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BJPsych Open Jul 2018Sexual dysfunctions are associated with multiple medical and psychiatric disorders, as well as pharmacotherapies used to treat these disorders. Although sexual...
BACKGROUND
Sexual dysfunctions are associated with multiple medical and psychiatric disorders, as well as pharmacotherapies used to treat these disorders. Although sexual dysfunctions negatively affect both quality of life and treatment adherence, patients infrequently volunteer these symptoms and clinicians do not pose directed questions to determine their presence or severity. This issue is especially important in psychiatric patients, for whom most common psychotropics may cause sexual dysfunctions (antidepressants, antipsychotics, anxiolytics and mood-stabilising agents). There is limited literature addressing benzodiazepines, and alprazolam in particular.
AIMS
To report dose-dependent alprazolam anorgasmia.
METHOD
Case analysis with PubMed literature review.
RESULTS
A 30-year-old male psychiatric patient presented with new-onset anorgasmia in the context of asymptomatic generalised anxiety disorder, social anxiety, panic disorder with agoraphobia, obsessive-compulsive disorder, major depression in remission, and attention-deficit hyperactivity disorder treated with escitalopram 10 mg q.a.m., gabapentin 1000 mg total daily dose, lisdexamfetamine dimesylate 70 mg q.a.m., nortriptyline 60 mg q.h.s. and alprazolam extended-release 2.5 mg total daily dose. All psychotropic doses had been constant for >6 months excluding alprazolam, which was titrated from 1 mg to 2.5 mg total daily dose. The patient denied any sexual dysfunction with alprazolam at 1 mg q.d. and 1 mg b.i.d. Within 1 week of increasing alprazolam to 2.5 mg total daily dose, the patient reported anorgasmia. Anorgasmia was alprazolam dose-dependent, as anorgasmia resolved with reduced weekend dosing (1 mg b.i.d. Saturday/1.5 mg total daily dose Sunday).
CONCLUSIONS
Sexual dysfunction is an important adverse effect negatively influencing therapeutic outcome. This case reports alprazolam-induced dose-dependent anorgasmia. Clinicians/patients should be aware of this adverse effect. Routine sexual histories are indicated.
DECLARATION OF INTEREST
None.
PubMed: 30083378
DOI: 10.1192/bjo.2018.35 -
Cureus Feb 2023A 72-year-old man with cardiovascular disease, depression, and anxiety presented to a chiropractor with a six-year history of anorgasmia, anejaculation, and erectile...
A 72-year-old man with cardiovascular disease, depression, and anxiety presented to a chiropractor with a six-year history of anorgasmia, anejaculation, and erectile dysfunction as well as chronic, episodic low back pain. He previously saw a neurologist, two urologists, and had extensive and expensive testing, including brain, cervical, thoracic, lumbar, and pelvic imaging and electrodiagnostic testing. The patient had a disc bulge at L5/S1 causing moderate spinal canal stenosis while other testing was relatively normal. He had previously tried discontinuing a selective serotonin reuptake inhibitor, trialing psychological counseling, and administering penile injections, all without any improvement in sexual function. The chiropractor identified lower extremity weakness, sensory, reflex, and balance deficits and initiated a one-month trial of care, applying lumbar mobilizations and thrust manipulation at L1/2. The patient reported resolution of anorgasmia and anejaculation the first week, which was maintained over a total three months' follow-up. Low back pain also did not return. The current case report highlights the apparent success of lumbar spinal manipulation in improving anorgasmia and anejaculation in an older man. This response may be explained in that the sympathetic (T10-L2) and somatic (S2-4) innervation required for male orgasm and ejaculation is derived from the lumbosacral region. Further research is needed to determine if these findings are reproducible.
PubMed: 36909050
DOI: 10.7759/cureus.34719 -
Annals of Physical and Rehabilitation... Jul 2014Summarize the data on sexual disorders in women with multiple sclerosis (MS). (Review)
Review
OBJECTIVES
Summarize the data on sexual disorders in women with multiple sclerosis (MS).
METHOD
Review of 99 Pubmed articles covering sexual dysfunction in women with MS.
