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In the irst group erectile dysfunction webmd order super viagra uk, the physician introduced an Type I (also called Sunna): Removal of the clitoris appropriately sized dilator impotence and age generic super viagra 160 mg fast delivery. Therapy sessions Removal of the clitoris and the labia minora and were conducted every two weeks to impotence treatment order super viagra pills in toronto follow and sup-- majora erectile dysfunction caused by spinal stenosis purchase super viagra 160mg line, sewing up of the oriicium vaginae, leaving port the progress made in the treatment. Damage to any of the neural networks as-- sociated with the vulvar and perineal areas may alter genital sensation [237], resulting in pain and other sensory outcomes. Psychological vulnerability factors for develop-- such as razors or piece of broken glass are often ing sexual pain; speciically, empirical indings with used. Consequences depend on the experience regard to individual differences on personality traits, of the operator and the hygienic conditions. Heavy personality disorders, and psychiatric comorbidity bleeding, causing anemia or death, may occur. Psychological variables that are found to predict There is a general assumption made that all women outcome of treatment of sexual pain disorders. However, recent evidence does not support following categories: this idea in all women. Psychometric data, showing differential presence whom 80% were circumcised) were examined and of psychopathology and personality levels (state and interviewed to investigate their psychosexual activ-- trait) in patients and non-patient comparison groups ity. Note that psychopathology and group complained signiicantly more frequently of impaired psychological functioning found in observa-- dysmenorrhea (80. Asterisks are added in the text to distress related to their sexual problems [235]. Ad-- provide an index of the robustness of the indings ditional evidence exists that when dyspareunia is that are mentioned: **: If more than one study with present, it is most commonly reported with irst inter-- results pointing in the same direction are retrieved; *: course and/or in the initial period after marriage, and if only single study results were retrieved. Their marital anxiety disorders* through assessment using both satisfaction regarding non-sexual aspects of the structured interviewing and self-report instruments relationship was equal to normative groups**. Speeded detection of sexual pain-related stimuli, dificulties with sexual arousal and vaginal lubrication relecting attentional bias towards such stimuli, has during partner interaction** as compared to their also been investigated with other methodologies. They were also When using a modiied pictorial Affective Simon found to lack sexual pleasure more often*. Signiicant correlation of pelvic experienced threat loor muscle activity and experienced monitor using threat. Length of therapy was related to lators, Kegel exercises, relaxation exercises, and of predictor variables. Later: digital penetration with intercourse without dificul-- cess was positively related to therapist-rated partner’s ingers before penile-vaginal containment ty to no change). Both Wiel, Blindeman, complaints fully disap-- treatments were equally effective (p >. Chadha & peared; 2 = dimished; 3 = Drogendijk, 1996 unchanged, but less of a [248] problem; 4 = unchanged; 5 = complaints worsened. Success tended to occur more often Blaser, 1998 [226] pist’s verbal explanation only (in vitro), participants of predictor variables. Treatment: outcome: therapist rated of the 32 women who had both surgical excision 2b Cannata, 1992 localized vestibulectomy, offer of sexual on 5-point scale: very of vulvar lesions and contact with the psychologist, [257] counseling, Kegel exercises, vaginal dilation and much improved to very 50% were much improved in perceived pain, 41% couple therapy. Predictor were somewhate improved, and 9% were unim-- variables: Sex History proved. Predictive for better outcome were: higher Form, Dyadic Adjustment socioeconomic status, childlessness. Psychological Inventory, Brief Symptom factors at pain onset and test scores were not pre-- Inventory, structured dictive. All groups improved regarding psycho-- logical adjustment and sexual function from pretreat-- ment to 6 month follow-up. No effects of treatment on other aspects of (with inger, self or sexual or marital functioning. Pain ratings during Gynecologic examination pain and intercourse 3b Amsel, Khalife & gynecologic pain decreased, nonsigniicant increases of Binik, 2007 [312] examination, vestibular the pain threshold. An etiological element tomy, and these results were found to be maintained may be the deicits in information processing, i. These latter ment and topically applied lidocaine were equally indings require replication in future