Treatment of erectile dysfunction by intracavernosal administration of mesenchymal stem cells in patients with diabetes mellitus.

Erectile dysfunction is observed in about 50% of men. It has been found that diabetes mellitus increases its prevalence to 19-86.3%, necessitating attention to a therapeutic strategy. Among the available treatment methods, intracavernosal injections of mesenchymal stem cells have proven to be particularly effective. OBJECTIVE: The purpose of study is to assess and analyse the effectiveness of their use in the treatment of erectile dysfunction in patients with diabetes mellitus. MATERIALS AND METHODS: The literature search was conducted using systematic methods and analysis in databases such as Web of Science, Scopus, PubMed, Elsevier, and Springer, with 41 sources included for further review. RESULTS: The study highlights microangiopathic and neuropathic links as key factors in erectile dysfunction development in diabetic patients, stemming from endothelial dysfunction and conductivity disturbances. Mesenchymal stem cell therapy from bone marrow, adipose tissue, and umbilical cord mitigates pathogenic impact through regenerative and anti-apoptotic effects. Due to this, most studies indicate high efficacy of the treatment and rapid therapeutic action through intracavernosal administration. Some studies suggest an increase in the body's receptor sensitivity to other drugs, such as sildenafil. CONCLUSION: From the perspective of further research on this issue, standardising the preparation of stem cells and the treatment method using a large sample size is essential to introduce such a method as an extremely promising therapy for this delicate issue in men into practical medicine. The practical value of the study lies in the systematisation of information on different sources of mesenchymal stem cells for treating erectile dysfunction.

Sexual dysfunction and associated factors in Thai patients with psychiatric disorders.

Background: Sexual dysfunction is common among patients with psychiatric disorders but might be under-reported due to Asian sociocultural factors. Recognition of sexual dysfunction and associated factors in this vulnerable population would help clinicians properly assess and manage related conditions. Aims: We aimed to examine the prevalence of sexual dysfunction and its associated factors among patients with psychiatric disorders in Thailand. Methods: This was a cross-sectional study. We enrolled participants aged 18 and older who visited the psychiatry clinic at King Chulalongkorn Memorial Hospital in Bangkok, Thailand between August 2020 and December 2021. Demographic and clinical data were assessed, and all psychiatric disorders and sexual dysfunctions were diagnosed by clinical interview using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Statistical analysis was done to explore the association between sexual dysfunction and related factors. Results: Sexual dysfunction was diagnosed in 101 (50.0%) of the total 202 participants. The mean (standard deviation, SD) age was 30.2 (9.0) years, and the majority of patients were men (54.5%), single (81.2%), employed (47.5%) and had a coexisting depressive disorder (48.0%). Multivariable logistic regression analysis showed a significant association between sexual dysfunction and quality of life, unemployment, and the dosage of antidepressants and benzodiazepines. Conclusions: The prevalence of sexual dysfunction among this population was relatively high. However, the findings may represent only a portion of affected psychiatric patients for others with sexual dysfunction symptoms but without functional impairment did not meet the diagnostic criteria for sexual dysfunction. Improvement of quality of life and optimising antidepressant/benzodiazepine dosage should be further investigated for promoting sexual function in patients with mental disorders.

Eficacia y seguridad de la testosterona en el tratamiento del deseo sexual hipoactivo en mujeres: ¿qué dice la evidencia? / Efficacy and safety of testosterone in the treatment of hypoactive sexual desire in women: what does the evidence say?