RESULTS
Prevalence of dysfunction in women with MS varies from 34% to 85%. They include poor vaginal lubrication, poor clitoral erection, and anorgasmia, which correlate with level of disability. Specific brain stem and pyramidal lesions appear to correlate with anorgasmia. Age and duration of the disease correlate with sexual disorders, but not age at onset. Secondary consequences of MS, including bladder and bowel dysfunction, spasticity, pain, fatigue, depression, anxiety, and side effects of medication contribute to sexual dysfunction. Treatments can involve alpha-blockers or phosphodiesterase-5 inhibitors to increase smooth muscle relaxation, while lubricants and oestrogen therapy can help vaginal dryness, burning and dyspareunia. Antidepressants can delay (or abolish) orgasm, suggesting reducing dosage or combining them with PDE5 inhibitors. Counselling should emphasize planning sexual activities, reducing fatigue, managing positions, preventing incontinence, promoting sexual aids, extra-genital and other sexual options to achieve pleasurable and intimacy. Psychosocial interventions should include couples' relationship and communication skills to increase satisfaction.
CONCLUSION
Sexual dysfunctions in women with MS are amenable to treatments covering primary, secondary and tertiary consequences of the disease.
Topics: Female; Humans; Multiple Sclerosis; Sexual Dysfunction, Physiological
PubMed: 24930089
DOI: 10.1016/j.rehab.2014.05.008 -
Neuropsychiatric Disease and Treatment 2015Human sexuality is contingent upon many biological and psychological factors. Such factors include sexual drive (libido), physiological arousal (lubrication/erection),... (Review)
Review
Human sexuality is contingent upon many biological and psychological factors. Such factors include sexual drive (libido), physiological arousal (lubrication/erection), orgasm, and ejaculation, as well as maintaining normal menstrual cycle. The assessment of sexual dysfunction can be difficult due to the intimate nature of the problem and patients' unwillingness to discuss it. Also, the problem of dysfunction is often overlooked by doctors. Atypical antipsychotic treatment is a key component of mental disorders' treatment algorithms recommended by the National Institute of Health and Clinical Excellence, the American Psychiatric Association, and the British Society for Psychopharmacology. The relationship between atypical antipsychotic drugs and sexual dysfunction is mediated in part by antipsychotic blockade of pituitary dopamine D2 receptors increasing prolactin secretion, although direct correlations have not been established between raised prolactin levels and clinical symptoms. Variety of mechanisms are likely to contribute to antipsychotic-related sexual dysfunction, including hyperprolactinemia, sedation, and antagonism of a number of neurotransmitter receptors (α-adrenergic, dopaminergic, histaminic, and muscarinic). Maintaining normal sexual function in people treated for mental disorders can affect their quality of life, mood, self-esteem, attitude toward taking medication, and compliance during therapy.
PubMed: 26185449
DOI: 10.2147/NDT.S84528 -
Archives of Medical Science : AMS 2022Many biological, psychological and sociocultural factors influence the prevalence of sexual dysfunctions and sexual behavior. The purpose of the study was to evaluate...
INTRODUCTION
Many biological, psychological and sociocultural factors influence the prevalence of sexual dysfunctions and sexual behavior. The purpose of the study was to evaluate the prevalence of sexual dysfunctions and sexual behaviors.
MATERIAL AND METHODS
The study was the third edition of a general population-based, cross sectional survey, evaluating sexual attitude, sexual behaviors within and outside relationships and type of sexual dysfunctions present in the Polish population. The survey consisted of 82 questions, grouped into five blocks that contained open- and closed-ended general questions, inquiries about early sexual contacts, sex life, relationships, sexual behaviors and preferences. A standard questionnaire was used to obtain data on age, education, marital status, religious beliefs, medical history, disabilities and other illnesses. A total of 1054 responders aged from 18 to over 70 years participated in the study. Risk factors and other causes contributing to certain sexual dysfunctions defined in the DSM-5 and in the available literature were analyzed.
RESULTS
In this research, 40% of women and 36.5% of men had at least one sexual dysfunction. Analysis of the total population showed that decreased sexual desire (29.0%), occasional climaxing (28.5%) and anorgasmia (21.0%) were the dysfunctions most frequently reported by women. In men, premature ejaculation (23%) and excessive sexual needs (16.3%) were most prevalent. Both men and women with arousal problems reported significantly more comorbid sexual dysfunctions ( < 0.001).
CONCLUSIONS
Sexual dysfunctions are highly prevalent in the Polish population. Of note, it is alarming that only very few patients seek professional help when sexual problems occur.
