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International Journal of Impotence... Mar 2022During the early stages of the outbreak, insufficient attention was paid to the impact on sexual function, which is logical in the face of potentially harmful and fatal... (Review)
Review
During the early stages of the outbreak, insufficient attention was paid to the impact on sexual function, which is logical in the face of potentially harmful and fatal infections. It is well documented that any close contact (6 feet or 2 m) with an infected person can result in exposure to SARS-CoV-2 so while coronavirus disease: (COVID-19) may not be "sexually transmitted" (through semen or vaginal fluids) the risks of proximal exposure are great-whether the activity is engaged in is sexual or not. For the last 3-4 months, scientific studies have shown that a mild or severe coronavirus infection can lead to sexual complications and prolonged libido problems as well as erectile dysfunction. Besides, following some barrier gestures during "face-to-face" sexual intercourse can be challenging. This paper focuses on the construction and prefiguration of a new paradigm of sexuality that distinguishes and associates sexual relations that take place in the presence of a real partner and those that take place within the context of a range of digital environments qualified as "virtual" that can provide safe contexts for erotic imagination and intimacy while both communicating and maintaining arousal. Together, they offer a vehicle for fantasy and entertainment of sexual arousal towards private pleasure.
Topics: COVID-19; Erotica; Female; Humans; Libido; Male; SARS-CoV-2; Sexual Behavior
PubMed: 34815550
DOI: 10.1038/s41443-021-00494-9 -
Seminars in Nephrology Mar 2021Chronic kidney disease (CKD) causes substantial alterations in the male endocrine system, which affect puberty, libido, and sexual function. A major effect of CKD is a... (Review)
Review
Chronic kidney disease (CKD) causes substantial alterations in the male endocrine system, which affect puberty, libido, and sexual function. A major effect of CKD is a reduction in testosterone levels because of both primary and hypogonadotrophic hypogonadism. In addition to impairment of pubertal growth and sexual maturation in children with CKD, clinical evidence suggests that uremic hypogonadism strongly contributes to several CKD complications, including erectile dysfunction, muscle wasting and frailty, anemia, decreased bone mineralization, depression, and cognitive impairment. This review focuses on a reappraisal of the physiologic role of testosterone, with an emphasis on the hypogonadal condition linked to CKD and its complications.
Topics: Child; Erectile Dysfunction; Humans; Hypogonadism; Libido; Male; Renal Insufficiency, Chronic; Testosterone
PubMed: 34140090
DOI: 10.1016/j.semnephrol.2021.03.006 -
Wiadomosci Lekarskie (Warsaw, Poland :... Oct 2019Sexual disorders are very common problems in the psychiatric patients. Many factors induce sexual dysfunction, e.g. the effects of antidepressants and antipsychotics.... (Review)
Review
Sexual disorders are very common problems in the psychiatric patients. Many factors induce sexual dysfunction, e.g. the effects of antidepressants and antipsychotics. The article reviews literature on sexual disorders in psychiatric diseases such as schizophrenia, bipolar disorder, depressive, anxiety, obsessive-compulsive disorders and eating disorders. Bipolar disorder significantly affects the quality of life and increases the risk of sexual dysfunction. In the manic phase there is an increase in libido, which is associated with the risky sexual behavior. Depressive disorders are associated with reduced libido and dissatisfaction with sexual activity. Panic disorder and obsessive-compulsive disorder are correlated with less frequent sexual contact. Decreased sexual desire and sexual aversion are strongly associated with anxiety disorders. The prevalence of sexual dysfunction in patients with schizophrenia is high among both those treated and untreated. Women suffering from schizophrenia have anorgasmia, decreased libido, vaginal dryness, vaginism, and dyspareunia. Men suffering from schizophrenia as the main complaints give lowering the drive of difficulty in maintaining an erection, delaying orgasm. In patients with eating disorders, libido decreases as well as sexual activity and the level of sexual satisfaction decreases. Satisfaction with sexual life is an important factor affecting the quality of life. Patients rarely deal with problems in sexual life, so questions about this area of life should not be overlooked during a medical interview.