Objetivo: Determinar la eficacia y seguridad de la testosterona, en el tratamiento del deseo sexual hipoactivo en mujeres. Materiales y métodos: Se hizo una revisión sistemática de la literatura en diferentes bases de datos electrónicas (CINAHL, DynaMed, EMBASE, Lilacs, Medline, Scopus, entre otras), entre enero de 1990 y mayo de 2021; a través de términos de búsqueda estandarizados. Los desenlaces evaluados incluyeron la eficacia y seguridad de la testosterona en el incremento del deseo sexual, el número total de actividad sexual satisfactoria, el número de orgasmos y el nivel de angustia en pacientes con deseo sexual hipoactivo y proporción de reacciones adversas. Resultados: Se incluyeron 72 artículos. El uso de testosterona, en mujeres posmenopáusicas con deseo sexual hipoactivo reporta un positivo efecto sobre la función sexual, con aumentos significativos en la actividad sexual satisfactoria, así como mejoría en todos los dominios de la función sexual (deseo, excitación y respuesta orgásmica) y una disminución de la angustia personal, con incremento en la puntuación del Índice de Función Sexual Femenino. En las mujeres en edad fértil, la testosterona se formula para uso «off-label», de tal manera que se utilizan compuestos y dosis ideadas para tratamientos en hombres o fórmulas magistrales (las cuales no están aprobadas por los grupos de consenso ni avalados por investigaciones), pero no ha demostrado ningún efecto sobre la función sexual. Las reacciones adversas más frecuentes suelen ser el hirsutismo y el acné, aunque en general la testosterona, a dosis fisiológicas, tiene un perfil de seguridad favorable. Conclusiones: La testosterona es una terapia eficaz y segura en el tratamiento del trastorno del deseo sexual hipoactivo en mujeres después de la menopausia. En la actualidad no hay disponibilidad de estudios que avalen el uso de la terapia con testosterona en mujeres en edad reproductiva, por lo tanto, no está aprobado su uso. (AU)

Objective: To determine the efficacy and safety of testosterone in the treatment of hypoactive sexual desire in women. Materials and methods: A systematic review of the literature was carried out in different electronic databases (CINAHL, DynaMed, EMBASE, Lilacs, Medline, Scopus, among others), between January 1990 and May 2021; through standardized search terms. The outcomes evaluated included the efficacy and safety of testosterone in increasing sexual desire, the total number of satisfactory sexual activity, the number of orgasms and the level of distress in patients with hypoactive sexual desire and the proportion of adverse reactions. Results: 72 articles were included. The use of testosterone, in postmenopausal women, with hypoactive sexual desire, reports a positive effect on sexual function, with significant increases in satisfactory sexual activity, as well as improvement in all domains of sexual function (desire, arousal and orgasmic response) and a decrease in personal anguish, with an increase in the Female Sexual Function Index score. In women of childbearing age, testosterone is formulated for “off-label” use, in such a way that compounds and doses designed for treatments in men or magisterial formulas are used (which are not approved by consensus groups or endorsed by research), but has not shown any effect on sexual function. The most frequent adverse reactions are usually hirsutism and acne, although in general testosterone, at physiological doses, has a favorable safety profile. Conclusions: Testosterone is an effective and safe therapy in the treatment of hypoactive sexual desire disorder in women after menopause. Currently there are no studies available to support the use of testosterone therapy in women of reproductive age, therefore, its use is not approved. (AU)

Comparison of sexual functions in women with and without type 1 diabetes

SUMMARY OBJECTIVE: This study aimed to investigate female sexual function in patients with type 1 diabetes by comparing female sexual function index scores between women with and without type 1 diabetes. METHODS: A total of 62 women with type 1 diabetes and 69 age-matched women without diabetes but with similar backgrounds were enrolled in the patient and control groups, respectively. All participants were sexually active and had no systemic diseases other than diabetes in the patient group. RESULTS: The frequency of female sexual dysfunction was significantly higher, and the mean female sexual function index score was significantly lower in women with diabetes compared to the control group (p=0.01). There was a significant relationship between sexual dysfunction and duration of diabetes, glycosylated hemoglobin test, and body mass index (p<0.05). CONCLUSION: This study demonstrates that female sexual dysfunction is more common among women with type 1 diabetes than among women without type 1 diabetes. Patients with type 1 diabetes should be evaluated in terms of sexual health. Health professionals should give more attention to and provide guidance regarding sexual function in women with type 1 diabetes.

[Efficacy and safety of testosterone in the treatment of hypoactive sexual desire in women: what does the evidence say?] / Eficacia y seguridad de la testosterona en el tratamiento del deseo sexual hipoactivo en mujeres: ¿qué dice la evidencia?

