Significados psicológicos sobre sexualidad, deseo y placer sexual en la adultez mayor / Psychological meanings on sexuality, desire, and sexual pleasure in seniorhood

Resumen Los significados sobre la sexualidad en la adultez mayor se encuentran sobre la base de una compleja interrelación entre factores sociales, culturales y personales. La presente investigación tuvo como objetivo explorar los significados psicológicos que personas adultas mayores de la Ciudad de México le confieren a la sexualidad, al placer sexual y al deseo sexual, mediante el empleo de las redes semánticas naturales (modificadas). La muestra estuvo constituida por 204 personas: 162 mujeres y 40 hombres, entre los 60 y 100 años, asistentes a centros de educación continua para personas adultas mayores en la Ciudad de México. El estudio fue mixto, descriptivo, no experimental, con muestreo no probabilístico y por conveniencia. Los resultados muestran que los significados psicológicos que las personas adultas mayores estudiadas refieren sobre la sexualidad, el deseo y el placer sexual son predominantemente positivos, y abarcan sentimientos, comportamientos y sensaciones. Se identifican diferencias por género tal como se planteó en la hipótesis de investigación, pero también se encontraron similitudes dentro de dichos significados. En las adultas mayores predomina la interrelación entre significados afectivos y contacto físico, mientras que en los hombres predominan las sensaciones. En general la muestra describe la sexualidad, el deseo y el placer sexual de manera muy similar, lo cual lleva a comprender que las fronteras entre los términos son sensibles, de tal manera que los significados y referentes de las propias personas llegan a permearse.

Abstract The meanings of sexuality in seniorhood are found at the base of a complex interrelation between social, cultural and personal factors. The present research aimed to explore the psychological meanings that senior adults in Mexico City confer on sexuality, sexual pleasure and sexual desire; through the use of modified natural semantic networks. The sample consisted of 204 people: 162 senior women and 40 senior men, between 60 and 100 years old, attending a continuing education centers for senior adults in Mexico City. The study was mixed, descriptive, non-experimental, with non-probability and convenience sampling. The results show how the psychological meanings that the studied senior adults have related to sexuality, desire and sexual pleasure are predominantly positive, encompassing feelings, behaviors and sensations. Differences by gender are identified as proposed in the research hypothesis, but similarities within these meanings were also found. The senior women studied define sexuality from the interrelation between affective meanings and physical contact; the word "love" was the most referenced. In addition, they mentioned "pleasure", "desire", "caresses", "satisfaction", "kisses", "joy", "hugs", "health", "attraction", and "knowledge". Senior men, for their part, consider sexuality mainly as an attraction and include others such as: "satisfaction", "pleasure", "respect", "life", "fidelity", "complete", "unique", "woman", "touch", "important", "love", "knowledge", "passion", "desire", "need", and "affection". Women and men in the sample describe sexual desire and pleasure in a very similar way to their sexuality referents, which leads us to understand that the boundaries between the two terms are sensitive. Regarding sexual desire, senior women cite defining words such as: "caresses", "kisses", "love", "hugs", "pleasure", "desire", "necessary", "satisfaction", "natural", "attraction", "partner", "happiness", and "respect". In relation to sexual pleasure, they include the words: "enjoyment", "tenderness", "affection", "friendship", "joy", "it is the maximum", and "relaxing". For their part, senior men defined sexual desire as: "attraction", "love", "caresses", "satisfaction", "looks", "necessary", "natural", "woman", "kisses", "being alive", "respect", "passion", "libido", "important", "moving", "pleasure", "hug", "energy", "games", "excitement", "communication", "masturbation", "eroticism", and "taste". Sexual pleasure includes: "important", "fullness", "enjoyment", "respect", "pleasure", "joy", and "naturalness". The results show that the stage of sexuality in seniorhood is diverse and it is influenced by gender and social beliefs, which evidences the psychological complexity of this sphere of life.

Cognitive-behavioral group therapy for women with hypoactive sexual desire: A pilot randomized study

Abstract Background: Hypoactive Sexual Desire Disorder (HSDD) is a very prevalent sexual problem, with limited options for treatment. Given that psychological factors are major contributors to the disorder, a therapy such as Cognitive-Behavioral Therapy (CBT) may be useful to treat HSDD. Objective: To evaluate the effects of group CBT on women with HSDD. Method: Clinical trial randomized study with 106 women diagnosed with HSDD, who were divided as follows: Group 1 (n = 53) underwent group CBT for 8-weeks, and Group 2 (n = 53), were put on a waiting list and used as a control group. Sexual function was assessed by the Female Sexual Quotient (FSQQ) at the initial interview and after 6-months. Mann Whitney test was used for group comparison. Main Outcome Measures: demographics, education, sexual history, FSQQ and its domains for sexual function assessment. Results: Both groups had similar characteristics regarding sexual response, self-image, and relationship with a partner at the initial interview. Women undergoing therapy showed significant improvement in sexual function when compared with the control group. The overall FSQQ result showed an average growth of 18.08 points (95% CI 12.87‒23.28) for the therapy group against a decrease of 0.83 points (95% CI 3.43‒1.77) for controls (p < 0.001). The five domains of the questionnaire also exhibited significant improvement in the therapy group: desire and interest (p = 0.003), foreplay (p = 0.003), excitation and tuning (p < 0.001), comfort (p < 0.001), and orgasm and satisfaction (p < 0.001). Conclusion: Group CBT was shown to be an effective tool for treating HSDD.