studies. Psychosocial vari-- ables predictive for positive outcome were: higher a) Individual Psychological And Personality socioeconomic status*, lower education*, and child-- Characteristics lessness*. Willingness to be psychologically of psychopathology in women with DyS were found evaluated was highly predictive for positive outcome with regard to depression** and anxiety disorders*, of limited vestibulectomy*, as was cooperation of pa-- more speciically: generalized anxiety disorder*, tient in postoperative counseling*, low erotophobia simple phobia*, obsessive-compulsive disorder*, score*, and lower pretreatment pain intensity*. Equal rates of psychopathology scores on instruments measuring fear of negative in women with DyS, compared with healthy con-- evaluation by others, phobia related to vaginal en-- trols, were found with regard to posttraumatic stress try and the Personality Assessment Screener have disorder* and eating disorder* (see Table 25. These indings scores on neuroticism*, depression** and state anxi-- were not consistently reported and only one study ety**. The crosssectional design of the relevant iors**, and social phobia (interpersonal sensitivity)**. Increased trait anxiety, pain catastrophizing, reward Women with dyspareunia also reported more symp-- dependency and harm avoidance in women with toms of hostility**, more (psycho)somatic complaints comitte 25. With respect to sexual to the domain of sexuality, women with DyS are functioning, women with dyspareunia are found to be found to score higher on erotophobia* than healthy more erotophobic, relecting negative and conserva-- control women. With regard to sexual functioning, tive attitudes towards sex, and aversion to engage in they also appear to have lower sexual arousal** in sex. Findings with regard to sexual arousal problems response to sexual intercourse stimuli. Furthermore, in women with DyS have thus far been contradic-- they more often report relationship discordance**. In a irst experimental study sponse to erotic stimulation in women with DyS war-- [246], genital response in women with DyS was rants further study. In women with DyS, genital response was lower to audiovisual representation of penile-vaginal 4. Subjective sexual arousal did not differ between women with and without dyspareunia*. Higher rates of psychopathology in women with vaginismus were found with regard to agoraphobia However, in more recent studies [242, 243, 245], without panic disorder* and obsessive-compulsive women with DyS and healthy control women disorder* (see Table 25. In women with were found to exhibit equivalent genital responses vaginismus, when compared with the general female to, respectively, 1. Women were found regarding subjectively experienced with vaginismus were found to have equal and sexual arousal, and negative and positive affect. In summary, women with DyS were found to have With respect to dispositional traits, women with vagi-- elevated rates of clinically relevant comorbid depres-- nismus were equal to the normal population on ex-- sion and anxiety disorders. Self- showed elevated traits of low self-esteem*, less posi-- report measurement of psychological characteristics tive sexual self-schema*, and hysterical personality*. With regard to their sexual functioning, wom-- to have signiicantly increased comorbid anxiety en with vaginismus reported less self-stimulation*, disorders (agoraphobia without panic disorder, and more problems with sexual desire* and arousal*. The role of c) Psychological Processes in Women with childhood sexual trauma is unclear since different Vaginismus frequency rates were found, and the presence of With respect to psychological processes causing or increased rates of posttraumatic stress disorder maintaining vaginismus (see Table 25. Psychological with and without vaginismus are found not to differ in characteristics, measured with self-report baseline pelvic loor muscle tension*, or in the ability instruments, only partially lend clear support to the to control pelvic loor muscles while performing ex-- role of anxiety symptoms in the etiology of vaginismus. Compared with to be more often present in this group suggest control women, women with vaginismus (28%) had the presence of pain catastrophizing cognitions, higher incidence of vaginal spasm*. Visual erotic disgust propensity, and a speciic fear of penile- stimulation does not increase the pelvic loor muscle vaginal penetration in the etiology or maintenance activity in women with vaginismus. In sum, whether vaginismus is caused Reduction of penetration-related fears was found or maintained by psychological factors requires to mediate positive response to treatment [250]. Fear of penetration, anxiety and disgust, and other aspects of negative affect d) Prediction of Treatment Outcome (Grade B) may play a role. No predictive value was found with respect to his-- Prevalence rates for vaginismus are