OBJECTIVE: To determine the efficacy and safety of testosterone in the treatment of hypoactive sexual desire in women. MATERIALS AND METHODS: A systematic review of the literature was carried out in different electronic databases (CINAHL, DynaMed, EMBASE, Lilacs, Medline, Scopus, among others), between January 1990 and May 2021; through standardized search terms. The outcomes evaluated included the efficacy and safety of testosterone in increasing sexual desire, the total number of satisfactory sexual activity, the number of orgasms and the level of distress in patients with hypoactive sexual desire and the proportion of adverse reactions. RESULTS: 72 articles were included. The use of testosterone, in postmenopausal women, with hypoactive sexual desire, reports a positive effect on sexual function, with significant increases in satisfactory sexual activity, as well as improvement in all domains of sexual function (desire, arousal and orgasmic response) and a decrease in personal anguish, with an increase in the Female Sexual Function Index score. In women of childbearing age, testosterone is formulated for "off-label" use, in such a way that compounds and doses designed for treatments in men or magisterial formulas are used (which are not approved by consensus groups or endorsed by research), but has not shown any effect on sexual function. The most frequent adverse reactions are usually hirsutism and acne, although in general testosterone, at physiological doses, has a favorable safety profile. CONCLUSIONS: Testosterone is an effective and safe therapy in the treatment of hypoactive sexual desire disorder in women after menopause. Currently there are no studies available to support the use of testosterone therapy in women of reproductive age, therefore, its use is not approved.

Sexual and Psychosocial Outcome After Neovaginoplasty Using Interceed in Females with Mayer-Rokitansky-Küster-Hauser Syndrome: A Case-Control Study.

There is a paucity of research on psychosexual outcomes after neo-vaginoplasty in women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. We compared anatomical and psychosexual outcomes between women with MRKH syndrome who had undergone vaginoplasty and age-matched, sexually active, childless women. Outcomes were assessed using the female sexual function index (FSFI), World Health Organization Disability Assessment Schedule (WHODAS 2.0), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) tools. Although mean vaginal length was shorter in women with MRKH syndrome than controls (8.6 ± 1.8 cm vs 9.3 ± 2.6 cm), FSFI scores were comparable in both groups (27.8 ± 1.4 vs. 27.3 ± 4.1). Women with MRKH syndrome reported fewer depressive symptoms, and WHODAS 2.0 scores were comparable in both groups (8.9 ± 2.4 vs. 7.8 ± 6.7). Therefore, psychosexual outcomes for women who had undergone neo-vaginoplasty for MRKH syndrome were not different from those of the general population.

Guideline No. 422d: Menopause and Sexuality.

OBJECTIVE: Provide strategies for improving the care of perimenopausal and postmenopausal women based on the most recent published evidence. TARGET POPULATION: Perimenopausal and postmenopausal women. BENEFITS, HARMS, AND COSTS: Target population will benefit from the most recent published scientific evidence provided via the information from their health care provider. No harms or costs are involved with this information since women will have the opportunity to choose among the different therapeutic options for the management of the symptoms and morbidities associated with menopause, including the option to choose no treatment. EVIDENCE: Databases consulted were PubMed, MEDLINE, and the Cochrane Library for the years 2002-2020, and MeSH search terms were specific for each topic developed through the 7 chapters. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE: physicians, including gynaecologists, obstetricians, family physicians, internists, emergency medicine specialists; nurses, including registered nurses and nurse practitioners; pharmacists; medical trainees, including medical students, residents, fellows; and other providers of health care for the target population. SUMMARY STATEMENTS: RECOMMENDATIONS.

Validação da escala curta de avaliação funcional do desejo sexual feminino / Validation of the female sexual desire functional short scale

A disfunção do desejo sexual feminino é prevalente e impacta negativamente sobre a função sexual e a qualidade de vida, mas não existem escalas funcionais que levem em conta função e disfunção. OBJETIVO: construir e validar uma escala curta para avaliação funcional do desejo sexual feminino. MÉTODO: Correlação dos resultados de função do desejo sexual avaliado pelo Índice de Função Sexual Feminina (FSFI) e a nova escala funcional, em uma amostra via internet da população feminina brasileira em geral por meio do teste T de Student e o coeficiente de Spearman. Curva ROC fomentou a análise de corroboração entre os dados do domínio disfunção do desejo do FSFI com a nova escala de avaliação funcional. RESULTADOS: Metade das mulheres da amostra apresentou disfunção sexual pelo FSFI, sendo que um terço apresentou disfunção do desejo sexual. Houve boa correlação entre os resultados da nova escala e do domínio desejo sexual do FSFI, bem como boa sensibilidade e especificidade do modelo pela curva ROC. CONCLUSÃO: a nova escala curta de avaliação funcional do desejo sexual feminino com base na Classificação Internacional de Funcionalidade, Incapacidade e Saúde pode ser uma ferramenta útil na avaliação da função do desejo sexual feminino.

