100005 Sex and Birth Control
    Sex and Birth Control: Are they connected? About 25% of women will have decreased sexual thoughts and arousability on Hormonal Contraception Enjoying sex is related to motivation for birth control The type of hormone, IUD or barrier may affect sexual pleasure There are biological drives to reproduce at odds with logical life plans REFERENCES 1. Schaffir J. Hormonal contraception and sexual desire: A critical review. J Sex Marital Ther. 2006;32:305-14 2. Oinonen, K. A. and D. Mazmanian. To what extent do oral contraceptives influence mood and affect? J Affect Disord. 2002;70(3):229-240. 3. Sanders SA, Graham CA, Bass JL, Bancroft J. A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation. Contraception. 2001;64(1):51-58. 4. Sabatini R, Cagiano R. Comparison profiles of cycle control, side effects and sexual satisfaction of three hormonal contraceptives. Contraception. 2006 Sep;74:220-3. 5. Wiebe ER, Brotto L, MacKay J. Characteristics of women who complain of mood and sexual side effects from hormonal contraception J Obstet Gynaecol Can 2011;33(11):1234-40. 6. Oinonen KA. Putting a finger on potential predictors of oral contraceptive side effects: 2D:4D and middle-phalangeal hair. Psychoneuroendocrinology. 2009 Jun;34(5):713-26. 7. Wallwiener M, Wallwiener L, Seeger H, Mueck AO, Bitzer J, Wallwiener CW. Effects of sex hormones in oral contraceptives on the female sexual function score: A study in German female medical students. Contraception; Volume 82, Issue 2, August 2010, Pages 155-159 8. Wiebe ER, Kaczorowski J, MacKay J.
    [Show full text]
  • Disorders of Ejaculation: an AUA/SMSNA Guideline - American Urological Association
    02.07.2020 Disorders of Ejaculation: An AUA/SMSNA Guideline - American Urological Association Home Guidelines Clinical Guidelines Disorders of Ejaculation Disorders of Ejaculation: An AUA/SMSNA Guideline Panel Members Alan W. Shindel MD, Stanley E. Althof, Ph.D., Serge Carrier, MD, Roger Chou, MD, FACP, Chris G. McMahon, MD, John P. Mulhall, MD, Darius A. Paduch, MD, Ph.D., Alexander W. Pastuszak, MD, Ph.D., David Rowland, Ph.D., Ashely H. Tapscott, MD , Ira D. Sharlip MD. Executive Summary Ejaculation and orgasm are distinct but simultaneous events that occur with peak sexual arousal. It is typical for men to have some control over the timing of ejaculation during a sexual encounter. Men who ejaculate before or shortly after penetration, without a sense of control, and who experience distress related to this condition may be diagnosed with Premature Ejaculation (PE). There also exists a population of men who experience difficulty achieving sexual climax, sometimes to the point that they are unable to climax during sexual activity; these men may be diagnosed with Delayed Ejaculation (DE). While up to 30% of men have self- reported PE, few of these men have an ejaculation latency times (the time between penetration and ejaculation) of less than two minutes, making the actual prevalence of clinical PE and DE less than 5%.1, 2 Regardless, the experience of many clinicians suggest that the problem is not rare and can be a source of considerable embarrassment and dissatisfaction for patients. Data on the prevalence of DE are more limited, but a proportion of epidemiological studies report that men have difficulty achieving orgasm.3 Disturbances of the timing of ejaculation can pose a substantial impediment to sexual enjoyment for men and their partners.
    [Show full text]
  • Understanding Low Libido in Women
    Understanding Low Libido in Women Contents What is Low Libido? 3 How is Libido Classified? 3 Why Does Low Libido Develop? 5 Who Develops Low Libido? 9 When Should I Be Concerned? 9 What are the Signs and Symptoms of Low Libido? 10 What is Normal Sexual Activity? 11 Testosterone and Women 12 Using Testosterone in Women – Options? 14 Seeking Medical Assistance 16 Female Sexual Function Questionnaire 17 Sexual History 23 Physical Examination 24 Sexual Response Review 26 Switching Contraceptive Method 29 Diagnostics 30 Psychological Assessment 34 Specialist Referral Options 35 Additional Treatment Options 36 What About Homeopathic and Herbal Treatments? 37 About Lawley Pharmaceuticals 38 Our Mission Statement 38 Completed Clinical Studies 39 Copyright Information 40 2 What is Low Libido? Libido is the sex drive. It is the necessary forerunner of sexual fantasy, arousal and sexual enjoyment. Low libido is a serious condition because it can diminish psychological health and well-being, and impacts on personal relationships. Low libido can be extremely well managed with appropriate treatment. Often women are too shy or feel uncomfortable discussing issues relating to sexual function, including low libido, and they may experience unfulfilling sexual and personal relationships as a result. How is Libido Classified? Every woman can experience short-term, intermittent disinterest in sex due to fatigue, acute illness, or stress. True low libido is a persistent, enduring disorder causing personal distress. There are four distinct medical classifications of female sexual dysfunction that result in low libido: Hypoactive Sexual Desire Disorder (HSDD) - The woman lacks sexual fantasies, has little or no sexual thoughts or inclination towards sexual activity of any kind or she is unreceptive to sexual activity.
    [Show full text]