scarce, without tory of sexual abuse* or presence of additional the beneit of multiple studies on speciic populations. No replica-- Population-based estimates for vaginismus range tions of prediction models have been reported. Second, questions about and/or treatment may have consequences on the pain mediators are crucial as pain is a complex sexual functioning of the patient and her partner. It is subjective experience that can be impacted by a therefore advisable for health care providers to ask range of factors. Thus, asking whether any factors each patient whether she has any sexual concerns. Furthermore, skills that enhance openness, comfort, trust, and inquiring about patients’ theories regarding their conidence within a non-judgmental context.
The in men with erectile dysfunction: Use of a novel noninferiority efficacy of sildenafil in different etiologies of erectile study design. Efficacy of sildenafil as prostaglandin E1 is effective in patients with erectile the first-step therapeutic tool for Japanese patients dysfunction not responding to phosphodiseterase 5 inhibitors. Role of sildenafil septicemia following intracavernous injection therapy for citrate in treatment of erectile dysfunction after radical erectile dysfunction in diabetes. Early combination therapy: intracavernosal injections and sildenafil following Ohebshalom M, Mulhall J P. Transdermal and topical radical prostatectomy increases sexual activity and the return of pharmacotherapy for male sexual dysfunction. Rationale for combination therapy of intraurethral prostaglandin E(1) and Opsomer R J, Wese F X, De Groote P et al. 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Management and challenges of corticosteroid therapy in men with metastatic castrate-resistant prostate cancer. Obstructive uropathy from locally advanced and metastatic prostate cancer: an old problem with new therapies. Men’s strategies for preserving emotional well-being in advanced prostate cancer: An interpretative phenomenological analysis. We are indebted to the many volunteers who contributed their time, knowledge, and energy to bringing this document to completion. Practices are encouraged to go beyond the parameters to provide additional service and information as needed. Several sections of this parameter (Qualifications and Responsibilities of Personnel, Documentation, and Quality Control and Improvement, Safety, Infection Control, and Patient Education Concerns) vary between the organizations and are addressed by each separately. This parameter has been developed to assist practitioners performing an ultrasound examina- tion in the practice of urology. While it is not possible to detect every abnormality, adherence to the following parameters will maximize the probability of answering the clinical question prompting the study. Specifications for Individual Examinations 1 Doppler ultrasound may be useful to differentiate vascular from nonvascular structures in any location. Indications Indications for an ultrasound examination of the kidney and/or bladder include but are not limited to: • Flank and/or back pain; • Signs or symptoms that may be referred from the kidney and/or bladder regions such as hematuria; • Abnormal laboratory values or abnormal findings on other imaging examinations sug- gestive of kidney and/or bladder pathology; • Follow-up of known or suspected abnormalities in the kidney and/or bladder; • Evaluation of suspected congenital abnormalities; • Abdominal trauma; • Pretransplantation and posttransplantation evaluation; and • Planning and guidance for an invasive procedure. Specifications for a Kidney Examination the examination should include long-axis and transverse views of the upper poles, midportions, and lower poles of the kidneys. Decubitus, prone, or upright positioning may provide better images of the kidneys. When possible, renal echogenicity should be compared to echogenicity of the adjacent liver or spleen. For this application, angle-adjusted measurements of the peak systolic velocity should be made proximally, centrally, and distally in the extrarenal portion of the main renal arteries when possible. The peak systolic velocity of the adjacent aorta (or iliac artery in transplanted kidneys) should also be documented for calculating the ratio of the renal to aortic peak systolic velocity. Spectral Doppler evaluation of the intrarenal arteries from the upper and lower portions of the kidneys, performed to evaluate the early systolic peak, may be of value as indirect evidence of proximal stenosis in the main renal artery. Urinary Bladder and Adjacent Structures When performing a complete ultrasound evaluation of the urinary tract, transverse and 2 longitudinal images of the distended urinary bladder and its wall should be included, if possible. Transverse and longitudinal scans may be used to demonstrate any postvoid residual, which may be quantitated and reported. Equipment