Female sexual desire dysfunction is prevalent and negatively impacts sexual function and quality of life, but there are no functional scales that take into account function and dysfunction. OBJECTIVE: To construct and validate a short scale for functional evaluation of female sexual desire. METHOD: Correlation of sexual desire function results assessed by the Female Sexual Function Index (FSFI) and the new functional scale in an internet sample of the Brazilian female population in general through the Student's t test and the Spearman coefficient. ROC curve fostered corroborating analysis between data from the FSFI desire dysfunction domain with the new functional assessment scale. RESULTS: Half of the women in the sample had sexual dysfunction by FSFI, and one third had sexual desire dysfunction. There was a good correlation between the results of the new scale and the FSFI sexual desire domain, as well as good sensitivity and specificity of the model by the ROC curve. CONCLUSION: The new short functional rating scale for female sexual desire based on the International Classification of Functioning, Disability and Health may be a useful tool in assessing the function of female sexual desire.

Sleep, Sleep Disorders, and Sexual Dysfunction.

Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems. Recent research indicates that insufficient sleep, disrupted sleep, and sleep disorders affect many aspects of human health including sexual function. In fact, patients with urological disorders or erectile dysfunction (ED) may have a sleep disorder that contributes to their urological or sexual dysfunction. Obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders and are associated with ED and/or other urological disorders. Therefore, careful attention should be paid to the diagnosis and treatment of concomitant sleep disorders in patients with sexual dysfunction. In this review, we provide an overview of what sleep is and how it is assessed in the clinic or laboratory; our current understanding of the functions of sleep and sleep health; a description of common sleep disorders, as well as how they are diagnosed and treated; and how sleep and its disorders are associated with male sexual dysfunction. Sleep is considered to be a 'third pillar of health', along with diet and exercise. With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.

INFERTILITY AND SEXUAL DYSFUNCTIONS: A SYSTEMATIC LITERATURE REVIEW.

This study aimed to investigate whether infertility and its treatment affect couple sexuality. A systematic literature review was performed, focusing on female and male sexual dysfunctions due to infertility. The method was descriptive, using a meta-synthesis of scientific research published between 2012 and 2017 in the English language. The search for suitable studies was carried out with the research databases Medline, CINAHL, PubMed and ScienceDirect using the following keywords: infertility, sexual dysfunctions, couple. It can be concluded that infertility negatively affects the sexuality of an infertile couple, which is further proven by a high percentage of sexual dysfunctions (43%-90% among women and 48%-58% among men). Couples report less satisfaction with sexuality. Since lower satisfaction and dysfunctions are closely connected with infertility and its treatment, couples might benefit from sexual therapy and support during the process of infertility treatment. Further research should focus on the evaluation of different psychological interventions that would address sexuality in couples when diagnosed and treated for infertility.

Sleep, Sleep Disorders, and Sexual Dysfunction

Good sleep is necessary for good health. Sleep health is increasingly recognized as important for physical and mental health by both the medical profession and the general public, and there is great interest in how to avoid and treat sleep disorders and problems. Recent research indicates that insufficient sleep, disrupted sleep, and sleep disorders affect many aspects of human health including sexual function. In fact, patients with urological disorders or erectile dysfunction (ED) may have a sleep disorder that contributes to their urological or sexual dysfunction. Obstructive sleep apnea, insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders and are associated with ED and/or other urological disorders. Therefore, careful attention should be paid to the diagnosis and treatment of concomitant sleep disorders in patients with sexual dysfunction. In this review, we provide an overview of what sleep is and how it is assessed in the clinic or laboratory; our current understanding of the functions of sleep and sleep health; a description of common sleep disorders, as well as how they are diagnosed and treated; and how sleep and its disorders are associated with male sexual dysfunction. Sleep is considered to be a ‘third pillar of health’, along with diet and exercise. With an understanding of common sleep disorders and how they can impact male sexual function, the urologist can ensure that sleep disorders are considered as a contributor to sexual dysfunction in their patients in order to provide them with the optimal treatment for overall health.

[The Role of Testosterone in The Improvement of Sexual Desire in Postmenopausal Women: An Evidence-Based Clinical Review]. / O Papel da Testosterona na Melhoria do Desejo Sexual da Mulher Pós-Menopáusica: Uma Revisão Baseada na Evidência.

