[Human orgasm from the physiological perspective--part I]. / Orgazm czlowieka z perspektywy fizjologicznej--czesc I.

Physiological phenomenon of sexuality occurring in both sexes that brings physical and mental satisfaction, and often affects the quality of life is an orgasm. The ability to experience regular orgasms affects relationship with partner. The definition of orgasm is not an easy task. The way of experiencing it is subjective, and the possibility of observing significantly reduced. Contemporary works on the phenomenon of orgasm are concentrated on several aspects: biological perspective (neurophysiological and biochemical determinants of orgasm), psychological perspective and on the differences in its course in both sexes. In sexology are two models of sexual response: a linear model of sexual response (by W. Masters and V. Johnson, and H. S. Kaplan) and the circular model of sexual response (created by R. Basson). The ability to experiencing an orgasm is inherent in men. In women, that phenomenon is acquired, is the consequence of further experience.

[Human orgasm from the physiological perspective--part II]. / Orgazm czlowieka z perspektywy fizjologicznej--czesc II.

In contrast to the male orgasm, female orgasm is characterized by high variability and diversity, not only in the general population, but also during the life. Women experience sexual pleasure on many levels: physical, emotional, spiritual and intellectual. Sexual functioning of women and men is determined by many factors. A strong correlation between the state of subjective arousal and genital response (erection) is typical for men. In the case of women important role played: emotions, cognitive interpretation of the situation, age, self-esteem and previous sexual experiences. Among women experience orgasm during intercourse or masturbation is not a goal in itself. Modern approach to the phenomenon of orgasm and sexual education of women, make absence of orgasm as a failure. It becomes a source of low self-esteem, less self-confidence or sense of lack of attractiveness.

[Depressive disorder, treatment and sexual dysfunction--part II]. / Charakterystyka i leczenie dysfunkcji seksualnych w depresji--Czesc II.

Depressive disorders and antidepressant therapy have been associated with sexual dysfunction. Sexual dysfunctions are recognized as a potential side effect of antidepressant therapy. Not reliable algorithms have been developed in the presence of sexual dysfunctions in the course of depressive disorders. The most commonly used methods of treatment of sexual dysfunction in depressive disorders include: waiting for spontaneous remission, reduction in dose of a repressive drug, the change of drug discontinuation for a short time, the use of the drug after having sexual intercourse, drug holidays and corrective medications (yohimbine, phosphodiesterase type 5 and anesthetic creams). Among the most effective agents used in the treatment sre: bupropion, trazodone, nefazodone, agomelatine, tianeptine and flibanserin. Optimal antidepressant treatment should result in remission of the symptoms of the underlying illness and minimize the potential for short-term and long-term adverse effects, including sexual dysfunction. Physicians should monitor their patients for antidepressant-induced sexual adverse effects, as these may affect compliance with therapy and ultimate treatment success.

[Characteristic and treatment of sexual dysfunctions in depression (part I)]. / Charakterystyka i leczenie dysfunkcji seksualnych w depresji (cz. I).

Sexual dysfunction in patients diagnosed with depressive disorders affect all phases of sexual response: a decline in libido, erectile dysfunction, ejaculation disorders in men and orgasm and menstruation in women. It is estimated that are present in approximately 70% of patients, affecting 23-50% of men suffering from depression and 33-90% of women. The most common symptoms include disorders of sexual arousal in women (usually in the form of excessive vaginal dryness), erectile dysfunction in men and affects both sexes abnormal orgasm (anorgasmia or delayed). Sexual dysfunction is treated as a potential side effect of antidepressant therapy. These drugs can exacerbate the symptoms of primary sexual dysfunction, and induce it in those patients who were not present before treatment. Symptoms of sexual dysfunction reduces quality of life, self-esteem, mood, and negatively affect the relationship with your partner. Most currently used antidepressants in the world leads to the occurrence of sexual dysfunction. These include monoamine oxidase inhibitors, tricyclic antidepressants, serotonin reuptake inhibitors, serotonin reuptake inhibitors and norepinephrine, and a new generation of antidepressants. SSRIs are considered to be preparations for the largest iatrogenic effect. Sexual dysfunction resulting from treatment with antidepressant among the most serious reasons for discontinuation by the patients.