Specifications Kidney and/or bladder ultrasound studies should be conducted with real-time scanners, preferably using sector or linear (straight or curved) transducers. The equipment should be adjusted to operate at the highest clinically appropriate frequency, realizing that there is a trade-off between resolution and beam penetration. When Doppler studies are performed, the Doppler frequency may differ from the imaging frequency. Diagnostic information should be optimized while keeping total ultrasound exposure as low as reasonably achievable. Indications Indications for a prostate ultrasound examination include but are not limited to: • Guidance for biopsy in the presence of abnormal digital rectal examination findings or an elevated prostate-specific antigen level; • Assessment of gland and prostate volume before medical, surgical, or radiation therapy; • Symptoms of prostatitis with a suspected abscess; • Assessment of congenital anomalies; • Infertility; and • Hematospermia. Specifications of the Prostate Ultrasound Examination the following parameters describe the examination of the prostate and surrounding structures: a. Prostate the prostate should be imaged in its entirety in at least 2 orthogonal planes, sagittal and axial or longitudinal and coronal, from the apex to the base of the gland. An esti- mated volume is determined from measurements in 3 orthogonal planes (volume = length ? height ? width ? 0. The volume of the prostate may be correlated with the prostate-specific antigen level. The gland should be evaluated for a focal mass, echogenicity, symmetry, and conti- nuity of margins. Color and power Doppler sonography may be helpful in detecting areas of increased vascularity that can be used to select potential sites for biopsy. The periprostatic fat and neurovascular bundle should be evaluated for symmetry and echogenicity.
There has been an increasing focus on sports-related violence as a form of interpersonal violence (Fields et al. Violence and intimidation are more common in heavy-contact and collision sports, giving rise to a tendency to tolerate sports-related violence ‘as part of the game’ (Shields, 1999). Nevertheless, sports-related violence has been found to result in serious physical and psychological injuries to its victims (Campo et al. It has also been proposed that the focus in the sports media on personal rivalry, conflict, and fierce competition reinforces the social attitude that violence and aggression are normal and natural expressions of masculine identity (Children Now, 1999). From a sex and gender differences perspective, such distinctions are important, since women have been found to be over- represented among victims of intimidation and psychological violence, while men are more at risk of physical violence and assault (European Foundation for the improvement of living and working conditions, 2003). Measuring violence presents a number of challenges, not least being the inconsistencies that are to be found in defining and collecting data on violence across different countries. A German study that explored men’s experiences of interpersonal violence noted that: “Certain forms of violence are so normal in men’s lives that the men themselves do not perceive them as violence and therefore have only limited memory of them. Children who are exposed to violence are also more likely to become a violent offender themselves in later life (Moses, 1999). In addition to the more obvious physical effects, interpersonal violence can have severe repercussions on mental health. This can include feelings of dissociation, post-traumatic stress disorder-like symptoms, anger and depression (Buka at al. It should also be acknowledged that interpersonal violence data derived from mortality and hospitalisation data is likely to represent a mere fraction of the overall incidence of interpersonal violence, with only a small minority of physical assaults resulting in death or severe injury requiring hospitalisation (Harrison & Tyson, 1993; Voukelatos & Mitchell, 2009). Connell (1995) highlights the prevalence of violence in maintaining what he describes as the ‘patriarchal dividend’, and that it is predominantly men who hold and use violence to sustain their dominance. A number of studies (see Hong, 2002) have linked traditional male gender roles and hegemonic masculinity with violence, and with a much greater propensity for men to be perpetrators and victims of violence: 284 “The motivation for all male violence is related to males attempting to reinforce and render incontestable their heterosexual masculinity. The sense of obligation to uphold ‘honour’ or to reciprocate violence can be magnified considerably in the context of drinking (Brooks, 2001). Meuser (2002) differentiates between two forms of male violent action, emphasizing that both are gendered in specific ways: ‘reciprocal’ versus ‘asymmetrical’. Reciprocal violence, though