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Clinical Anatomy (New York, N.Y.) Jan 2020Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal... (Review)
Review
Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO , vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de-coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated-they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat. 32:136-145, 2019. © 2019 Wiley Periodicals, Inc.
Topics: Arousal; Circumcision, Female; Clitoris; Female; Fertility; Humans; Reproduction; Sexual Behavior; Vagina
PubMed: 31691374
DOI: 10.1002/ca.23498 -
Frontiers in Medicine 2021With the onset of the coronavirus disease 2019 (COVID-19) pandemic at the beginning of 2020, all non-essential medical treatments were suspended, including fertility...
With the onset of the coronavirus disease 2019 (COVID-19) pandemic at the beginning of 2020, all non-essential medical treatments were suspended, including fertility treatments. As a unique group in society, patients with infertility may be more sensitive and vulnerable in the face of pressure and crisis. However, to the best of our knowledge, there have been no reports on the influence of postponed fertility treatment on the sexual health of infertile patients owing to COVID-19. Therefore, this study aimed to investigate whether postponed fertility treatment resulting from COVID-19 affects the sexual health of patients with infertility. A total of 1,442 participants were included for analysis in this large-scale study. Those with postponed fertility treatment were categorised as group A ( = 474), whereas those whose fertility treatment was not delayed were in group B ( = 968). The sexual health and psychological well-being were compared between the two groups. The total Female Sexual Function Index score and five domains of female sexual function (arousal ability, vaginal lubrication, orgasm, satisfaction, and coital pain) were significantly lower in group A than those in group B ( < 0.05). The International Index of Erectile Dysfunction score and Premature Ejaculation Diagnostic Tool score were significantly higher in group A than those in group B ( < 0.05). Delaying fertility treatment obviously affects patients' sexual and mental health. Through a structural equation model, we observed that postponed fertility treatment mediates sexual health by regulating psychological distress and couple relationship quality.
PubMed: 34957137
DOI: 10.3389/fmed.2021.730994 -
Urologiia (Moscow, Russia : 1999) Mar 2023Ejaculation disorders occur in 62-75% of patients after surgical treatment for benign prostatic hyperplasia (BPH). Despite the development and widespread introduction...
INTRODUCTION
Ejaculation disorders occur in 62-75% of patients after surgical treatment for benign prostatic hyperplasia (BPH). Despite the development and widespread introduction into clinical practice of laser procedures, which have reduced the overall incidence of complications, the frequency of ejaculatory disorders is still high. This complication negatively affects the quality of life of patients.
AIM
To study the nature of ejaculation disorders in patients with BPH after surgical treatment. In this work, we did not compare the effect of various surgical methods and techniques in patients with BPH on ejaculation. At the same time, we selected the most widely used procedures in routine urological practice and assessed the presence and development of ejaculatory dysfunction prior to and after surgery. It should be emphasized that we determined the disorders that occurred in the same patients in whom ejaculatory function was evaluated prior to surgery.
MATERIALS AND METHODS
A prospective study of the ejaculatory function of 224 sexually active men aged 49 to 84 years with LUTS/ BPH before and after surgical treatment was performed. From 2018 to 2021, thulium laser enucleation of prostatic hyperplasia (ThuLep) was done in 72 patients, conventional TURP in 136 patients, and 16 patients underwent open transvesical simple prostatectomy. Surgical treatment was carried out by certified urologists with extensive experience. ThuLep and conventional TURP were not ejaculatory-sparing. All patients underwent a standard examination for LUTS/ BPH pre- and postoperatively, including IPSS score, uroflowmetry to determine the maximum urine flow rate (Qmax), PSA, urinalysis, transrectal ultrasound examination with a calculation of prostate volume, postvoid residual. The erectile function was assessed according to the IIEF-5 score. Ejaculation function was evaluated according to the Male Sexual Health Questionnaire (MSHQ-EjD) preoperatively and at 3- and 6-months follow-up. For the diagnosis of premature ejaculation, CriPS questionnaire was used. For the differential diagnosis of retrograde ejaculation and anejaculation after surgical treatment, patients underwent an analysis of post-orgasmic urine for the presence and quantity of spermatozoa.