Topics: Female; Humans; Libido; Male; Orgasm; Quality of Life; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological
PubMed: 31982027
DOI: No ID Found -
Epilepsy & Behavior : E&B Aug 2017Sexual pharmacotoxicity renders patients with epilepsy at a risk for sexual dysfunction (SD). This study is aimed to analyze the relationship between sexual function and... (Review)
Review
INTRODUCTION
Sexual pharmacotoxicity renders patients with epilepsy at a risk for sexual dysfunction (SD). This study is aimed to analyze the relationship between sexual function and topiramate to avoid topiramate-associated SD.
METHODS
A systematic review following the PRISMA guidelines was performed to elucidate any SD occurrence in patients receiving topiramate.
RESULTS
A total of 17 publications were reviewed. Based on limited polytherapy observational studies, the frequency of self-reported topiramate-associated SD, libido disorder, and orgasmic disorder in patients with polytherapy was 9.0%, 9.0%, and 2.6%, respectively (grade C evidence). Female patients mainly had anorgasmia, whereas male patients principally had erectile dysfunction. The daily dose of topiramate in patients with SD was within the recommended dose. Sexual adversity usually occurred from 4weeks after topiramate use but favorably subsided without eventful complications after topiramate substitution or dose reduction in all patients.
CONCLUSIONS
Topiramate can elicit different patterns of SD, especially anorgasmia in women and erectile dysfunction in men, even with a therapeutic dose. Detailed drug education and careful monitoring are necessary to maximize sexual health, especially in persons undergoing polytherapy and with other risks for SD. Moreover, a rapid response, such as substitution or reduction of the dose, is suggested when SD occurs during its use.
Topics: Adult; Anticonvulsants; Epilepsy; Erectile Dysfunction; Female; Fructose; Humans; Libido; Male; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Topiramate
PubMed: 28605628
DOI: 10.1016/j.yebeh.2017.05.014 -
The Journal of Sexual Medicine Mar 2020The role of testosterone (T) replacement therapy (TRT) in men is still conflicting. In particular, safety concerns and cardiovascular (CV) risk related to TRT have not... (Review)
Review
INTRODUCTION
The role of testosterone (T) replacement therapy (TRT) in men is still conflicting. In particular, safety concerns and cardiovascular (CV) risk related to TRT have not been completely clarified yet. Similarly, the clear beneficial effects of TRT are far to be established.
AIM
To systematically and critically analyze the available literature providing evidence of the benefit-risk ratio derived from TRT in aging men.
METHODS
A comprehensive PubMed literature search was performed to collect all trials, either randomized controlled trials (RCTs) or observational studies, evaluating the effects of TRT on different outcomes.
MAIN OUTCOME MEASURE
Whenever possible, data derived from RCTs were compared with those resulting from observational studies. In addition, a discussion of the available meta-analyses has been also provided.
RESULTS
Data derived from RCT and observational studies clearly documented that TRT can improve erectile function and libido as well as other sexual activities in men with hypogonadism (total T < 12 nM). Conversely, the effect of TRT on other outcomes, including metabolic, mood, cognition, mobility, and bone, is more conflicting. When hypogonadism is correctly diagnosed and managed, no CV venous thromboembolism or prostate risk is observed.
CLINICAL IMPLICATIONS
Before prescribing TRT, hypogonadism (total T < 12 nM) must be confirmed through an adequate biochemical evaluation. Potential contraindications should be ruled out, and an adequate follow-up after the prescription is mandatory.
STRENGTH & LIMITATIONS
When correctly diagnosed and administered, TRT is safe, and it can improve several aspects of sexual function. However, its role in complicated vasculogenic erectile dysfunction is limited. Conversely, TRT is not recommended for weight reduction and metabolic improvement. Further well-powered studies are advisable to better clarify TRT for long-term CV risk and prostate safety in complicated patients as well as in those curatively treated for prostate cancer.