Correlates between sexual desire and disposition to sexual fantasies with inhibitory control and cognitive planning in young Colombians / Correlación del deseo sexual y disposición a fantasías sexuales con control inhibitorio y planificación cognitiva en jóvenes colombianos

Abstract Objective: the research was oriented to investigate the correlation between some executive functions (inhibitory control, risk-benefit calculation, cognitive flexibility, the planning ability, and decision making) and the general, dyadic and solitary sexual desire, sexual desire inhibition and disposition to sexual fantasies in a 17-to-30-year-old people sample. Method: An observational cross-sectional study in a purposive sample of 64 young college students, aged between17 and -30, who were in a couple relationship at the time of the study and gave their consent for their participation in the research. The participants completed the Neuropsychological Battery of Executive Functions and Frontal Lobes tasks (BANFE for its abbreviation in Spanish): Stroop, card games, card classification and Hanoi Tower, and it was administered the Inhibited Sexual Desire Test, the Sexual Desire Inventory (SDI-2) and the Scale of Attitude Towards Sexual Fantasies. Results: The results indicate a correlation between the executive functions and sexual desire; it was found a correlation between total and dyadic sexual desire and disposition towards sexual fantasies with inhibitory control; and the inhibited sexual desire was correlated to planning ability and inhibitory control. Discussion: Although the study presents some methodological limitations (size of the sample and need of a more rigorous validation of instruments in the Colombian population), the results confirm previous research findings, allowing to formulate new hypotheses in the field of sexuality and neurosciences. The study findings draw attention to the educational implications aimed to develop the executive functions in adolescents and young people to prevent risky sexual behavior.

Resumen Objetivo: El estudio se orientó a indagar la relación entre algunas funciones ejecutivas (FE) (control inhibitorio, cálculo de riesgo-beneficio, flexibilidad cognitiva, habilidad de planeación y toma de decisiones) con el deseo sexual general, diádico y solitario, inhibición del deseo sexual y disposición hacia las fantasías sexuales en una muestra de jóvenes entre 17 y 30 años. Método: Estudio de enfoque cuantitativo de corte transversal. Mediante un muestreo intencional por conveniencia se seleccionaron 64 jóvenes entre 17 y 30 años, estudiantes universitarios que se encontraban en una relación de pareja. Para evaluar las variables de las FE se utilizaron tareas de la Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales (BANFE): Stroop, juego de cartas, clasificación de cartas y Torre de Hanoi, y las variables relacionadas con el deseo sexual fueron valoradas mediante el Test del Deseo Sexual Inhibido, el Inventario del Deseo Sexual (SDI-2, sigla de Sexual Desire Inventory) y la Escala de la Actitud hacia las Fantasías Sexuales. Resultados: Se encontraron correlaciones entre las variables del deseo sexual, disposición hacia las fantasías sexuales y el deseo sexual inhibido; deseo sexual total y diádico y disposición hacia las fantasías sexuales correlacionó con el control inhibitorio; y el deseo sexual inhibido correlacionó con la planificación y el control de impulsos. Discusión: Los hallazgos del estudio llaman la atención sobre las implicaciones educativas encaminadas a desarrollar las funciones ejecutivas en adolescentes y jóvenes con el fin prevenir conductas sexuales de riesgo.

Implante de testosterona para la mujer, evaluación de seguridad y efectividad en esta vía de administración / Testosterone implant for women, evaluation of safety and effectiveness in this route of administration

INTRODUCCIÓN Y OBJETIVO: El rol de la testosterona exógena en la función sexual femenina ha sido estudiado durante muchos años, con resultados contradictorios. En el último tiempo se ha promovido el uso de pellets de testosterona como una solución para mejorar la libido femenina, la cognición, la fuerza muscular y los sistemas cardiovascular y óseo, e incluso evitar el envejecimiento. Por ello, revisamos las publicaciones para tratar de responder si esto es una moda o el tratamiento más innovador del último tiempo. MÉTODO: Se analizaron las bases de datos PubMed/Medline, Trip Database, Cochrane, SciELO, Scopus, UpToDate, Ovid, ProQuest, Science Direct y ResearchGate. RESULTADOS: De acuerdo con la evidencia, la mejor testosterona disponible es la transdérmica y debe ser usada solo en el trastorno del deseo sexual hipoactivo (TDSH). Los trabajos que evalúan los pellets de testosterona tienen sesgos metodológicos importantes. Si bien son útiles para mejorar la función sexual femenina, producen concentraciones plasmáticas suprafisiológicas de testosterona, por lo que no se puede establecer su seguridad a largo plazo. Tampoco hay datos suficientes que avalen su uso para mejorar el rendimiento cognitivo y el bienestar general, en el tratamiento de enfermedades cardiovasculares o en la prevención de enfermedad ósea. CONCLUSIONES: La testosterona solo se recomienda en el tratamiento del TDSH por vía transdérmica. No recomendamos el uso de pellets de testosterona para el tratamiento de la disfunción sexual ni como hormona antienvejecimiento, ya que no hay estudios consistentes sobre su seguridad, eficacia y efectos adversos a largo plazo.

INTRODUCTION AND OBJECTIVE: The role of exogenous testosterone in female sexual function has been studied for many years with contradictory results. In recent times, the use of testosterone pellets has been promoted as a solution to improve female libido, cognition, muscle strength, cardiovascular system, bone and even prevent aging. Therefore, we will review the publications in order to answer whether this is a fad or the most innovative treatment of recent times. METHOD: The databases PubMed/Medline, Trip Database, Cochrane, SciELO, Scopus, UpToDate, Ovid, ProQuest, Science Direct and ResearchGate were analyzed. RESULTS: So far, the evidence best testosterone available is transdermal testosterone and that it should be used only in hypoactive sexual desire disorder (HSDD). Papers evaluating testosterone pellets have significant methodological biases. While they are useful in improving female sexual function, they produce supra-physiological plasma levels of testosterone, so their long-term safety cannot be established. There is also insufficient data to support their use in improving cognitive performance and general well-being, treatment of cardiovascular disease or prevention of bone disease. CONCLUSIONS: Testosterone is only recommended for the tratment of HSDD via the transdermal route. We do not recommended the use of testosterone pellets for the treatment of sexual dysfunction or as an anti aging hormone, as there are no consistent studies on its safety, efficacy, and long-term adverse effects.