RESULTS
The average age of patients was 64 years. At baseline, various ejaculatory disorders were detected in 61.6% of cases. In 48.2% of patients (n=108) a decrease in the ejaculate volume was found, while 47.3% (n=106) noted a decrease in the intensity of ejaculation. In 15.2% of cases (n=34), acquired premature ejaculation was detected, and 17% (n=38) men reported pain or discomfort during ejaculation. In addition, 11.6% (n=26) had delayed ejaculation during intercourse. There were no patients with anejaculation at baseline. The average score on the IIEF-5 scale was 17.9, and on the IPSS scale 21.5 points. Three months after surgical treatment, the following disorders of ejaculation were documented: retrograde ejaculation in 78 (34.8%), anejaculation in 90 (40.2%) patients. In the remaining 56 (25%) men, antegrade ejaculation was preserved. Among those with antegrade ejaculation, an additional survey was carried out, which showed a decrease in ejaculate volume and in the intensity of ejaculation in 46 (20.5%) and 36 (16.1%) cases, respectively. Pain during ejaculation was noted by 4 (1.8%) men, however, there was neither premature nor delayed ejaculation after surgical treatment.
CONCLUSION
In patients with BPH, the predominate types of ejaculation disorders before surgical treatment were as following: a decrease in ejaculate volume (48.2%), a decrease in the speed (intensity) of ejaculation (47.3%), painful ejaculation (17%), premature ejaculation (15.2%), and delayed ejaculation (11.6%). After surgical treatment, retrograde ejaculation (34.8%, n=78) and anejaculation (40.2%, n=90) prevailed.
Topics: Humans; Male; Middle Aged; Female; Prostatic Hyperplasia; Premature Ejaculation; Quality of Life; Prospective Studies; Ejaculation; Pain; Lower Urinary Tract Symptoms
PubMed: 37401683
DOI: No ID Found -
Cells Jul 2021Post orgasmic illness syndrome is a rare, mysterious condition with an unknown pathomechanism and uncertain treatment. The symptoms of post orgasmic illness syndrome...
Post orgasmic illness syndrome is a rare, mysterious condition with an unknown pathomechanism and uncertain treatment. The symptoms of post orgasmic illness syndrome last about 2-7 days after an ejaculation. The current hypothesis proposes that the primary injury in post orgasmic illness syndrome is an acute compression proprioceptive axonopathy in the muscle spindle, as is suspected in delayed onset muscle soreness. The terminal arbor degeneration-like lesion of delayed onset muscle soreness is theorized to be an acute stress response energy-depleted dysfunctional mitochondria-induced impairment of Piezo2 channels and glutamate vesicular release. The recurring symptoms of post orgasmic illness syndrome after each ejaculation are suggested to be analogous to the repeated bout effect of delayed onset muscle soreness. However, there are differences in the pathomechanism, mostly attributed to the extent of secondary tissue damage and to the extent of spermidine depletion. The spermidine depletion-induced differences are as follows: modulation of the acute stress response, flu-like symptoms, opioid-like withdrawal and enhanced deregulation of the autonomic nervous system. The longitudinal dimension of delayed onset muscle soreness, in the form of post orgasmic illness syndrome and the repeated bout effect, have cognitive and memory consequences, since the primary injury is learning and memory-related.
Topics: Animals; Ejaculation; Humans; Ion Channels; Male; Muscle Contraction; Muscle Spindles; Muscle, Skeletal; Myalgia; Orgasm; Peripheral Nervous System Diseases; Proprioception; Receptors, N-Methyl-D-Aspartate; Receptors, Opioid; Spermidine; Stress, Physiological; Syndrome; Time Factors
PubMed: 34440637
DOI: 10.3390/cells10081867 -
The Journal of Sexual Medicine Mar 2023Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE).
BACKGROUND
Little is known regarding the demographic, sexual, and relationship characteristics of men with symptoms of delayed ejaculation (DE).
AIM
To identify differences between men with and without DE symptomology to validate face-valid diagnostic criteria and to identify various functional correlates of DE.
METHODS
A total of 2679 men meeting inclusion criteria were partitioned into groups with and without DE symptomology on the basis of their self-reported "difficulty reaching ejaculation/orgasm during partnered sex." Men were then compared on a broad array of demographic and relationship variables, as well as sexual response variables assessed during partnered sex and masturbation.
OUTCOMES
Outcomes included the identified differences between men with and without DE symptomology.
RESULTS
Men with DE-whether having comorbid erectile dysfunction or not-differed from men without DE on 5 face-valid variables related to previously proposed diagnostic criteria for DE, including ones related to ejaculation latency (P < .001); self-efficacy related to reaching ejaculation, as assessed by the percentage of episodes reaching ejaculation during partnered sex (P < .001); and negative consequences of the impairment, including "bother/distress" and (lack of) "orgasmic pleasure/sexual satisfaction" (P < .001). All such differences were associated with medium to large effect sizes. In addition, men showed differences on a number of functional correlates of DE, including anxiety, relationship satisfaction, frequency of partnered sex and masturbation, and level of symptomology during partnered sex vs masturbation (P < .001).
CLINICAL IMPLICATIONS
Face-valid criteria for the diagnosis of DE were statistically verified, and functional correlates of DE relevant to guiding and focusing treatment were identified.