PubMed: 35832714
DOI: 10.5114/aoms.2019.86794 -
Journal of Clinical Medicine Oct 2019Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is often associated with sexual dysfunction (SD). Given its... (Review)
Review
Major depressive disorder is a serious mental disorder in which treatment with antidepressant medication is often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) has a low rate of spontaneous reports by patients, and this side effect therefore remains underestimated in clinical practice and in technical data sheets for antidepressants. Moreover, the issue of TESD is rarely routinely approached by clinicians in daily praxis. TESD is a determinant for tolerability, since this dysfunction often leads to a state of patient distress (or the distress of their partner) in the sexually active population, which is one of the most frequent reasons for lack of adherence and treatment drop-outs in antidepressant use. There is a delicate balance between prescribing an effective drug that improves depressive symptomatology and also has a minimum impact on sexuality. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antidepressant with a low rate of TESD) to possible pharmacological interventions aimed at improving patients' tolerability when TESD is present. The suggested recommendations include the following: for low sexual desire, switching to a non-serotoninergic drug, lowering the dose, or associating bupropion or aripiprazole; for unwanted orgasm delayal or anorgasmia, dose reduction, "weekend holiday", or switching to a non-serotoninergic drug or fluvoxamine; for erectile dysfunction, switching to a non-serotoninergic drug or the addition of an antidote such as phosphodiesterase 5 inhibitors (PD5-I); and for lubrication difficulties, switching to a non-serotoninergic drug, dose reduction, or using vaginal lubricants. A psychoeducational and psychotherapeutic approach should always be considered in cases with poorly tolerated sexual dysfunction.
PubMed: 31591339
DOI: 10.3390/jcm8101640 -
Fertility and Sterility Nov 2015There are a variety of dysfunctions of the ejaculatory process which may negatively impact male fertility but are not commonly discussed. The meanings of the terms used...
There are a variety of dysfunctions of the ejaculatory process which may negatively impact male fertility but are not commonly discussed. The meanings of the terms used to describe these conditions are often unclear. This month's Views and Reviews define the commonly used and confused terms. The initial article explains normal male function with an emphasis on the ejaculatory process. Following articles discuss the causes, evaluation and management of the male with ejaculatory dysfunction.
Topics: Animals; Ejaculation; Fertility; Humans; Infertility, Male; Male; Penis; Risk Factors; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological
PubMed: 26432529
DOI: 10.1016/j.fertnstert.2015.09.026 -
Clinics (Sao Paulo, Brazil) 2011Orgasmic dysfunction in women is characterized by persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase. Research has shown...
INTRODUCTION
Orgasmic dysfunction in women is characterized by persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase. Research has shown that almost two thirds of women have concerns about their sexual relationship. Sexual dysfunction has many problems for couples; some researchers found that up to 67% of divorces related to sexual disorders.
OBJECTIVE
The aim of this cross-sectional study was to assess the prevalence and related factors of anorgasmia among reproductive age Iranian women.
METHODS
This study was conducted in 2006-7 in Hesarak, Karaj, Iran. A total of 1200 women were randomly recruited to the study. Sexual satisfaction questions were prepared according to the Enrich Sexual Satisfaction Questionnaire. Orgasms were assessed according to the relevant questions in the Female Sexual Function Index (FSFI) questionnaire. The data were analyzed using SPSS version 11; Chi-square, Mann-Whitney and independent t-test were used for statistical purposes.
RESULTS
This study showed that the prevalence of anorgasmia among Iranian women in Hesarak, Karaj, was 26.3%. There was a significant difference between the anorgasmic and normal orgasm groups regarding the women's age, age at marriage, duration of marriage and education during puberty (p<0.05). Some psychological factors, e.g. anxiety, fatigue, pain, feeling of guilt, anti-masculine feelings and embarrassment in sexual relationships were higher in the anorgasmic group (p<0.001).
DISCUSSION
The results of this study showed that the prevalence of anorgasmia in Hesarak is high and most of the anorgasmic women were highly unsatisfied with their sexual relationship compared to the normal orgasm group.
CONCLUSION
The prevalence of anorgasmia among Iranian women in Hesarak, Karaj, is high and some socio-demographic and psychological factors have a strong relationship with anorgasmia.
Topics: Adolescent; Adult; Age Factors; Case-Control Studies; Cross-Sectional Studies; Female; Humans; Iran; Middle Aged; Orgasm; Personal Satisfaction; Prevalence; Risk Factors; Sexual Behavior; Sexual Dysfunctions, Psychological; Socioeconomic Factors; Statistics, Nonparametric; Surveys and Questionnaires; Young Adult
PubMed: 21437441
DOI: 10.1590/s1807-59322011000100015 -
Agri : Agri (Algoloji) Dernegi'nin... Nov 2020Recent studies have shown a more frequent occurrence of sexual dysfunction in patients with headache. The aim of this study was to assess the effects of demographic and...
OBJECTIVES
Recent studies have shown a more frequent occurrence of sexual dysfunction in patients with headache. The aim of this study was to assess the effects of demographic and clinical characteristics and psychiatric symptoms on sexual dysfunction in Turkish female patients with migraine.