Translation and assessment about the Sexual Interest and Desire Inventory-Female / 中国实用护理杂志

Objective:To translate the English version of Sexual Interest and Desire Inventory-Female (SIDI-F) into Chinese, evaluate its reliability, validity and the proper cut-off point of diagnosis of hypoactive sexual desire disorder (HSDD) in China.Methods:Chinese version of SIDI-F was developed and 96 healthy women from January 1, 2019 to December 31, 2019 in Taihe Hospital, Shiyan City, Hubei Province were selected to fill in the Chinese version of SIDI-F and the Female Sexual Function Index (FSFI). Next, analyzed the reliability, validity and the cut-off point of diagnosis of HSDD of the SIDI-F.Results:The Cronbach coefficient of the Chinese version of SIDI-F was 0.931, split-half reliability was 0.922, the intra-group correlation coefficient was 0.805. Analysis of content validity of the SIDI-F indicated that the average of scale-level content validity index was 1.00, the item-level content validity index was 1.00, and the Pearson correlation coefficient between the score of SIDI-F and the erotica score of the FSFI (FSFI-D) was 0.802. Factor analysis of the Chinese version of SIDI-F showed good construct validity. The area under ROC was 0.835. With the SIDI-F score and the best cut-off point of 26.5, Youden index was the largest, at 0.635. The validity indicators were 76.7% for sensitivity, 86.8% for specificity, 5.95 for positive likelihood ratio.Conclusions:The Chinese version of SIDI-F has high reliability and validity in Chinese population, and these show 26.5 point can be used as the best cut-off value of diagnose HSDD.

Suplementación de testosterona durante el climaterio en mujeres con trastorno por deseo sexual hipoactivo / Testosterone supplementation during the climacteric period in women with hypoactive sexual desire disorder

A partir del caso de una paciente con trastorno por deseo sexual hipoactivo durante su climaterio y a través del resumen de los resultados de dos revisiones sistemáticas, los autores de este artículo revisan la evidencia sobre la suplementación con andrógenos para el tratamiento de esta condición clínica. Concluyen que su uso sería relativamente seguro a corto plazo, aunque su eficacia no alcanzaría la relevancia clínica y no contamos aún con mayor información sobre la seguridad en el largo plazo. Los autores destacan además que el abordaje de las pacientes con este problema de salud debería ser realizado en forma integral, incluyendo opciones terapéuticas no farmacológicas e informando sobre las incertidumbres todavía presentes. (AU)

Based on the case of a patient with hypoactive sexual desire disorder during her climacteric period and through the summary of the results of two systematic reviews, the authors of this article review the evidence supporting androgen supplementation for the treatment of this clinical condition. They conclude that its use would be relatively safe in the short term, although its efficacy would not reach clinical relevance and no further information on long-term safety is available. The authors also highlight that patients with this health problem should be approached comprehensively, including non-pharmacological therapeutic options and providing information on the uncertainties still present. (AU)

Uso de testosterona en mujeres: un comentario sobre el consenso global sobre el uso de la terapia de testosterona para mujeres / Global consensus position statement on the use of testosterone therapy for women

Las mujeres han sido tratadas por décadas con testosterona intentando aliviar una gran variedad de síntomas con riesgos y beneficios inciertos. En la mayoría de los países, la testosterona se prescribe "off-label", de modo que las mujeres están utilizando compuestos y dosis ideadas para tratamientos en hombres. En este sentido, varias sociedades médicas de distintos continentes adoptaron recientemente por consenso una toma de posición sobre los beneficios y potenciales riesgos de la terapia con testosterona en la mujer, explorar las áreas de incertidumbre e identificar prácticas de prescripción con potencial de causar daño. Las recomendaciones con respecto a los beneficios y riesgos de la terapia con testosterona se basan en los resultados de ensayos clínicos controlados con placebo de al menos 12 semanas de duración. A continuación se comentan las recomendaciones. (AU)

There are currently no clear established indications for testosterone replacement therapy for women. Nonetheless, clinicians have been treating women with testosterone to alleviate a variety of symptoms for decades with uncertainty regarding its benefits and risks. In most countries, testosterone therapy is prescribed off-label, which means that women are using testosterone formulations or compounds approved for men with a modified dose for women. Due to these issues, there was a need for a global Consensus Position Statement on testosterone therapy for women based on the available evidence from placebo randomized controlled trials (RCTs). This Position Statement was developed to inform health care professionals about the benefits and potential risks of testosterone therapy intended for women. The aim of the Consensus was to provide clear guidance as to which women might benefit from testosterone therapy; to identify symptoms, signs, and certain conditions for which the evidence does not support the prescription of testosterone; to explore areas of uncertainty, and to identify any prescribing practices that have the potential to cause harm. (AU)

Posiciones discursivas sobre sexualidad, deseo y placer sexual en jóvenes estudiantes chilenos y mexicanos / Discursive positions on sexuality, sexual desire and pleasure among Chilean and Mexican young students / Posições discursivas sobre sexualidade, desejo e prazer sexual em jovens estudantes chilenos e mexicanos

Resumen En este artículo buscamos comprender los significados sobre sexualidad, deseo y placer sexual de jóvenes heterosexuales, estudiantes, de entre 15 y 19 años, de Ocotlán, México y Antofagasta, Chile. Si bien geográficamente distantes, al estar situados en Latinoamérica, ambos emplazamientos comparten elementos socioculturales como: feminidad asociada al modelo mariano; cultura occidental de hegemonía masculina; procesos de colonización europea; religiosidad influyente en la familia y la vida sexual; y peso preponderante del neoliberalismo. La metodología fue cualitativa, con perspectiva pos/decolonial y feminista. La recolección de datos se efectuó con entrevistas y grupos de conversación. Realizamos análisis de inferencias discursivas. Entre los hallazgos, encontramos que en los dos contextos emergen posiciones discursivas de tipo esencialistas sexuales, sexistas, mercantilistas, románticas y contrasexuales.

Abstract This paper seeks to understand the meanings of sexuality, sexual desire and pleasure among young heterosexual students between 15 and 19 years of Ocotlán, México and Antofagasta, Chile. Although geographically distant, being located in Latin America, both sites share sociocultural elements such as: femininity associated with the Marian model; the Western culture of male hegemony; European colonization processes; influential religiosity in the family and sexual life; and preponderant weight of neoliberalism. The methodology was qualitative, with pos/decolonial and feminist perspectives. The data collection was carried out with through interviews and discussion groups, followed by analysis of discursive inferences. In the findings, we discovered that in both contexts emerge discursive positions classified as sexual essentialism, sexist, mercantilist, romantic and counter sexual.