STRENGTHS AND LIMITATIONS
In this first comprehensive analysis of its kind, we have demonstrated widespread differences on sexual and relationship variables relevant to the diagnosis of DE and to its functional correlates between men with and without DE symptomology during partnered sex. Limitations include participant recruitment through social media, which likely biased the sample; the use of estimated rather than clocked ejaculation latencies; and the fact that differences between men with acquired and lifelong DE were not investigated.
CONCLUSION
This well-powered multinational study provides strong empirical support for several face-valid measures for the diagnosis of DE, with a number of explanatory and control covariates that may help shed light on the lived experiences of men with DE and suggest focus areas for treatment. Whether or not the DE men had comorbid erectile dysfunction had little impact on the differences with men having normal ejaculatory functioning.
Topics: Male; Humans; Ejaculation; Erectile Dysfunction; Sexual Behavior; Masturbation; Sexual Partners; Premature Ejaculation
PubMed: 36781403
DOI: 10.1093/jsxmed/qdad008 -
Neurological Sciences : Official... May 2020Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of...
BACKGROUND
Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS.
METHODS
This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis.
RESULTS
Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002).
CONCLUSION
According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Iran; Multiple Sclerosis; Prevalence; Sexual Dysfunction, Physiological; Surveys and Questionnaires
PubMed: 31897948
DOI: 10.1007/s10072-019-04222-6 -
The Journal of Sexual Medicine Aug 2019Mechanisms underlying delayed orgasm (DO) are poorly understood; however, known effects of psychotropic medications on sexual function provides a rationale for aberrant...
Functional Magnetic Resonance Imaging Detects Between-Group Differences in Neural Activation Among Men with Delayed Orgasm Compared with Normal Controls: Preliminary Report.
BACKGROUND
Mechanisms underlying delayed orgasm (DO) are poorly understood; however, known effects of psychotropic medications on sexual function provides a rationale for aberrant central nervous system signaling as a cause.
AIM
To compare brain activation between men with normal orgasm and those with lifelong DO during sexual stimulation using brain fMRI algorithms.
METHODS
3 subjects with self-reported life-long DO and 6 normal controls were included in this study. The International Index of Erectile Function, Male Sexual Health Questionnaire, and self-reported time to orgasm were used to assess sexual function. Subjects underwent a 3-T fMRI study while viewing 3 video clips: a neutral control (NC), a positive emotional control (EC), and a sexual condition (SC). Each video sequence was repeated 5 times, with 50-second clips presented in a randomized fashion. fMRI data were analyzed in a block design manner to determine areas of differential brain activation between groups. The Allen Brain Atlas of gene expression in the human brain was used to identify signaling pathways in the areas of differential fMRI activation between the DO and control groups.
OUTCOMES
The primary outcome was differential activation of fMRI neural activation between groups.
RESULTS
Analysis of differential activation in the SC compared with the NC and EC revealed increased activation in the right frontal operculum (P = .003), right prefrontal gyrus (P = .003), and inferior occipital gyrus (P = .003). Increased activation in the right fusiform gyrus of the occipital lobe and the right hippocampus (P = .0004) was seen in the DO group compared with controls. Using the Allen Atlas of Human Brain Expression, we identified corresponding neurotransmitter receptors to this region, including adenosine receptors, muscarinic and nicotinic cholinergic receptors, cannabinoid receptors, and dopamine receptors, among others.
CLINICAL IMPLICATIONS
Lifelong DO in men may be due to abnormal neurotransmitter signaling leading to poor progression of arousal due to aberrant processing of sexual cues. Identification of neurotransmitter pathways by fMRI will aid the development of pharmacotherapeutic agents.
STRENGTHS & LIMITATIONS
Strengths of this study include the novel application of functional neuroimaging to investigate the pathogenesis of DO. Limitations include the small sample size, making this study exploratory in nature.
CONCLUSION
This study revealed differences in brain activation on visualization of sexual stimuli in men with a history of DO compared with controls. Identified regions are rich in numerous neurotransmitter receptor subtypes and may be amenable to pharmacologic targeting to identify novel therapies for these men. Flannigan R, Heier L, Voss H, et al. Functional Magnetic Resonance Imaging Detects Between-Group Differences in Neural Activation Among Men with Delayed Orgasm Compared with Normal Controls: Preliminary Report. J Sex Med 2019:16;1246-1254.
Topics: Adult; Algorithms; Arousal; Brain; Case-Control Studies; Emotions; Female; Functional Neuroimaging; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Orgasm; Sexual Behavior; Sexual Dysfunctions, Psychological; Young Adult
PubMed: 31303572
DOI: 10.1016/j.jsxm.2019.05.007 -
Journal of Clinical Medicine Jan 2024Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary...