INTRODUCTION: Female sexual dysfunction is a common problem, affecting more than 1/3 of women during their lives. The aim of this review is to review the evidence for the effectiveness of testosterone in sexual dysfunction in postmenopausal women, particularly in the improvement of sexual desire. MATERIAL AND METHODS: The authors searched in international databases National Guidelines Clearinghouse, Guidelines Finder, Cochrane Library and MEDLINE/PubMed, for guidelines, systematic reviews, meta-analysis and randomized controlled trials, published between January 2005 and February 2017, using the MeSH terms 'testosterone', 'androgens', 'libido', 'sexual dysfunctions' and 'menopause'. RESULTS: From a pool of 506 articles, 11 were selected: three guidelines, one systematic review with meta-analysis and seven randomized controlled trials. The selected articles showed testosterone's efficacy on global sexual function and improvement of sexual desire in postmenopausal women, when both are used in monotherapy or in association with other hormones. No study showed changes in hepatic enzymes or serious adverse effects. DISCUSSION: The small sample size and short follow-up used in the included studies limits the ability to assess testosterone's long-term benefits and effects. CONCLUSION: At short-term, testosterone seems to improve sexual function in postmenopausal women, particularly sexual desire. Nevertheless, more studies with larger sample size and longer follow-up are needed to understand its long-term safety and effectiveness.

Introdução: A disfunção sexual feminina é um problema comum que atinge mais de 1/3 das mulheres em alguma fase da vida. O objetivo deste trabalho é rever a evidência existente acerca da eficácia da testosterona na disfunção sexual, em particular na melhoria do desejo, em mulheres pós-menopáusicas.Material e Métodos: Pesquisa nas bases de dados National Guidelines Clearinghouse, Guidelines Finder, The Cochrane Library e MEDLINE/PubMed, de normas de orientação clínica, revisões sistemáticas, meta-análises e ensaios clínicos aleatorizados e controlados, publicados entre janeiro de 2005 e fevereiro de 2017, utilizando os termos MeSH 'testosterone', 'androgens', 'libido', 'sexualdysfunctions' e 'menopause'.Resultados: Foram incluídos 11 artigos de uma pesquisa inicial de 506: três normas de orientação clínica, uma revisão sistemática com meta-análise e sete ensaios clínicos aleatorizados e controlados. Os artigos selecionados mostraram eficácia da terapêutica com testosterona, em monoterapia ou em associação com outras hormonas, na melhoria global da função sexual e na melhoria do desejo sexual em mulheres na pós-menopausa. Nenhum dos estudos evidenciou alterações das enzimas hepáticas ou efeitos adversos graves.Discussão: Os estudos incluídos tinham amostras de pequenas dimensões e período de follow-up curto, o que impossibilitou a avaliação dos efeitos a longo prazo do tratamento com testosterona.Conclusão: A terapêutica com testosterona tem benefício, a curto prazo, na melhoria das queixas de disfunção sexual em mulheres pós-menopáusicas, em particular na melhoria do desejo. Contudo, são necessários estudos com amostras de maior dimensão e período de follow-up mais longo, de modo a avaliar a sua efetividade e segurança a longo prazo.

Female Sexual Function and Dysfunction: A Cross-National Prevalence Study in Slovenia.

The purpose of the current study was to evaluate the prevalence of female sexual dysfunction in Slovenia. We aimed to explore the prevalence itself, comparison among demographic groups and potential correlations. Data were collected based on the validated standardized Female Sexual Function Index (FSFI) (N=605). Most participants had sexual intercourse with one partner (n=523), and the majority of sexual relationships were heterosexual (n=584). University educated subjects had the highest claims of arousal, followed by those with master/doctoral degrees and college educated ones. The lowest level was expressed by subjects with elementary school. The youngest subjects (18-23 years) expressed the highest levels of desire and arousal, followed by the 24-29 age group. The 42-47 age group reported higher levels of lubrication and orgasm. The claim of satisfaction was highest in the 24-29 age group, while the pain was highest in the 42-47 age group. Strong correlation was found between the claims of desire and arousal (r=0.585), arousal and lubrication (r=0.879), lubrication and pain (r=0.856), orgasm and lubrication (r=0.856), satisfaction and orgasm (r=0.782), and pain and arousal (r=0.776) (p<0.001). We identified a 31% prevalence of female sexual dysfunction in Slovenia.