Resumo Neste trabalho procuramos compreender os significados atribuídos à sexualidade, desejo e prazer sexual entre jovens estudantes heterossexuais entre 15 e 19 anos de Ocotlán, México e Antofagasta, Chile. Embora ambos os contextos sejam geograficamente distantes, sua localização na América Latina faz com que compartilhem elementos socioculturais, tais como a feminilidade associada ao modelo Mariano, a cultura ocidental de hegemonia masculina, processos de colonização Europeia, religião influente na vida familiar e sexual e peso preponderante do neoliberalismo. A metodologia foi qualitativa com perspectiva pós/descolonial e feminista. A coleta de dados foi realizada com entrevistas e grupos focais, seguido de análises de inferências discursivas. Nos resultados verificou-se que em ambos os contextos emergem posições discursivas do tipo: essencialista sexual, sexista, mercantilista, romântica e contra sexual.

Caracterización del deseo sexual en mujeres climatéricas de un centro de salud rural / Characterization of sexual desire in climacteric women in a rural health center

OBJETIVO GENERAL: Caracterizar el deseo sexual en mujeres climatéricas de un centro de salud rural. METODOLOGÍA: Estudio no exploratorio descriptivo - transversal, que comprende mujeres entre 45 a 64 años que se controlan en un CESFAM Rural, 2016. La muestra fue de 146 mujeres que contestaron una encuesta auto aplicada, entre ellos el test del deseo sexual inhibido de M&J. Los datos fueron analizados con el software estadístico SPSS versión 22.0. RESULTADOS: Se encuestó a un total de 146 mujeres climatéricas, con un promedio de edad de 51.8 años, de ellas un 64.4% había tenido su menopausia. De las encuestadas sólo un 19,9% presentó inhibición del deseo sexual. La inhibición del deseo sexual se presentó con mayor frecuencia en mujeres que llevaban en promedio 29,3 años con sus parejas, aquellas que presentaban morbilidad crónica, y aquellas que reconocieron tener síntomas somáticos, psicológicos y urogenitales asociados a la menopausia. CONCLUSIÓN: En la evaluación del deseo sexual se debe considerar que existen varios factores que en él influyen y también una gran gama de instrumentos que pretenden medirlo. La mayoría de las usuarias climatéricas rurales (65,1%) no presentan inhibición del deseo sexual. Existen factores que pueden fomentar y causar una inhibición del deseo sexual, mientras otros pueden ayudar a evitar su aparición. Es fundamental conocer y manejar estos factores, con la finalidad de ayudar a la mujer climatérica a tener una mejor calidad de vida.

OBJECTIVE: To characterize the sexual desire in climacteric women of a rural health center. METHODOLOGY: Descriptive - transversal non - exploratory study, comprising women between 45 and 64 years old who are controlled at a Rural CESFAM, 2016. The sample was 146 women who answered a self - administered survey, including the M & J inhibited sex drive test. The data were analyzed with the statistical software SPSS version 22.0. RESULTS: A total of 146 climacteric women were surveyed, with a mean age of 51.8 years, of which 64.4% had had their menopause. Of the respondents, only 19.9% showed inhibition of sexual desire. Inhibition of sexual desire occurred more frequently in women who had on average 29.3 years with their partners, those with chronic morbidity, and those who recognized having somatic, psychological and urogenital symptoms associated with menopause. CONCLUSION: In the evaluation of sexual desire, it should be considered that there are several factors that influence it and also a wide range of instruments that aim to measure it. Most rural climateric users (65.1%) do not present inhibition of sexual desire. There are factors that can encourage and cause inhibition of sexual desire, while others can help prevent it from appearing. It is essential to know and manage these factors, in order to help climacteric women to have a better quality of life.

Conflict and desire into question: The tension of individualization in couple relationship experience in Chilean young adults / Sin conflicto y sin deseo: las tensiones de la individualización en la experiencia de pareja de jóvenes chilenos

Resumen Este artículo busca conocer y comprender las tensiones en las dimensiones de amor, sexualidad e intimidad en la experiencia de pareja en jóvenes hombres y mujeres de nivel socioeconómico medio y bajo, residentes en la ciudad de Santiago de Chile. La sociedad chilena ha vivido importantes transformaciones sociales y culturales que han impactado las formas de parentesco, en particular, las relaciones de pareja. Desde una perspectiva fenomenológico-hermenéutica, se analizaron e interpretaron los relatos de vida y el material recogido mediante grupos focales de hombres y mujeres entre 18 y 25 años. Los resultados evidencian tensiones y ambivalencias en el lugar dado al otro de la pareja en jóvenes chilenos. Los quiebres de los mandatos sobre la pareja, vinculados a la experiencia del conflicto, dependencia y deseo sexual, implican el despliegue de estrategias de regulación que tienden a minimizar las diferencias ya sea a través de la comunicación que intenta hacer transparente el mundo interno al otro, la evitación del conflicto o la suspensión de la relación.

Abstract This paper intends to learn and understand tensions in love, sexuality, and intimacy dimensions according to the experience of couples ranked in middle and low socioeconomic status, which inhabit in Santiago de Chile. Chilean society has gone through significant social and cultural changes that have had an impact on kinship forms, especially in couple relationships. From a phenomenological and hermeneutic perspective, life narratives and material collected from focus groups of men and women between 18 and 25 years old were analyzed. Results evidenced pressure and ambivalence in regards to the Chilean young´s conception about the role of the other. Breakdowns in couple agreements, associated with conflict, dependence, and sexual desire involve in motion of regulatory strategies tending to minimize differences, either through communication, that might see through the other's inner world, or conflict avoidance, or the end of the relationship.