directly targeting other men and not women, contributes to the reproduction of hegemonic masculinity and the masculine habitus. Whereas male violence against women solely degrades its victims, thus reinforcing women’s subordinated position in the gender order. Reciprocal violence allows for mutual acknowledgement within the competitive relations between men, related to notions of male honour. According to Meuser (2002), male violence should not be viewed as a case of disorder or deviance, but rather as a resource: a means of reproducing the gender order and male dominance. Like Meuser, Whitehead (2005) distinguishes two forms of male violence, though giving them different names: ‘inclusive’ and ‘exclusive’ violence. By acts of inclusive violence, men position themselves and their opponents as either ‘Heroes’ or ‘Villains’, mutually affirming their status as men and ‘worthy’ rivals. Exclusive violence, in contrast, degrades the attacked to the position of the ‘Non-Man’: Thus, through violence, he [the perpetrator] excludes the victim from the category ‘man’ as unworthy of belonging there. Such violence in its extreme, overt form, is characterised by overwhelming force, removing any pretence of competition, and humiliation on a sexual level. Such violence may manifest itself, for example, in a vigilante attack on a man who is perceived by the perpetrators as a ‘paedophile’, or in an attack against a gay man. In a study of antigay behaviours among young adults, Franklin (2000) found that many young adults believed that antigay harassment and violence was socially acceptable, particularly in response to inferred sexual innuendos or gender norms violations. With antigay behaviours being culturally normative and 285 mostly going unreported, the study concluded that educational outreach to adolescents and preadolescents is likely to be a more effective prevention strategy than a criminal prosecutions approach. Schuck (2009) extends Whitehead’s category of ‘exclusive violence’ to include violence against women, not just men; and he further subdivides the ‘exclusive violence’ into the categories of ‘disciplinary exclusive violence’ and ‘eliminatoric exclusive violence’. Studies of ‘hate crimes’ – that can be seen as cases of eliminatoric exclusive violence – might benefit a lot from including a perspective on gender and masculinity (see Tomsen, 2009). In addition to criminal intent incidents, violence can result from hostile customer/ client confrontations, conflict between work colleagues, as well as personal relationship incidents involving domestic violence expressed in the workplace (ibid). The occupations with the greatest risk of occupational violence 286 incidents include retail sales, law enforcement, teaching, health care, transportation and private security (Peek-Asa et al. Previous studies (see Wassell, 2009) have categorised workplace violence into four broad types: I. External/intrusive violence: comprising workplace violence incidents of criminal intent by unknown assailants (e. Organisational violence: workplace violence promoted or condoned by organisations against staff, consumers/clients/patients A report on violence prevention in the workplace (European Foundation for the improvement of living and working conditions, 2003) identified contributing factors of an individual, situational, organisational and societal nature, and called for a more holistic approach to understanding and preventing workplace violence. Workplace violence also carries considerable financial costs, in terms of sickness absenteeism, premature ill health and retirement, higher rates of staff turnover, reduced job satisfaction and productivity, and increased insurance premiums (ibid). Evidence of physical violence from northern European countries (see European Foundation for the improvement of living and working conditions, 2003), suggests that between 2%-10% of the population have been exposed to physical violence. This took various forms and included being insulted, intimidated, shouted at aggressively by superiors or colleagues, having one’s character defamed or being ridiculed, belittled or humiliated. Representative studies in European countries have explored bullying, as a core element of workplace violence (see Puchert, 2007). Most national studies do not show significant gender differences in rates of exposure to physical violence or 39 ‘Othering’ refers to the construction of groups, based on stereotypes, as ‘others’ in other to copper fasten one’s own ‘normality’, e. Strategies directed at preventing bullying emphasise the importance of an open and secure climate and working environment; making provisions for the free flow of information and openness in communication where bullying is brought to light; having clear sanctions against bullying; and establishing clear boundaries as to what constitutes acceptable and unacceptable behaviour in the workplace. A number of studies