A Psychiatrist’s Guide to Sexual Dysfunction in Women
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Fifty-nine uremic patients (38 males and 21 females) maintained on chronic hemodialysis (CHD) served as the subjects in a study of the relationship between sexual dysfunction and serum prolactin levels (SPL). Sexual desire and activity were evaluated by a self-report sexual function rating scale (SFRS). About half the population of this study reported sexual dysfunction. Males and females reporting disturbance of sexual function had significantly higher SPL than those with normal sexual function. Bromocriptine treatment in five hyperprolactinemic patients reduced SPL to normal range and improved the sexual function. Association between sexual dysfunction and hyperprolactinemia in uremic patients is suggested.
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Abstract Background Sexual function is highly neglected in individuals with schizophrenia (SZ). Clinicians usually underestimate the rates of sexual dysfunctions in these patients, and this group does not spontaneously complain about it. Sexual dysfunction in this population could reach up to 80% and its known to affect all domains of sexual function. Moreover, it may be linked to stigma and discrimination factors. Medication side effects on sexuality concern more than any other side effects, and it is known to be a major cause of poor quality of life and non-adherence to medication. Furthermore, the relationship between sexual dysfunction and other psychiatric symptoms in SZ is still unclear. Our aim was to describe the sexual dysfunction in chronic patients with SZ and its relation to negative, positive and depressive symptoms. Methods A convenience and exploratory sample of 57 patients (age 43.75±10.38, 69% men, 86,2% single) were recruited from an university outpatient schizophrenia clinic, in Porto Alegre – Brazil. Participants were assessed using Arizona Sexual Experience Scale (ASEX), Medication Adherence Rating Scale (MARS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Inventory and demographic information. Sexual dysfunction was considered following the ASEX scoring criteria. Results Sexual dysfunction was present in 51,8% of the patients, assessed by ASEX. Women showed increased sexual dysfunction than men (χ2=22,727, p < .001). There were no differences between patients that reported sexual dysfunction and the ones who did not regarding age, duration of illness and medication adherence assessed by MARS (p > .05). Additionally, there were no differences between groups on positive and negative symptoms assessed by PANSS. Interestingly, patients with sexual dysfunction had increased depressive symptoms compared to patients with a good perceived sexual function (t(54) = -3.326, p = .002). Calgary total scores were positively correlated with ASEX total scores (r = .369, p = .005). Nevertheless, we did not find significant correlations between ASEX total scores and other scales. Scores found on MARS (8.07±1.5) suggest that this sample is highly adherent to prescribed treatment. Discussion This is an exploratory and preliminary study that shows and reinforces the idea that sexual dysfunction is importantly prevalent and remains as a neglected issue in individuals with schizophrenia, as are the depressive symptoms. We showed that there is an association between these two domains, which might indicate a need for change of perspective for the pharmacological and psychosocial approaches currently used. In addition to the dopaminergic blockage by antipsychotics that lead to reduction in positive symptoms, we believe there is a need to look for depression symptoms to access, prevent and treat sexual dysfunction. Inattention to this event may result in abrupt treatment discontinuation and relapse. Curiously, the fact that we did not find any correlations between sexual evaluations and PANSS scores would suggest that sexual dysfunction in chronic patients could differ from others stages of the disease. The size of our sample and the fact that we did not access hormones and prolactin levels are important limitations of this study. However this is an exploratory study that provided clues on the subject, allowing to address further investigation taking into account the limitations.
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Severe obesity is most effectively treated with bariatric surgery. The resulting weight loss is expected to improve a variety of obesity-related conditions, including sexual dysfunction.To analyze changes in the sexual function of women with obesity following bariatric surgery.A prospective study was conducted between April 2015 and April 2016 involving 62 women with obesity who underwent Roux-en-Y gastric bypass. The Female Sexual Function Index (FSFI) was used to evaluate sexual function. Sexual dysfunction was defined as an FSFI score below 26.55. Patients' clinical and demographic data were recorded. Sexual frequency of 12 different sexual positions was also evaluated.Sexual dysfunction prevalence and the frequency of sexual positions before and 6 months after surgery.The prevalence of sexual dysfunction decreased from 62% before surgery to 19% 6 months after the procedure. There was a 19.2% improvement in the mean overall FSFI score (P < .01). 6 months after surgery, the mean overall FSFI score had improved in all patients, with a statistically significant change being found in all 6 domains of the questionnaire (P < .05). There was an increase in the frequency of 3 of 12 sexual positions evaluated.Sexual function in women with obesity effectively improves after bariatric surgery. Favorable changes following weight loss included a significant reduction in the prevalence of sexual dysfunction and an increase in the frequency of different sexual positions during intercourse. Oliveira CFA, dos Santos PO, Oliveira RA, et al. Changes in sexual function and positions in women with severe obesity after bariatric surgery. Sex Med 2019;7:80-85.
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