El deseo sexual en varones adultos mayores, su relación con la testosterona sérica y otros factores / Sexual desire in older men and its association with serum testosterone and other factors

Introducción: el deseo sexual cambia con el envejecimiento, la verdadera magnitud de estos cambios y los factores que los condicionan son aún objeto de debate. Objetivo: describir las características del deseo sexual en varones adultos mayores del municipio Plaza de la Revolución y su asociación con la testosterona sérica y otras variables. Métodos: estudio transversal descriptivo, con base poblacional. Participaron 510 varones de 60 años y más, sin limitaciones físicas o cognitivas, ni condiciones que causan hipogonadismo, seleccionados mediante muestreo estratificado polietápico complejo entre los residentes del municipio Plaza de la Revolución, en La Habana. Contestaron cuestionario anónimo autoadministrado, se recogieron datos del interrogatorio y examen físico, y se determinó testosterona sérica total. Se evaluaron aspectos del deseo sexual y factores con posible influencia sobre este; se analizaron estadísticas descriptivas y pruebas de chi cuadrado, Kruskal Wallis y regresión logística múltiple. Se cuidaron aspectos éticos. Resultados: la edad de los participantes fue entre 60 y 93 años (mediana 70). El 82,41 por ciento refirió cambios en su deseo sexual en relación con edades previas; de estos, 79,16 por ciento señaló disminución, 11,66 por ciento pérdida y 9,18 por ciento aumento. El 55,02 por ciento dijo tener nivel de deseo sexual medio, 44,53 por ciento lo experimentaban a menudo, y 4,25 por ciento nunca. El 71,22 por ciento refirió estar satisfechos o medianamente satisfechos con su deseo sexual. No se observó relación entre la testosterona sérica y los cambios en el deseo sexual, nivel o frecuencia actual (p> 0,05). La disminución del deseo sexual mostró asociación positiva significativa con la edad mayor a 80 años, disminución de la sensación de bienestar y consumo de medicamentos; y asociación negativa, con la actitud hacia la sexualidad (p< 0,05). La escolaridad, la ocupación, las creencias religiosas, el estado civil, el tiempo de relación de pareja, las enfermedades cónicas, los hábitos tóxicos, los ejercicios físicos, la socialización, el estado psicológico, la educación sexual, la importancia que le conceden a la sexualidad, o tener privacidad, no se relacionaron significativamente con la disminución del deseo sexual. Conclusiones: el deseo sexual cambia con la edad, predominantemente en sentido de disminución, pero la mayoría de los sujetos se sienten satisfechos o medianamente satisfechos, lo experimentan a menudo y en un nivel medio. La disminución del deseo sexual en los sujetos estudiados no depende de la testosterona sérica, y sí de otros factores biológicos, psicológicos y sociales(AU)

Introduction: sexual desire decreases with aging but the real scope of these changes and the factors unleashing them are still a topic under debate. Objective: to describe the characteristics of the sexual desire in older men from Plaza de la Revolution municipality and their association with serum testosterone and other variables. Methods: population-based descriptive and cross-sectional study which involved 510 men aged 60 years and older, who did not present either physical/cognitive handicaps or conditions leading to hipogonadism. They had been selected from the residents of Plaza de la Revolucion municipality in Havana through a complex multistage stratified sampling. They answered a self-administered anonymous questionnaire; their questioning and physical exam data were then collected and the total serum testosterone was determined. Several sexual desire aspects together with the possible influential factors were evaluated; the summary statistics in addition to Chi-square, Kruskall-Wallis's and multiple logistic regression tests were all analyzed. Moreover, ethical aspects were respected. Results: the age of the participants ranged 60 to 93 years (median of 70). In this group, 82.41 percent pointed out that their sexual desire had changed in comparison with earlier ages and from this percentage, 79.16 percent said their desire decreased, 11.66 percent stated it had disappeared whereas in 9.18 percent it had increased. The answers showed that the degree of sexual desire was medium in 55.02 percent of participants, 44.53 percent often felt it whereas 4.25 percent never had it. In the study group, 71.22 percent were satisfied or fairly satisfied with their degree of sexual desire. There was no association between the serum testosterone and the changes in the current degree and frequency of sexual desire (p> 0.05). The decrease in sexual desire showed significant positive association with the age older than 80 years, less sensation of wellbeing and lower consumption of drugs; however, it was negatively associated to the attitude towards sexuality (p< 0.05). Schooling, occupation, religious beliefs, marital status, length of time of a couple relationship, chronic diseases, toxic habits, physical exercising, socialization, psychological condition, sexual education, importance attached to sexuality or to privacy were not significantly associated with decrease of sexual desire. Conclusions: sexual desire changes with the age, particularly towards decrease, but the majority of older men are satisfied or fairly satisfied with it; they often feel it with medium degree. The decreased sexual desire in the studied subjects does not depend on the serum testosterone but it does on other biological, psychological and social factors(AU)

Sexualidad y climaterio: una mirada integral / Sexuality and climacteric: a comprehensive approach

Cuando hablamos de sexualidad humana debemos saber que estamos hablando de una compleja y cambiante interacción de factores biológicos y socioemocionales altamente influenciables por la familia, la religión y los patrones culturales. Esto se ve en los hombres y en las mujeres, especialmente en las mujeres. La sexualidad es un concepto intuitivo que cuesta definir. Según la Organización Mundial de la Salud, se define salud sexual como "un estado de bienestar físico, emocional, mental y social relacionado con la sexualidad, la cual no es solamente la ausencia de enfermedad, disfunción o incapacidad". Es una definición que tiene en cuenta varios conceptos, muy importantes todos ellos. La respuesta sexual consiste en una serie de cambios neurofisiológicos, hemodinámicos y hormonales que involucran al conjunto del organismo. Si bien es similar en ambos sexos, en las mujeres no siempre el inicio y la progresión se correlacionan en forma sistemática o lineal como en los hombres. Y de ese intrigante devenir de la respuesta sexual femenina surge la dificultad del diagnóstico de la "disfunción sexual femenina". Podríamos resumirla en "un conjunto de trastornos en los que los problemas fisiológicos o psicológicos dificultan la participación o la satisfacción en las actividades sexuales; lo cual se traduce en la incapacidad de una persona para participar en una relación sexual de la forma que le gustaría hacerlo"16. La menopausia es percibida por muchas mujeres como el fin de la sexualidad, y no solo como el fin de la vida reproductiva. Si bien es cierto que en esta etapa la actividad sexual suele declinar y puede verse afectada por una serie de factores hormonales, psicológicos y socioculturales, para la mayoría de las mujeres la sexualidad sigue siendo importante. Debemos comprender que la disfunción sexual femenina, en cualquier etapa de la vida, es multicausal y multidimensional. A la hora de realizar el abordaje de una paciente, debemos tener en cuenta todos los factores involucrados y saber con qué herramientas contamos. El abordaje terapéutico clásicamente incluye la terapia psicológica y la terapia hormonal. Sin embargo, recientemente se ha incorporado una nueva droga recientemente aprobada por la FDA de los Estados Unidos para el tratamiento del deseo sexual hipoactivo en la mujer: el flibanserín, un psicofármaco que actúa a nivel de mediadores del deseo sexual en el sistema nervioso central, favoreciéndolo. (AU)