have identified health care as having particularly high rates of workplace violence, with emergency care workers being particularly vulnerable (see Peek-Asa et al. The same study found that many acts of violence were accepted as being a normal part of military service. In particular, psychological violence in the form of being bullied, insulted or humiliated; being forced to say or do something against one’s will; or having one’s freedom curtailed; far exceeded levels that were subsequently experienced in civilian life. In a review of workplace violence intervention effectiveness, Wassell (2009) highlighted environmental designs in the retail industry setting and violence- prevention training for healthcare workers as important and effective interventions. The report from the European Foundation for the improvement of living and working conditions (2003) emphasised the need for increased research targeted at specific sectors, occupations and types of violence to inform policy making and legislative initiatives, both at a European and national levels. Many methodological difficulties exist in relation to the collation of data within and between countries. Perpetration of violence against children seems to play a particularly significant role in the transmission of violence from one generation to the next (Delsol & Gayla, 2004). One review of levels of domestic violence perpetrated against women in Eastern European countries, reported levels ranging from 5% in Romania to 29% in Georgia for reported lifetime experiences of spousal physical abuse. The same report highlighted that physical abuse during the past 12 months ranged from 2% in Georgia to 10% in Romania (Serbanescu & Goodwin, 2005). In a review of 48 population based surveys of physical assault perpetrated against women, between 11% and 58% of women [in the 6 European countries included in the study] reported being physically assaulted by an intimate partner at some point in their lives (Heise at al. A range of misogynist rationales have been identified to explain men’s violence against women, ranging from male entitlement to hatred of women (see Puchert at al. Underpinning such an approach is an explicit focus on the protection of women and children (and other men) as part of a multi agency approach to programme delivery. The experience of programme delivery has also indicated that male participants experience a cycle of adverse health outcomes, including mental health issues and addictions, arising from their violent behaviour (Department of Health & Children, 2008). It points to the need for increased research and evaluation to be carried out on the impact that the perpetration of violence has on the health of perpetrators themselves, particularly in relation to mental health, the use of anger and alcohol abuse, and the effectiveness of intervention programmes in reducing violent behaviour and in improving the health status of perpetrators. In a study that examined effective strategies for engaging abusive men, Campbell et al. Those that did seek help were more likely to do so with someone whom they felt was trustworthy, non-judgemental and knowledgeable. It recommends that such access should be ensured throughout the whole criminal justice process, (while in custody as well as in the wider community) and that programmes should address both the individual factors for domestic violence (aggression management, substance abuse etc. Male victims may be less likely to seek help for an issue that society deems they should be able to handle themselves (Addis & Mahalik, 2003) or because of fear of being ridiculed or feeling embarrassed (McNeely at al. The literature indicates that criminal justice and social service agencies are often unsure of how to respond to or provide services to female perpetrators or male victims (ibid). As highlighted by Ireland’s National Men’s Health Policy (Department of Health and Children, 2008), there is a need for the provision of increased training and awareness raising to all those involved in dealing with male victims of domestic violence – police, social workers, doctors and other service providers – so that they are sensitive to the fact that victims can be male as well as female, and to the potentially wide-ranging impact of domestic violence on victims. American Psychologist 58:5-14 Anderson P, Baumberg B (2006) Alcohol in Europe: A Public Health Perspective. Journal of American College Health 49(6): 285-97 Buka S, Stichnick T, Birdthistle I et al.