CONCLUSION
TRT results in sexual function improvement when men with hypogonadism (total T < 12 nM) are considered. Positive data in other outcomes need to be confirmed. Corona G, Torres LO, Maggi M. Testosterone Therapy: What We Have Learned From Trials. J Sex Med 2020;17:447-460.
Topics: Aging; Erectile Dysfunction; Hormone Replacement Therapy; Humans; Hypogonadism; Libido; Male; Penile Erection; Randomized Controlled Trials as Topic; Sexual Behavior; Testosterone
PubMed: 31928918
DOI: 10.1016/j.jsxm.2019.11.270 -
The International Journal of... Jun 2016Starting from the theory of the libido and the notions of the experience of satisfaction and the drive for mastery introduced by Freud, the author revisits the notion of... (Review)
Review
Starting from the theory of the libido and the notions of the experience of satisfaction and the drive for mastery introduced by Freud, the author revisits the notion of the drive by proposing the following model: the drive takes shape in the combination of two currents of libidinal cathexis, one which takes the paths of the 'apparatus for obtaining mastery' (the sense-organs, motricity, etc.) and strives to appropriate the object, and the other which cathects the erotogenic zones and the experience of satisfaction that is experienced through stimulation in contact with the object. The result of this combination of cathexes constitutes a 'representation', the subsequent evocation of which makes it possible to tolerate for a certain period of time the absence of a satisfying object. On the basis of this conception, the author distinguishes the representations proper, vehicles of satisfaction, from imagos and traumatic images which give rise to excitation that does not link up with the paths taken by the drives. This model makes it possible to conciliate the points of view of the advocates of 'object-seeking' and of those who give precedence to the search for pleasure, and, further, to renew our understanding of object-relations, which can then be approached from the angle of their relations to infantile sexuality. Destructiveness is considered in terms of "mastery madness" and not in terms of the late Freudian hypothesis of the death drive.
Topics: Drive; Humans; Libido; Paraphilic Disorders; Personal Satisfaction; Psychoanalytic Theory
PubMed: 26643947
DOI: 10.1111/1745-8315.12436 -
The Journal of Sexual Medicine Jun 2023Sexual dysfunction is thought to be highly prevalent in patients with psychiatric disorders. Factors such as the use of psychotropic substances (ie,...
BACKGROUND
Sexual dysfunction is thought to be highly prevalent in patients with psychiatric disorders. Factors such as the use of psychotropic substances (ie, psychopharmaceuticals and drugs), age, or somatic diseases may contribute to sexual problems, but the extent to which psychopathology itself affects sexual functioning is not well understood.
AIM
The study sought to provide an overview of the literature on the prevalence of sexual dysfunction in psychotropic-free and somatic disease-free psychiatric patients.
METHOD
A systematic review (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses]) was conducted by 2 authors (TH and AWMP) independently, with the review process being monitored by a third author. Relevant articles on the relationship between sexual dysfunctions and psychopathology were searched in PubMed, Web of Science, and PsycINFO from inception until June 16, 2022. The study methods were entered in the international register of systematic reviews PROSPERO (2021, CRD42021223410).
OUTCOMES
The main outcome measures were sexual dysfunction and sexual satisfaction.
RESULTS
Twenty-four studies were identified, including a total of 1199 patients. These studies focused on depressive disorders (n = 9 studies), anxiety disorders (n = 7), obsessive- compulsive disorder (OCD) (n = 5), schizophrenia (n = 4), and posttraumatic stress disorder (n = 2). No studies on bipolar disorder were found. Reported prevalence rates of sexual dysfunction in psychiatric disorders were 45% to 93% for depressive disorders, 33% to 75% for anxiety disorders, 25% to 81% for OCD, and 25% for schizophrenia. The most affected phase of the sexual response cycle was sexual desire, in both men and women with depressive disorders, posttraumatic stress disorder, and schizophrenia. Patients with OCD and anxiety disorders most frequently reported dysfunction in the orgasm phase, 24% to 44% and 7% to 48%, respectively.