METHODS
In all, 18 sexually active patients with episodic migraine (EM), 12 patients with chronic migraine (CM), and 22 healthy controls of similar age were enrolled in the study. A numeric rating scale was administered to assess pain intensity. The psychiatric symptoms and sexual function of all of the participants were evaluated using the Beck depression and anxiety scales and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).
RESULTS
The mean GRISS subscale scores did not differ significantly between the migraine groups and the control group (all p values <0.05). A positive correlation was found between the duration of headache and GRISS subscales of noncommunication, dissatisfaction, vaginismus, and anorgasmia in EM patients. In addition, there was a negative correlation with the infrequency and avoidance subscales. No correlation was detected between the GRISS subscale scores and the demographic and clinical characteristics of the patients with CM, with the exception of the level of education. Higher pain intensity scores and the presence of anxiety or depression among the EM and CM patients significantly affected all of the subscale scores of the sexual function inventory.
CONCLUSION
Although there was no relationship between migraine chronicity and sexual dysfunction, our data indicated that patient demographic characteristics, greater pain severity, and comorbidities of depression or anxiety were associated with greater sexual dysfunction among patients with EM and CM.
Topics: Adolescent; Adult; Case-Control Studies; Female; Humans; Middle Aged; Migraine Disorders; Risk Factors; Severity of Illness Index; Sexual Behavior; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Turkey; Young Adult
PubMed: 33398864
DOI: 10.14744/agri.2020.47640 -
The Journal of Sexual Medicine Nov 2017Although the literature on imaging of regional brain activity during sexual arousal in women and men is extensive and largely consistent, that on orgasm is relatively...
BACKGROUND
Although the literature on imaging of regional brain activity during sexual arousal in women and men is extensive and largely consistent, that on orgasm is relatively limited and variable, owing in part to the methodologic challenges posed by variability in latency to orgasm in participants and head movement.
AIM
To compare brain activity at orgasm (self- and partner-induced) with that at the onset of genital stimulation, immediately before the onset of orgasm, and immediately after the cessation of orgasm and to upgrade the methodology for obtaining and analyzing functional magnetic resonance imaging (fMRI) findings.
METHODS
Using fMRI, we sampled equivalent time points across female participants' variable durations of stimulation and orgasm in response to self- and partner-induced clitoral stimulation. The first 20-second epoch of orgasm was contrasted with the 20-second epochs at the beginning of stimulation and immediately before and after orgasm. Separate analyses were conducted for whole-brain and brainstem regions of interest. For a finer-grained analysis of the peri-orgasm phase, we conducted a time-course analysis on regions of interest. Head movement was minimized to a mean less than 1.3 mm using a custom-fitted thermoplastic whole-head and neck brace stabilizer.
OUTCOMES
Ten women experienced orgasm elicited by self- and partner-induced genital stimulation in a Siemens 3-T Trio fMRI scanner.
RESULTS
Brain activity gradually increased leading up to orgasm, peaked at orgasm, and then decreased. We found no evidence of deactivation of brain regions leading up to or during orgasm. The activated brain regions included sensory, motor, reward, frontal cortical, and brainstem regions (eg, nucleus accumbens, insula, anterior cingulate cortex, orbitofrontal cortex, operculum, right angular gyrus, paracentral lobule, cerebellum, hippocampus, amygdala, hypothalamus, ventral tegmental area, and dorsal raphe).
CLINICAL TRANSLATION
Insight gained from the present findings could provide guidance toward a rational basis for treatment of orgasmic disorders, including anorgasmia.
STRENGTHS AND LIMITATIONS
This is evidently the first fMRI study of orgasm elicited by self- and partner-induced genital stimulation in women. Methodologic solutions to the technical issues posed by excessive head movement and variable latencies to orgasm were successfully applied in the present study, enabling identification of brain regions involved in orgasm. Limitations include the small sample (N = 10), which combined self- and partner-induced stimulation datasets for analysis and which qualify the generalization of our conclusions.
CONCLUSION
Extensive cortical, subcortical, and brainstem regions reach peak levels of activity at orgasm. Wise NJ, Frangos E, Komisaruk BR. Brain Activity Unique to Orgasm in Women: An fMRI Analysis. J Sex Med 2017;14:1380-1391.
Topics: Adult; Brain; Brain Mapping; Cerebral Cortex; Clitoris; Female; Humans; Magnetic Resonance Imaging; Male; Orgasm; Sexual Dysfunctions, Psychological
PubMed: 28986148
DOI: 10.1016/j.jsxm.2017.08.014