Self-reported assessment of female sexual function among Brazilian undergraduate healthcare students: a cross-sectional study (survey)

ABSTRACT BACKGROUND: The present study aimed to evaluate female sexual function among young undergraduate women. DESIGN AND SETTING: Cross-sectional survey conducted among Brazilian undergraduate students. METHODS: This study used online questionnaires to assess sociodemographic and health-related data and used the Brazilian version of the Female Sexual Function Index (FSFI) among female undergraduate students aged 18 to 25 years who were regularly enrolled in undergraduate healthcare courses. The FSFI is composed of 19 items that measure female sexual function over the last four weeks, in six domains: desire and subjective stimulation, sexual arousal, lubrication, orgasm, satisfaction and pain or discomfort. RESULTS: Among the 149 female undergraduate students evaluated, 43 (28.8%) presented sexual dysfunction (score < 26.55). Health conditions were not associated with female sexual dysfunction. Among the women with sexual dysfunction, all domains of the sexual response cycle were affected (P < 0.001). CONCLUSIONS: Sexual dysfunction was identified in at least a quarter of these young undergraduate women and it was not associated with gynecological problems, menstrual cycles, dysmenorrhea, contraceptive use or physical activity.

Sexual Dysfunction in Patients with Antidepressant-treated Anxiety or Depressive Disorders: a Pragmatic Multivariable Longitudinal Study.

OBJECTIVE: To investigate early evolution, tolerability, and predictors of antidepressant-emergent sexual dysfunction in patients with anxiety or depressive disorder. METHODS: Patients with anxiety or depressive disorders who were prescribed antidepressant monotherapy (mirtazapine, sertraline, desvenlafaxine, escitalopram, or fluoxetine) at the discretion of the treating clinician were recruited from July 2012 to June 2014 from a hospital outpatient service. All were free of psychotropic medication for least 1 month. Sexual function was assessed at baseline, week 2, and week 6 using the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ). A PRSexDQ score of ≥2 was considered to indicate sexual dysfunction. Sexual function was dichotomised to 'favourable' or 'impaired'. RESULTS: Of 230 patients recruited, 209 were assessed at baseline of whom 184 were assessed at week 2; of these, 154 were also assessed at week 6. At baseline, 138 (66%) of the 209 patients were diagnosed with depressive disorder and 71 (34%) with anxiety disorder; 29% of patients had sexual dysfunction (in any domain of PRSexDQ). By week 6, the percentage had increased to 41%, although the change in the mean PRSexDQ score was only marginal (from 1.04 at baseline to 1.55 at week 6). With regard to individual questionnaire items, by week 6, sexual desire improved, but erectile and ejaculatory function in men and orgasmic function in women worsened. Fluoxetine and sertraline were associated with impaired sexual function, whereas mirtazapine was associated with favourable sexual function. In a logistic regression analysis, at week 2, mirtazapine and desvenlafaxine were predictors of favourable sexual outcome, whereas fluoxetine and higher baseline PRSexDQ score were predictors of impaired sexual outcome. At week 6, mirtazapine remained a predictor of favourable sexual outcome, whereas fluoxetine, higher 2-week PRSexDQ score, and adequate dose were predictors of impaired sexual outcome. CONCLUSIONS: In patients with anxiety or depressive disorder, the risk of antidepressant-emergent sexual dysfunction at 6 weeks is low when drug doses are initially low with gradual up-titration. Baseline sexual dysfunction was independently associated with impaired sexual outcome. Men may be more likely than women to experience impaired sexual outcome. In patients with baseline sexual dysfunction, prescription of mirtazapine might be preferable to fluoxetine.

The tendency towards the development of psychosexual disorders in androgenetic alopecia according to the different stages of hair loss: a cross-sectional study

Abstract: Background: Androgenetic alopecia is a common dermatological condition affecting both genders. Objective: To evaluate the tendency towards development of psychosexual disorders according to the clinical stages of androgenetic alopecia. Methods: A cross-sectional study was conducted including 353 patients of both sexes on different clinical stages of hair loss, and the patients were enquired about self-perception, self-esteem, sexual experiences, anxiety and depression states. Hair loss was classified by standardized hair loss scales, and psychological effects were assessed with questionnaires. Results were compared to p<0.05. Results: Negative effects on each psychological parameter of androgenetic alopecia in females were higher than in males. While overall comparisons according to hair loss stages for each parameter were significant in males, only sexual experiences, anxiety and depression values were significant in females. Sexual experiences and depression values were higher in Ludwig 3 than in 1&2, while anxiety was higher in Ludwig 3 than 1. Self-perception values in Norwood 2&2A were higher than 3A, 3V, 4 and 4A, while self-esteem values in 2A were higher than 3&4. Sexual experiences values in 2&2A were lower than 3, 3A, 3V, 4 and 4A, while 3&3A were lower than 4&4A. Depression was lower in 2A than 3, 3A, and 3V, and lower in 2A than 4A. Anxiety was lower in 2A than in 4&4A. Study limitations: Relatively small number of patients, who were from a single center. Conclusions: In the management of androgenetic alopecia, it should be considered that patients may need psychological support according to the clinical stages, because of increased tendency to develop psychosexual disorders.