When we talk about human sexuality, we know that we are talking about a complex and changing interaction between biological and socioemotional factors, which are highly influenced by society, family, religion and cultural norms. This can be seen in men and women especially in women. Sexuality is an intuitive concept difficult to define. According to the World Health Organization, it is defined as "A state of physical, emotional, mental and social well being related to sexuality, which is not merely the absence of disease, dysfunction or disabilityˮ. It is a definition that takes into account several concepts, all very important. Sexual response is a series of neurophysiological, hemodynamic and hormonal changes involving the whole body. While similar in both sexes, women are not always the onset and progression correlate systematically or linearly as in men. And that intriguing evolution of the female sexual response, the difficulty of diagnosis of "female sexual dysfunctionˮ. We could summarize it in "a group of disorders in which the physiological or psychological problems impede participation or satisfaction in sexual activities; which results in the inability of a person to participate in a sexual relationship the way she or he would like to do itˮ16. Menopause is perceived by many women as to the end of sexuality, not only as the end of reproductive life. Sexual activity declines with age, and may be affected by a number of hormonal, psychological and sociocultural factors, but, for most women it continues to be important. We must understand that female sexual dysfunction, at any stage of life is multicausal and multidimensional. When approaching a patient, it is important to know all the factors that are involved, and which tools we have for deal with it. Classically, the therapeutic approach has consisted of psychological therapy and hormone therapy. However, we have to consider a recently approved drug by the FDA for the treatment of hypoactive sexual desire in women: Flibanserin. It is a psychotropic substance that acts on the mediators of sexual desire on the central nervous system favoring it. (AU)

Flibanserin- A Novel drug for Hypoactive Sexual Desire Disorder

Low sexual desire is a very common symptom in women of any age with potential negative consequences on quality of life and well-being according to The American Psychiatric Association’s Diagnostic, Statistical Manual of Mental Disorders (DSM-IV TR) and the World Health Organization’s International Classifications of Disease. They also established that the definition of hypoactive sexual desire disorder (HSDD) should include not only the lack or absence of sexual fantasies or desire for any form of sexual activity, but also the presence of personal distress and/or interpersonal difficulties. Flibanserin, a novel, non-hormonal, multifunctional serotonin agonist antagonist (MSAA) was used in most of the pre-menopausal women diagnosed with Hypoactive Sexual Desire Disorder (HSDD) but its approval also faced a little scepticism.

Exploring the Sexuality of African American Older Women.

Aims: To identify sexually-related themes of the sexuality of older African American women. Study Design: Mixed method. Place and Duration of Study: Department of Psychology, California State University Northridge, between July 2009 and June 2011. Methodology: We included 13 African American older women (57 to 82 years of age), 11 of whom self-identified as heterosexual, one as bisexual, and one as lesbian. We used a semi-structured interview protocol through which we explored some aspects of the respondents’ sexuality (assessed at a superficial level, to be as tactful as possible). Moreover, we collected information on demographics and self-rated physical health. Two co-authors served as coders, and used content analysis to identify the most salient sexuality themes. Results: Emerging themes were (in order from most to least endorsed): having sexual desire (often unfulfilled); engaging in less sexual activity in older age; experiencing changes in one’s sexual life as a function of absence of a spouse; and exercising control over how one’s sexual life is conducted. Motivated by the paucity of our sexuality data, we have also provided suggestions to scholars interested in conducting more in-depth further research on this topic with older African American women. Conclusion: Our findings indicate that the common notion that older women are asexual is a myth, while lack of a suitable sexual partner is a problem reported by many African American older women who would otherwise enjoy sexual interaction.

Paixões Reguladas: a invenção da inibição do desejo sexual e da adicção sexual / Pasiones reguladas: la invención de la inhibición del deseo sexual y de la adicción al sexo / Regulated Passions: the Invention of Inhibited Sexual Desire and Sex Addiction

A partir de um olhar sociológico, o artigo trata da emergência das categorias de inibição do desejo sexual (IDS) e da adicção sexual no campo da sexologia norte-americana. O texto busca explicartal emergência a partir da triangulação de imperativos e saberes médicos articulados a demandas e experiências individuais e ansiedades culturais. Além disso, nele se explora a constituição histórico-sócio-política do campo sexológico e médico neste contexto, bem como suas diferenças, mudanças, mediadores culturais, ambivalências e contenciosos.

Desde una mirada sociológica, este artículo aborda la emergencia de las categorías inhibición del deseo sexual (IDS) y adicción al sexo, en el campo de la sexología norteamericana. El texto buscaexplicar tal emergencia a partir de la triangulación de imperativos y saberes médicos articulados a demandas y experiencias individuales, y a ansidades culturales.Se explora la constitución histórico-socio-política del campo sexológico y médico en ese contexto, así como sus diferencias, cambios, mediadores culturales, ambivalencias y conflictos.

In this article the emergence of the categories Inhibited Sexual Desire (IDS), and Sex Addiction within North American sexology is explained as the result of the combination of medical imperatives and knowledge, articulated to individual experiences and demands, as well as to cultural anxieties. In that process the historical, social, and political constitution of the medical and the sexological field is also explored, as well as their differences, changes, cultural mediators, ambivalences, and conflicts.