In the Study of Women’s Health across Endocrine Society concluded that although there the Nation, a longitudinal 9-year study of 949 sub-- was evidence for short-term eficacy of T patches in jects, an increase in bioavailable T was associated selected populations, generalized use of testosterone with increased risk of the metabolic syndrome [133]. The European Commission approved the pausal hyperandrogenism and its associated insulin Intrinsa T patch (300 mcg) in July 2006 for use in resistance. The majority Testosterone patch therapy increases satisfying sex-- of data are from large multi-center trials of the ual activity, libido, arousal and orgasmic response in transdermal testosterone patch (300 mcg). Use of T alone in estrogen deicient postmenopausal women has Current data are not adequate to support the use shown effectiveness in short term studies, but long of T therapy in premenopausal and perimenopausal term this regimen would result in a nonphysiological women (GradeA). Regarding risks, androgenic Achieving physiological free T levels by transdermal adverse events appear to be increased with T use, delivery appears to be the best approach for mini-- but unwanted hair growth and acne are cosmetic mizing the adverse effects of androgens (Grade C). Several thorough reviews of relevant basic T therapy is relatively contraindicated in women with science research and observational studies address hyperlipidemia or liver dysfunction (Grade C). Whether the effects are due to 6 months should be contingent on a clear improve-- androgenic, estrogenic actions or both is unknown. Wom-- Women with hypopituitarism have profound estrogen en must be informed that data on long term safety and androgen deiciency and should be considered are lacking. Whether a lower target level for older wom-- en should be advised remains unknown. Although a) Evidence that supports the inluence of no adverse effects on lipids have been found with elevated levels of prolactin on female sexual short term parenteral therapies, a lipid proile and dysfunction. Hyperprolactinemia may be due to physiologic, phar-- macologic or organic causes [138]. Hyperprolactinemia is observed in primary hypothy-- roidism and commonly with medications that inhibit 1. Elevated a) Evidence that supports the inluence of prolactin may alter libido via direct neuroendocrine pituitary hormone deiciencies on female effects (impaired negative dopaminergic and posi-- sexual dysfunction. Although menstrual mone deiciencies, either genetic or commonly after disturbances are a more common symptom than removal of a pituitary and/or hypothalamic tumor or sexual dysfunction, hyperprolactinemic women with-- radiation [136]. Combination of sex hormone, thy-- out depression or other hormonal disorders reported roid hormone, glucocorticoid and /or growth hor-- lower scores for sexual desire, arousal, lubrication, mone deiciency may occur and require physiologic orgasm and satisfaction in comparison with controls replacement. A 12 month ran-- en with pituitary disease had a decrease in sexual domized study in 51 women with hypopituitarism desire, while problems with lubrication and orgasm demonstrated improvements in mood and sexual were reported in 65% and 69%, respectively [142]. These women lar tumor correlated with normal sexual desire and had variable forms of estrogen replacement with sexual function. Side ef-- tuitary disorders, 63% had decreased sexual desire fects included 1/3 with hirsuitism and 65% with skin [142]. Secondary adrenal insuficiency is due beneicial effect on female sexual dysfunction [143]. Adrenal insuficiency, irrespective of cause, drug-induced hyperprolactinemia, as demonstrated has been associated with impaired quality of life, by less sexual dysfunction in patients treated with low libido and lack of wellbeing. Improvements in sexual function (thoughts, interest and satisfaction measured by a visual analogue 3. These subjects are phenotypically female with normal b) Recommendations breast development, but variable shallow vaginal development which may impair sexual performance. This model women, suggesting that moderate hyperandrogen-- suggests that androgens are not necessary for ism alone may not signiicantly modulate sexual func-- normal sexual function. Pediatric or postmenopausal women with hirsutism,acne,seborrhea, alopecia etc)togetherwith estrogen-producing tumors present with postmeno-- obesity and infertility may cause emotional distress, pausal bleeding or isosexual precocity. Anxiety, able in women with sex hormone producing tumors vulnerability to distress, abnormal eating attitudes [173]. Limita-- activity in the mechanism underlying both male and tions of this report include that this patient cohort female sexual dysfunction in diabetes [180]. A recent was derived from a specialized referral base and review of the literature of 400 citations concluded may represent a biased group of subjects and lack that research on sexual function in women with appropriate controls. No intervention a history of discomfort and social stress related to studies are available concerning changes in sexual their extent of masculinization prior to treatment. Thus, these women should be screened tially contributing to their risk of sexual dysfunction, for sexual dysfunction. The literature is limited by few studies with