CLINICAL IMPLICATIONS
The high prevalence of sexual dysfunction requires more clinical attention by means of psychoeducation, clinical guidance, sexual anamnesis, and additional sexological treatment.
STRENGTHS AND LIMITATIONS
This is the first systematic review on sexual dysfunction in psychotropic-free and somatic disease-free psychiatric patients. Limitations include the small number of studies, small sample sizes, the use of multiple questionnaires (some not validated), which may contribute to bias.
CONCLUSION
A limited number of studies identified a high prevalence of sexual dysfunction in patients with a psychiatric disorder, with substantial variation between patient groups in frequency and phase of reported sexual dysfunction.
Topics: Male; Humans; Female; Sexual Dysfunction, Physiological; Sexual Behavior; Schizophrenia; Libido; Stress Disorders, Post-Traumatic
PubMed: 37279603
DOI: 10.1093/jsxmed/qdad074 -
Current Opinion in Urology Nov 2017Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play... (Review)
Review
PURPOSE OF REVIEW
Erectile dysfunction and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide an overview of these findings and the utility of TTh. We specifically examine the role of TTh on erectile function, coadministration with phosphodiesterase type 5 inhibitors, and libido.
RECENT FINDINGS
Recent publications suggest that TTh improves mild erectile dysfunction, though may be less useful in men with more severe erectile dysfunction. In men unresponsive to phosphodiesterase type 5 inhibitors and with mild erectile dysfunction, TTh can further improve erectile function. TTh has also shown consistent benefit in improving libido in men with low testosterone levels at baseline, with no additional improvements once testosterone levels are normalized.
SUMMARY
The available literature supports a role for TTh in men with low testosterone levels, erectile dysfunction, and low libido, with symptomatic improvement in these men.
Topics: Erectile Dysfunction; Humans; Hypogonadism; Libido; Male; Penile Erection; Testosterone
PubMed: 28816715
DOI: 10.1097/MOU.0000000000000442 -
Menopause (New York, N.Y.) Oct 2015Testosterone declines with aging, so most midlife women have "low" testosterone levels. Because libido also declines with aging, and distressing sexual problems peak at... (Review)
Review
Testosterone declines with aging, so most midlife women have "low" testosterone levels. Because libido also declines with aging, and distressing sexual problems peak at midlife, should midlife women with low libido and associated distress be treated with testosterone? This Practice Pearl reports clinical trial evidence, reviews the risks, and explains how testosterone might be used in a clinical setting. For women who may be considering a trial of testosterone therapy, limitations and adverse effects should be disclosed and appropriate monitoring instituted once treatment has begun.
Topics: Female; Humans; Libido; Middle Aged; Postmenopause; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Testosterone
PubMed: 26397145
DOI: 10.1097/GME.0000000000000540 -
Endocrinology and Metabolism Clinics of... Mar 2021The role of testosterone in women and its potential as a therapeutic agent continue to attract controversy. The clinical trials of testosterone therapy for women... (Review)
Review
The role of testosterone in women and its potential as a therapeutic agent continue to attract controversy. The clinical trials of testosterone therapy for women primarily have focused on treatment of female sexual dysfunction, with the largest placebo-controlled studies being of transdermal testosterone in postmenopausal women. Based on the cumulative data from these studies, loss of sexual desire with associated personal distress currently is the only agreed-on indication for judicious testosterone supplementation for postmenopausal women. This article reviews the physiology of testosterone in women, summarizes the findings from observational studies and clinical trials, and considers indications for testosterone use.
Topics: Administration, Cutaneous; Androgens; Female; Humans; Libido; Postmenopause; Sexual Dysfunctions, Psychological; Testosterone
PubMed: 33518180
DOI: 10.1016/j.ecl.2020.11.002