A fisioterapia pélvica melhora a dor genitopélvica/desordens da penetração? / Does the pelvic physical therapy improves genitopelvic pain/penetration disorder?

Muitas vezes, as Disfunções Sexuais Femininas (DSF) são subdiagnosticadas, têm causas multifatoriais e não recebem devida atenção para o tratamento. Estas disfunções podem se manifestar em qualquer idade, sobretudo em mulheres adultas e idosas, e de diferentes formas. Para ajudar essa mulher na resolução do seu problema, o ideal é que profissionais especializados em saúde sexual a aborde, cada um em sua área de atuação. Além de apoio médico e psicológico, a fisioterapia tem papel fundamental na reabilitação sexual da dor genitopélvica/desordens da penetração (vulvodínea, vestibulodínea, dispareunia e vaginismo). O fisioterapeuta utiliza recursos como terapia manual, cinesioterapia, eletroestimulação, biofeedback, eletromiografia, cones vaginais e dilatadores na conduta terapêutica para essas disfunções. A literatura ainda apresenta-se restrita neste tema, mas é possível afirmar que a fisioterapia pélvica, se bem conduzida, é resolutiva, proporcionando satisfação e melhora da qualidade de vida da mulher.(AU)

Often, Female Sexual Dysfunction (FSD) is underdiagnosed, have multifactorial causes and do not receive adequate attention for treatment. These dysfunctions may appear at any age, especially in adult and elderly women, and in different ways. To help this woman in the resolution of her problem, the ideal is that professionals specialized in sexual health address her, each one in its area of operation. In addition to medical and psychological support, physiotherapy plays a key role in sexual rehabilitation genito-p-elvic pain/penetration disorders (vulvodynea, vestibulodynea, dyspareunia and vaginismus). The physical therapist works with manual therapy, therapeutic exercise, electrical stimulation, biofeedback, electromyography, vaginal cones and dilators in the therapeutic approach. The literature also presents restricted in this area, but we can say that the pelvic physical therapy, if well conducted, is resolute, providing satisfaction and improving quality of life of women.(AU)

Esquemas mal adaptativos tempranos del área de la autovaloración y satisfacción sexual en adultos jóvenes de la ciudad de Medellín / Early maladaptive schemas in self-esteem and sexual satisfaction in young adults of Medellin / Esquemas mal adaptativos precoces da área da autovalorização e satisfação sexual nos adultos jovens da cidade de Medellín

Objetivo: describir la relación entre la presencia de esquemas mal adaptativos tempranos del área de la autovaloración y el índice de satisfacción sexual en adultos, hombres y mujeres con preferencia heterosexual, del área metropolitana de Medellín, Antioquia. La satisfacción sexual es un tema de interés de estudio propio de la psicología, pero que ha sido tratado por la ginecología y la urología en nuestro país. Los esquemas mal adaptativos tempranos son estructuras cognitivo-afectivas, con una alta carga emocional que se desarrollan en los primeros años de vida a partir de las interacciones del bebé con los cuidadores y que posteriormente se relacionan directa o indirectamente con trastornos y problemáticas psicológicas. Metodología: investigación cuantitativa, estudio analítico de tipo no experimental, de corte transversal. No se manipularon deliberadamente las variables ni se influyó sobre ellas. Se establecieron comparaciones y se analizaron las relaciones entre el área de la autovaloración de los esquemas mal adaptativos tempranos y el índice de satisfacción sexual en adultos jóvenes del área metropolitana. Resultados: del total de la muestra el 59.3% de la población, tiene activos uno o varios esquemas mal adaptativos tempranos del área de la autovaloración; se encontró que el 60.3% de los sujetos con esquemas activos en el área de autovaloración está insatisfecho sexualmente. Conclusiones: se confirman relaciones estadísticas (p <0.01) y con relevancia clínica, entre esquemas mal adaptativos tempranos del área de la autovaloración y la satisfacción sexual. El esquema con mayor correlación con el índice de satisfacción sexual fue el de Defectuosidad/Inamabilidad.