control groups, the poorly validated types of tools a) Evidence that obesity inluences sexual used to diagnose female sexual dysfunction, and the function changing deinitions of female sexual dysfunction from older to newer studies. The authors noted rates the metabolic syndrome (MetS) is a constellation of of decreased desire ranged from 9-60% in controls indings including central adiposity, insulin resistance, to 17-85% in female diabetics, and of decreased hypertension and various other clinical features. Reduced lu-- the International Diabetes Federation consensus brication was about 2-fold more common in diabetic deinition for MetS includes a waist circumference in all but one study; pain and orgasmic dificulties >80cm in addition to 2 of the following factors: were more prevalent in diabetics than nondiabetics. A l) or treatment for lipids, elevated blood pressure or careful dissection of any differences in the incidence treatment for hypertension, and /or elevated fasting of or etiologies of sexual dysfunction in Type 1 com-- serum glucose >=100mg/dl (5. Of the group, 18% had induced hyperandrogenism do not suggest that ex-- MetS[184]. The rate of these normal or hypersexuality, suggesting an optimal bal-- disorders increased with transition to menopause. Impaired desire was and metabolic syndrome on female sexual dysfunc-- present in 59% in premenopausal women with MetS tion suggest that the disorder is common in these compared to 32% of controls. It is hoped that this review of the state of b) Recommendations: the ield will spur new research into the impact of hormones and endocrine disorders on female sexual Women with MetS may have an increased incidence dysfunction and additional research into the beneits of sexual dysfunction, which may be due to vascular, and risks of hormonal therapies for these patients. We recommend screening women with MetS for sexual dysfunction and study of treatment interventions; none are currently available in these patients. Introduction to standardization of laboratory supporting the mechanisms by which hormonal results. Comparison with ive production and action of hormones, on sexual func-- immunoassay techniques. Measurement of total serum testosterone in adult sors may impact female sexual function. The conse-- men: comparison of current laboratory methods versus liquid chromatography-tandem mass spectrometry. Limitations of direct estradiol and testosterone cally induced estrogen deiciency with selective es-- immunoassay kits. Hypopituitarism, chromatography-mass spectrometry in sera from 116 hyperprolactinemia, thyroid disorders and adrenal men, women, and children. In Reproductive endocrinology, surgery and tional model systems for future interventional trials. Phenotypic spectrum of polycystic ovary syndrome: clinical Effect of intravaginal dehydroepiandrosterone (Prasterone) and biochemical characterization of the three major clinical on libido and sexual dysfunction in postmenopausal subgroups. Analog-based [33] Dennerstein L, Randolph J, Taffe J, Dudley E, Burger free testosterone test results linked to total testosterone H. Hormones, mood, sexuality, and the menopausal concentrations, not free testosterone concentrations. Clinical review 82: Androgens and testosterone assay: are the results in men clinically useful? Potential role of ultra- focus on indings from the Melbourne Women>s Midlife sensitive estradiol assays in estimating the risk of breast Health Project. Liquid circulating androgens in mid-life women: the study of chromatography-tandem mass spectrometry assay for women>s health across the nation. Determination of oestradiol-17 beta in human hour mean plasma testosterone concentration declines serum by isotope dilution-mass spectrometry. Meeting Report: First and Second Estradiol A prospective longitudinal study of serum testosterone, International Workshops. Circulating rum by liquid chromatography-tandem mass spectrometry androgen levels and self-reported sexual function in without derivatization. Comparison of sex steroid measurements in gonadotropin-driven androgen-producing gland. The effects of oestrogen on urogenital [30] Labrie F, Luu-The V, Belanger A, et al. Sexual problems and distress in United States women: Marked decline in serum concentrations of adrenal C19 sex prevalence and correlates. Hormones equine estrogen vaginal cream to relieve menopausal and sexuality: effect of estrogen and progestogen. Predictors of decreased libido in women during statement of the North American Menopause Society. Psychoneuroendocrine correlates estrogen levels affect sexual function in elderly post- of secondary amenorrhea. Correlates of sexual functioning among mid-life human female genital tract: review of the literature. Study of sexual transdermal estradiol on sexual function in postmenopausal functioning determinants in breast cancer survivors.
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