The prevalence of sexual dysfunction among patients with end stage renal disease in Jamaica / Prevalencia de la disfunción sexual entre los pacientes con enfermedad renal en etapa terminal en Jamaica

BACKGROUND: Sexual performance and gratification impact quality of life. Although recognized in the literature as a problem, sexual dysfunction among patients with end stage renal disease (ESRD) has never been studied in Jamaica. SUBJECTS AND METHOD: The prevalence ofsexual dysfunction was determined among 268 adult Jamaican patients (166 males, 102 females) with ESRD who had been on haemodialysis for at least three months. Erectile dysfunction (ED) was assessed using the International Index of Erectile Function (IIEF). Female sexual dysfunction (FSD) was determined using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and International Classification of Diseases (ICD)-10 classifications of sexual disorders. Prevalence, severity of sexual dysfunctions and relationships with the primary aetiology ofESRD and anaemia were assessed. RESULTS: Erectile dysfunction, desire disorder and orgasmic disorder were found in 91.4%, 88.3%, and 81.6% of male subjects, respectively. The majority of male patients were dissatisfied with their performance at intercourse after progressing to ESRD. Hypoactive sexual disorder, sexual arousal and orgasmic disorders, and aversion sexual disorder were prevalent, found in 96%, 88.1% and 87.1% of female patients. All diabetic patients with ESRD reported hypoactive sexual disorder and orgasmic dysfunction; arousal disorder was found in 94.7%. Aversion sexual disorder was found more among patients with underlying chronic glomerulonephritis. All patients with severe anaemia were found to have hypoactive sexual disorder and among these, 87.5% and 97.8% had severe arousal and orgasmic disorders, respectively. CONCLUSION: Sexual dysfunction among patients with ESRD in Jamaica was prevalent in males and females. Associations exist between sexual dysfunction and diabetes mellitus, chronic glomerulonephritis and anaemia.

ANTECEDENTES: El funcionamiento y la satisfacción sexual afectan la calidad de vida. Aunque la literatura la reconoce como un problema, la disfunción sexual entre los pacientes con enfermedad renal en etapa terminal (ERET) nunca se ha estudiado en Jamaica. SUJETOS Y MÉTODOS: Se determinó la prevalencia de la disfunción sexual entre 268pacientes jamaicanos adultos (166 varones y 102 hembras) con ERET, que habían estado en hemodiálisis por al menos tres meses. La disfunción eréctil (DE) fue evaluada mediante el índice internacional de función eréctil (IIFE). La disfunción sexual femenina (DSF) se determinó usando el Manual diagnóstico y estadístico de trastornos mentales, cuarta edición (DSM-IV) y las clasificaciones de trastornos sexuales en la Clasificación internacional de enfermedades (CIE)-10. Se evaluaron laprevalencia, la gravedad de las disfunciones sexuales y las relaciones con la principal etiología de ERETy la anemia. RESULTADOS: Se halló disfunción eréctil, trastorno de deseo, y trastorno orgásmico en 91.4%, 88.3% y 81.6% de los sujetos masculinos, respectivamente. La mayoría de los pacientes masculinos estaban insatisfechos con su desempeño en las relaciones sexuales después del avance de ERET. Trastornos sexuales hipoactivo, trastornos de la excitación sexual y del orgasmo, así como trastornos de aversión se caracterizaron por su prevalencia, y fueron hallados en 96%, 88.1% y 87.1% de los pacientes femeninos, respectivamente. Todos los pacientes diabéticos con ERET reportaron trastorno sexual hipoactivo y disfunción orgásmica. Se hallaron trastornos de excitación en el 94.7%. El trastorno de aversión sexual se observó más entre los pacientes con glomerulonefritis crónica subyacente. Se halló que todos los pacientes con anemia presentaban trastorno sexual hipoactivo y entre éstos, 87.5% y 97.8%presentaban trastornos severos de excitación y orgasmo, respectivamente. CONCLUSIÓN: La disfunción sexual entre los pacientes con ERET en Jamaica fue prevalente tanto en los varones como en las hembras. Existen asociaciones entre la disfunción sexual y la diabetes mellitus, la glomerulonefritis crónica y la anemia.

A perversão, o desejo e o gozo: articulações possíveis / Perversion, desire and jouissance: possible articulations

Os autores procuram subsidiar aportes para uma discussão acerca da especificidade estrutural da perversão e sua relação com o desejo e com o gozo. Circunscrever o campo da perversão a partir de sua etiologia, delimitar os processos metapsicológicos capazes de objetivá-la e definir suas características específicas contrapostas às da neurose e da psicose, desde Freud, não constitui tarefa fácil. Ao estudar esse controverso construto teórico-clínico, os autores acentuam o quanto a perversão, na maioria das vezes, aparece como um conceito fronteiriço, tênue e de referências confusas no que diz respeito à sua especificidade estrutural. A proposta é avançar para além dos paradigmas freudianos, tendo como pano de fundo a dialética do desejo no ensino de Lacan. Existiria um caminho propiciador de uma articulação possível entre o desejo e o gozo?...

The authors seek to subsidize contributions to a discussion regarding the structural specificity of perversion and its relation to desire and jouissance. Circumscribing the field of perversion from its etiology, delimiting the metapsychological processes able to objectify it, and defining their specific features as opposed to neurosis and psychosis since Freud is not an easy task. By studying this controversial theoretical and clinical construct, the authors emphasize how perversion most often appears as a tenuous border concept, with confusing references in regard to its structural specificity. The proposal is to move beyond the Freudian paradigms, with the backdrop of the dialectic of desire in Lacan. Is there a way that would provide a possible link between desire and jouissance?...

Sexual Desire and Sexual Activity of Men and Women Across their Lifespan.

Objective: To study the sexual desire and activity of men and women aged 30-80 years. Methodology: A representative sample was surveyed and correlated with their social, individual and interpersonal characteristics. A total of 100 subjects were recruited. Observations: The study showed that sexual desire declined with advancing age with overall men reporting more frequent and stronger sexual desire compared to women. For both men and women, sexual activity in older participants was mostly an issue of denial or disagreement of the other partner. There were additional social and personality determinants of lack of sexual desire and sexual inactivity, which included illness, lack of privacy, erectile dysfunction, spiritual reasons and menopause. Conclusions: Sexual history should be a routine part of history taking and should be undertaken during assessment of the patient.