Objective: To describe the relationship between the presence of early maladaptive schemas in self-esteem and sexual satisfaction in adults; men and women with heterosexual preference in the Medellin metropolitan area. Sexual satisfaction is a topic of interest in the field of psychology, which in Colombia has been treated by gynecologists and urologists. Early maladaptive schemas are cognitive-affective structures with a high emotional charge which develop during the first years of life as a result of the interaction between baby and caregivers and which later on are directly or indirectly related to psychological disorders. Methodology: Observational, analytical, cross-sectional study. Variables were not deliberately manipulated nor influenced upon. Comparisons were established and the relationships between early maladaptive schemas in self-esteem and the index of sexual satisfaction in young adults in Medellin were analyzed. Results: Of the sample total, 59.3% of the population had one or more active early maladaptive schemas in self-esteem; 60.3% of subjects with active schemas in self-esteem were sexually dissatisfied. Conclusions: Statistical relationships (p <0.01) with clinical relevance were confirmed amongst early maladaptive schemas in self-esteem and sexual satisfaction. Defectiveness/unkindness was the schema with highest correlation with the sexual satisfaction index.

Objetivo: descrever a relação entre a presença de esquemas mal adaptativos precoces da área da autovalorização e o índice de satisfação sexual nos adultos, homens e mulheres com preferência heterossexual, da área metropolitana de Medellín, Antioquia. A satisfação sexual é um assunto de interesse de estudo próprio da psicologia, mas que há sido tratado pela ginecologia e a urologia no nosso país. Os esquemas mal adaptativos precoces são estruturas cognitivo-afetivas, com uma alta carga emocional que se desenvolvem nos primeiros anos de vida a partir das interações do bebê com os cuidadores e que posteriormente se relacionam direta ou indiretamente com transtornos e problemáticas psicológicas. Metodologia: investigação quantitativa, estudo analítico de tipo não experimental, de corte transversal. Não se manipularam deliberadamente as variáveis nem se influiu sobre elas. Se estabeleceram comparações e se analisaram as relações entre a área da autovalorização dos esquemas mal adaptativos precoces e o índice de satisfação sexual nos adultos jovens da área metropolitana. Resultados: do total da amostra 59.3% da população, têm ativos um ou vários esquemas mal adaptativos precoce da área da autovalorização; se encontrou que 60.3% dos sujeitos com esquemas ativos na área de autovalorização está insatisfeito sexualmente. Conclusões: se confirmam relaciones estatísticas (p <0.01) e com relevância clínica, entre esquemas mal adaptativos precoces da área da autovalorização e a satisfação sexual. O esquema com maior correlação com o índice de satisfação sexual foi o de Defeituoso/Apego.

Subjective sleep quality, unstimulated sexual arousal, and sexual frequency.

INTRODUCTION: REM sleep deprivation increases unstimulated erections in rats, and total sleep deprivation increases erections during audiovisual sexual stimulation in men, but the effects of sleep problems on human unstimulated sexual arousal are unknown. OBJECTIVE: We examined the associations of subjective sleep quality with unstimulated sexual arousal, satisfaction with sex life, and sexual frequency and desire over the past month. METHODS: 275 Portuguese (169 women) reported their anxiety, sexual arousal and sexual desire during a resting state, and completed the Pittsburgh Sleep Quality Index, the sexual satisfaction subscale of the LiSat scale, the Desire dimensions of the Female Sexual Function Index (women only) and International Index of Erectile Function (men only). They additionally reported how many days in the past month they engaged in penile-vaginal intercourse, noncoital sex, and masturbation. Salivary testosterone (T) was assayed by luminescence immunoassays. RESULTS: Poorer sleep quality correlated with greater unstimulated sexual arousal in men with higher T levels and in women with higher T levels not taking oral contraceptives. In women with lower T, poorer subjective sleep quality correlated with greater sexual dissatisfaction. In both sexes, sleep quality was uncorrelated with sexual desire and sexual frequency over the past month. DISCUSSION: Consistently with other studies in humans and animals, the findings are congruent with the notion that lack of sleep can increase sexual arousal, but not sexual frequency. T might play a role in the sexual arousal caused by lack of appropriate sleep.