In men with erectile dysfunction, satisfaction with quality of erections correlates with erection hardness, treatment satisfaction, and emotional well-being.

INTRODUCTION: The validated Quality of Erection Questionnaire (QEQ) evaluates satisfaction with erection quality. AIM: To collate QEQ data, including correlations between QEQ outcomes and outcomes assessing emotional well-being, treatment satisfaction, and erection hardness after sildenafil citrate treatment. METHODS: In four trials, men older than 18 years and with erectile dysfunction, a stable sexual partner, and no recent phosphodiesterase type 5 inhibitor use were randomized to double-blind flexible-dose sildenafil or placebo (1:1 ratio) for 6 or 10 weeks (two trials), fixed-dose 50 mg, 100 mg, and placebo (1:1:1 ratio) for 8 weeks (one trial), and 50 mg and 100 mg (1:1 ratio) for 4 weeks after 4 weeks of single-blind sildenafil 50 mg. Exclusion criteria included recent significant cardiovascular disease, use of nitrates, nitric oxide donors, cytochrome P450 3A4 inhibitors, or other erectile dysfunction treatment, and sildenafil hypersensitivity or previous severe or serious treatment-related adverse event. MAIN OUTCOMES MEASURES: Scores on the QEQ, QEQ Question 5 (satisfaction with erection hardness), the Self-Esteem and Relationship Questionnaire, and the Erectile Dysfunction Inventory of Treatment Satisfaction; the percentage of occasions with Erection Hardness Score 3 (EHS 3, hard enough for penetration but not completely hard) and/or EHS 4 (completely hard and fully rigid); and Pearson correlation coefficients. RESULTS: 1,296 men (18-80 years) were randomized. Except for the percentage of occasions with EHS 3, all outcomes improved in men treated with sildenafil and correlated positively with the change in QEQ scores in all trials. CONCLUSIONS: Satisfaction with the quality of erections, which is easily monitored with the QEQ, correlated positively with measures of emotional well-being and treatment satisfaction and with the change in percentage of erections that were completely hard and fully rigid, but not with the change in percentage of erections that were hard enough for penetration but not completely hard.

Quality of erections in men treated with flexible-dose sildenafil for erectile dysfunction: multicenter trial with a double-blind, randomized, placebo-controlled phase and an open-label phase.

INTRODUCTION: Erectile dysfunction (ED) impacts erection hardness and compromises quality of life. AIM: Assess erection hardness and its correlation with sexual function, emotional well-being, and satisfaction (erection quality, intercourse, sex life, sexual relationship, and treatment). METHODS: Men with ED were randomized to double-blind, flexible-dose sildenafil (25, 50, or 100 mg) or placebo (6 weeks) with open-label extension (6 weeks). MAIN OUTCOME MEASURES: Erection Hardness Score (EHS), Quality of Erection Questionnaire (QEQ), International Index of Erectile Function (IIEF), Self-Esteem And Relationship (SEAR) questionnaire, and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: A total of 307 men (mean [range] age, 45 [18-55] years) were randomized to sildenafil (N = 154) or placebo (N = 153). At the end of double-blind treatment, occasions with EHS 3 (hard enough for penetration but not completely hard) or 4 (completely hard) had increased by 40% +/- 3% for sildenafil vs. 11% +/- 3% for placebo (least squares mean +/- standard error; P < 0.0001); the estimated percentage of occasions with EHS 4 was 58% (95% CI, 52-65%) vs. 14% (95% CI, 10-19%) (odds ratio, 8.5; P < 0.0001). There was greater improvement in mean QEQ, IIEF, and SEAR scores (P < 0.0001), and more men were satisfied with sildenafil treatment (EDITS Index score >50: 90% vs. 49%). QEQ, IIEF, SEAR, and EDITS outcomes correlated positively with EHS 3 or 4, and with EHS 4 alone and were highest (no overlap of 95% CI vs. other EHS subgroups) in the subgroup with most frequent EHS of 4. CONCLUSIONS: In the group of men with ED treated with sildenafil, it was estimated that completely hard erections were achieved on 58% (95% CI, 52-65%) of occasions. Improvement in function, emotional well-being, and satisfaction was greatest in men with completely hard erections and correlated positively with other measures of hardness.