Indicadores de deseo, autoerotismo e impulsividad sexual en mujeres de la Ciudad de México / Desire, Autoerotic and Sexual Impulsivity Indicators in Women from Mexico City

El propósito de este trabajo fue describir indicadores de deseo sexual, impulsividad sexual y autoerotismo en 402 mujeres entre 17 y 35 años de edad residentes de la Ciudad de México. Se encontraron relaciones positivas entre los factores de autoeficacia sexual y cuatro de los seis factores de deseo sexual (atracción, excitación, romanticismo y entrega) y sólo una relación negativa entre autoeficacia y culpabilidad sexual. La impulsividad sexual correlacionó positivamente con culpabilidad sexual. El deseo de autoerotismo se vinculó negativamente con los factores de autoeficacia y culpabilidad sexual. Tanto en los grupos divididos por edad como en los grupos divididos por haber o no iniciado una vida sexual activa; se encontraron algunas diferencias significativas siendo las mujeres con más edad y las que habían ya iniciado su vida sexual, las que obtuvieron las medias más altas en los factores de deseo sexual (entrega y excitación).

The purpose of this study was to describe indicators of sexual desire, sexual impulsivity and auto-eroticism in 402 women aged between 17 and 35 years living in Mexico City. Positive relationships were found between the factors sexual self-efficacy and four of the six factors of sexual desire ('attraction', 'excitement', 'romance' and 'sexual surrender') and only one negative relationship between 'self-efficacy' and 'sexual guilt'. 'Sexual impulsivity' correlated positively with sexual guilt. 'Autoerotic desire' correlated negatively with the factors 'self-efficacy' and 'sexual guilt'. Some significant differences were found between age groups and between those classified as being or not sexually active. The group of elder women and of those who had already started their sexual life obtained the highest averages in the factors 'sexual surrender' and 'excitement'.

Prevalencia del desorden de deseo sexual hipoactivo en mujeres colombianas y factores asociados / The prevalence of hypoactive sexual desire disorder in colombian females and associated factors

Objetivo: medir la prevalencia del desorden de deseo sexual hipoactivo (DDSH) en una muestra de mujeres sexualmente activas con edades entre 15 y 59 años en Colombia, y explorar posibles factores asociados. Materiales y métodos: estudio de corte transversal. Se incluyeron mujeres colombianas entre 15 y 59 años, con vida sexualmente activa. Estas mujeres no son una muestra clínica sino de grupos de mujeres entrevistados de la población general. Criterios de exclusión: analfabetismo y enfermedad sistémica. El tamaño muestral mínimo estimado fue de 369 mujeres, para una prevalencia de 35 por ciento con un error máximo de 5 por ciento y con 95 por ciento de confianza. Muestreo por conveniencia. El cuestionario Female Sexual Function Index (FSFI), validado previamente al español, fue administrado a 567 mujeres sexual-mente activas en varios grupos focales. Se usó un valor de corte de 5 en la escala del deseo para definir DDSH. Se evaluaron además edad, nivel educativo, nivel socioecónomico, estado marital, cohabitación, sentimientos de depresión, uso de drogas antidepresivas, ciclo menstrual, número de hijos y método anticonceptivo. Se calculó la frecuencia relativa en las variables. Para evaluar la asociación entre las variables y la presencia del desorden de deseo sexual hipoactivo se utilizó la razón de Odds (OR) y su respectivo intervalo de confianza. Resultados: en el grupo de estudio 101 de 497 mujeres tuvieron un puntaje menor de 5 para una prevalencia de desorden de deseo sexual hipoactivo de 20,3 por ciento. Las variables asociadas fueron: bajo nivel educativo (OR = 2,77; IC 95 por ciento: 1,1-6,5), número de hijos (OR = 3; IC 95 por ciento: 1,8-5,1), edad mayor de 50 (OR = 3,19; IC 95 por ciento: 1-9,4), falta de cercanía emocional con la pareja (OR = 5; IC 95 por ciento: 3-8,3), sentimientos de depresión (OR = 1,9; IC 95 por ciento: 1,2-2,9) y el uso de antidepresivos (OR = 5; IC 95 por ciento: 3-8,3). Conclusiones: un importante porcentaje de la población en Colombia presenta puntajes bajos en el FSFI, sugestivos de desorden de deseo sexual hipoactivo

Objective: Measuring the prevalence of hypoactive sexual desire disorder (HSDD) in a sample of sexually-active Colombian females aged 15 to 59 years old and exploring possible associated factors. Materials and methods: This was a crosssectional study. Colombian females aged 15 to 59 years old having an active sex-life. Exclusion criteria were being illiterate and suffering systemic disease. Minimum estimated sample size was 369 females, using 35 percent prevalence, 5 percent maximum error and 95 percent confidence level. Convenience sampling was used. The Female Sexual Function Index (FSFI) questionnaire, previously validated in Spanish, was administered to 567 sexually active females in several focal groups. A cut-off value of 5 on the scale of desire was used for defining HSDD. Age, educational level, socio-economic status, marital state, cohabitation, feelings of depression, antidepressant medication use, menstrual cycle, number of children and contraceptive method were also evaluated. The variables’ relative frequency was calculated. The odds ratio (OR) and their confidence intervals (95 percent) was used for evaluating the association between variables and the presence of HSDD. Results: 101 of the 497 females in the study group scored less than 5, giving 20.3 percent HSDD prevalence. The associated variables were: low educational level (OR = 2.77; 1.1-6.5 95 percent CI), number of children (OR = 3; 1.8-5.1 95 percent CI), being aged over 50 (OR = 3.19; 1-9.4 95 percent CI), a lack of emotional closeness to the partner (OR = 5; 3-8.3 95 percent CI), feelings of depression (OR = 1.9; 1.2-2.9 95 percent CI) and antidepressant medication use (OR = 5; 3-8.3 95 percent CI). Conclusions: An important percentage of the Colombian population in question had low scores on the FSFI, suggestive of hypoactive sexual desire disorder