UNLABELLED
Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD in naturalistic settings.
STUDY OBJECTIVES
To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting.
METHODOLOGY
observational pragmatic and naturalistic study to determine the effectiveness of the switch to vortioxetine (mean dosage 13.11 ± 4.03) in 74 patients aged 43.1 ± 12.65 (54% males) at risk of discontinuing treatment due to sexual dysfunction. The PRSexDQ*- SALSEX scale ( Psychotropic-Related Sexual Dysfunction Questionnaire) was applied at two moments: baseline visit and after 3 months of follow-up.
RESULTS
global Sexual Dysfunction (SD) measured with the SALSEX scale decreased significantly between the baseline visit (10.32; SD 2.73) and the follow-up visit (3.78; SD 3.68), < 0.001. There was a significant improvement ( < 0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to vortioxetine, 83.81% of patients experienced an improvement in sexual function (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. A total of 58.1% of patients showed an improvement in depressive symptoms from the baseline visit.
CONCLUSION
switching to vortioxetine is an effective and reliable strategy to treat patients with poorly tolerated previous antidepressant-related sexual dysfunction in real-life clinical settings.
PubMed: 38256680
DOI: 10.3390/jcm13020546 -
Chronobiology International Sep 2022Chronotype can be defined as an overt expression of circadian rhythmicity in an individual that dictates tendencies towards being a morning or evening person - also...
Chronotype can be defined as an overt expression of circadian rhythmicity in an individual that dictates tendencies towards being a morning or evening person - also referred to as 'morningness' or 'eveningness.' Chronotypes generally impact preferred bed and wake times, in addition to a range of personal and social factors. This study examined how matching/mismatching chronotypes within relationships impact sexual satisfaction and sleep quality. A sample of 32 couples (52% females, 38.3 ± 11.7 years) each completed an online survey that assessed chronotype (reduced Morningness Eveningness Questionnaire), sleep (Pittsburgh Sleep Quality Index), and sexual satisfaction (Index of Sexual Satisfaction). Partner surveys were matched to identify whether chronotypes were matching or mismatching. Couples with matched chronotypes reported greater sexual satisfaction than those with mismatched chronotypes, F(1, 58) = 19.57, p < .001. Matched couples also reported better sleep quality than couples whose chronotypes were mismatched, F(1,62) = 48.02, p < .001. The individual chronotype did not seem to impact on sleep quality or sexual satisfaction. To improve sleep quality and sexual satisfaction, strategies (e.g., circadian phase advance or delay) could be used to increase circadian alignment between members of a couple.
Topics: Circadian Rhythm; Cross-Sectional Studies; Female; Humans; Male; Orgasm; Sleep; Surveys and Questionnaires
PubMed: 35762311
DOI: 10.1080/07420528.2022.2093213 -
Medical Hypotheses May 2020Based on the ancient role of oxytocin and its homologues as amplifiers of reproduction we argue for an evolutionary coupling of oxytocin to signaling pathway which...
Based on the ancient role of oxytocin and its homologues as amplifiers of reproduction we argue for an evolutionary coupling of oxytocin to signaling pathway which support restorative mechanisms of cells and tissue. In particular, the survival and function of different categories of stem cells and primordial cells are enhanced by mitogen-activated protein kinase (MAPK) pathways. Furthermore, oxytocin stimulates the AMP-activated protein kinase pathway (AMPK) in numerous of cell types which promotes the maintenance of different cell structures. This involves autophagic processes and, in particular, may support the renewal of mitochondria. Mitochondrial fitness may protect against oxidative and inflammatory stress - a well-documented effect of oxytocin. The combined specific trophic and protective effects oxytocin may delay several degenerative phenomena including sarcopenia, type-2 diabetes and atherosclerosis. These effects may be exerted both on a central level supporting the function and integrity of the hypothalamus and peripherally acting directly on blood vessels, pancreas, heart, skeletal muscles and adipose tissue etc. Furthermore, in the capacity of being both a hormone and neuromodulator, oxytocin interacts with numerous of regulatory mechanisms particularly the autonomic nervous system and HPA-axis which may reduce blood pressure and affect the immune function. The potential of the oxytocin system as a behavioral and molecular target for the prevention and treatment of cardiovascular disease is discussed. Focus is put on the affiliative and sexual significance and the different options and limitations associated with a pharmaceutical approach. MeSH: Aging, Atherosclerosis, Heart, Hypothalamus, Inflammation, Love, Orgasm, Oxytocin.
Topics: Cardiovascular Diseases; Humans; Hypothalamus; Oxytocin; Pharmaceutical Preparations; Sarcopenia
PubMed: 32032912
DOI: 10.1016/j.mehy.2020.109597