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Cureus Dec 2023Epilepsy is a chronic neurological disorder characterized by recurrent seizures, necessitating lifelong medication management. One common side effect of these...
Epilepsy is a chronic neurological disorder characterized by recurrent seizures, necessitating lifelong medication management. One common side effect of these medications is sexual dysfunction. In this case report, a 37-year-old male epilepsy patient who was an office clerk by occupation presented at the outpatient department (OPD) of occupational therapy with the chief complaints of anxiety, depression, and sexual dysfunction primarily reporting of anorgasmia, which required longer foreplay to reach an effective erection leading to delayed ejaculation. The patient reported a nine-year history of complicated, partial, and generalized seizures for which he consulted the physician who prescribed him AED (antiepileptic drug) carbamazepine twice a day; however, the symptoms persisted, and the medication was changed to pregabalin. In addition to this, the patient was advised for occupational therapy intervention by the physician. In the occupational therapy department, the patient was assessed for various parameters that involved sexual functioning using the Changes in Sexual Functioning Questionnaire-Male (CSFQ-M), for anxiety using the Generalised Anxiety Disorder-7 (GAD-7) questionnaire, for depression using the Patient Health Questionnaire-9 (PHQ-9), and quality of life (QOL) using the Quality of Life in Epilepsy Inventory - 31 (QOLIE-31) questionnaire. As part of the intervention, occupational therapy was provided to the patient for four months, which mainly focused on three major areas: health promotion, remediation, and modification. Each of these methods was used at all levels of the intervention, as outlined by the EX-Permission, Limited Information, Specific Suggestions, and Intensive Therapy model (P-LI-SS-IT), which reflected positive results, as there was enhanced sexual functioning, reduced symptoms of depression, and anxiety, and improved quality of life. In conclusion, occupational therapists along with doctors and other practitioners should focus on addressing intimacy and sexuality within their practice for epilepsy patients demonstrating symptoms of sexual dysfunction, which will consequently impact an individual's QOL. Additionally, screening and monitoring of sexual dysfunction should be included during the routine assessment of patients with epilepsy.
PubMed: 38283457
DOI: 10.7759/cureus.51153 -
Trials Aug 2020Lactation has a negative effect on female sexual function. Hormonal changes during lactation cause changes which might lead to dyspareunia, lack of libido, and...
BACKGROUND
Lactation has a negative effect on female sexual function. Hormonal changes during lactation cause changes which might lead to dyspareunia, lack of libido, and anorgasmia. There are various pharmacological and non-pharmacological approaches to treat sexual dysfunction. While pharmacological treatment has multiple unwanted side effects, non-pharmacological therapies such as complementary medicine are a potential safer alternative. The aim of this study is to evaluate the effect of ear acupressure on sexual function of lactating women.
METHODS/DESIGN
This is a randomized clinical trial with a parallel sham control group. In this study, 76 lactating women between 6 months and 1 year after childbirth were referred to health care centers in Qazvin City and would be invited to participate. Participants will be divided into intervention (n = 38) and control (n = 38) groups using simple block randomization. Both intervention and sham control groups will be visited over 10 sessions within a 4-day interval. At each visit, the adhesives containing Vaccaria seed will be adhered for the intervention group, while non-latex-based adhesives with no Vaccaria seeds will be placed on the same ear acupoints for the sham control group. Selected ear acupoints include genitalia (two ear points), pelvic point, master shoulder, and posterior pituitary gland. The women will be asked to hold the seeds on their ears for 3 days and press each ear point three times a day for 20 s. After 3 days, they will be asked to remove the seeds from their ears and rest for 1 day. Sexual function as primary outcome in both groups will be assessed using the Female Sexual Function Index before and immediately after 1 and 2 months after the intervention. Also, Sexual Quality of Life as secondary outcome will be assessed using Sexual Quality of Life-Female (SQOL-F) before and 2 months after intervention. Data will be analyzed using repeated measure ANOVA at the significant level of 0.05.
DISCUSSION
This study is expected to support the impact of ear channel ear acupressure on sexual function in lactating women.
TRIAL REGISTRATION
Iranian Clinical Trial Registration Center IRCT20190626044028N1 . Registered on 16 August 2019.
Topics: Acupressure; Auriculotherapy; Female; Humans; Iran; Lactation; Pregnancy; Quality of Life; Randomized Controlled Trials as Topic; Sexual Health
PubMed: 32819441
DOI: 10.1186/s13063-020-04663-x -
Movement Disorders Clinical Practice 2017Autonomic dysfunction is common in the later stages of Parkinson's disease (PD), but less is known about its presence and severity in early disease.
BACKGROUND
Autonomic dysfunction is common in the later stages of Parkinson's disease (PD), but less is known about its presence and severity in early disease.
OBJECTIVE
To analyze features of autonomic dysfunction in recent onset PD cases, and their relationship to motor severity, medication use, other nonmotor symptoms (NMS), and quality-of-life scores.
METHODS
Detailed patient-reported symptoms of autonomic dysfunction were assessed in a multicenter cohort study in PD cases that had been diagnosed within the preceding 3.5 years.
RESULTS
There were 1746 patients (1132 males, 65.2%), mean age 67.6 years (SD 9.3), mean disease duration 1.3 years (SD 0.9), mean Movement Disorder Society Unified Parkinson's Disease Rating Scale motor score 22.5 (SD 12.1). Orthostatic symptoms were reported by 39.6%, male erectile dysfunction by 56.1%, and female anorgasmia by 57.4%. Sialorrhea was an issue in 51.4% of patients, constipation in 43.6%, and dysphagia in 20.1%. Autonomic features increased with higher modified Hoehn and Yahr stages ( < 0.001). The severity of autonomic dysfunction was associated with the postural instability gait difficulty motor phenotype [β-coefficient 1.7, 95% confidence interval (CI) 0.7, 2.6, < 0.001], depression (β-coefficient 4.1, CI 3.0, 5.2, < 0.001), and excess daytime sleepiness (β-coefficient 3.1, CI 1.9, 4.2, < 0.001). Dopamine agonists were the only drug class associated with greater autonomic dysfunction ( = 0.019). The severity of autonomic dysfunction strongly correlated with the presence of other NMS (ρ = 0.717, < 0.001), and with poorer quality-of-life scores (ρ = 0.483, < 0.001).
CONCLUSIONS
Autonomic dysfunction is common in early PD. Autonomic dysfunction correlates with the presence of other NMS, and with worse quality of life.
PubMed: 30363477
DOI: 10.1002/mdc3.12454 -
British Journal of Pharmacology Dec 19981. Ejaculatory problems and anorgasmia are well-known side-effects of the SSRI antidepressants, and a pharmacologically induced increase in serotonergic...
Facilitation and inhibition of male rat ejaculatory behaviour by the respective 5-HT1A and 5-HT1B receptor agonists 8-OH-DPAT and anpirtoline, as evidenced by use of the corresponding new and selective receptor antagonists NAD-299 and NAS-181.
1. Ejaculatory problems and anorgasmia are well-known side-effects of the SSRI antidepressants, and a pharmacologically induced increase in serotonergic neurotransmission inhibits ejaculatory behaviour in the rat. In the present study the role of 5-HT1A and 5-HT1B receptors in the mediation of male rat ejaculatory behaviour was examined by use of selective agonists and antagonists acting at these 5-HT receptor subtypes. 2. The 5-HT1A receptor agonist 8-OH-DPAT (0.25-4.00 micromol kg(-1) s.c.) produced an expected facilitation of the male rat ejaculatory behaviour, and this effect was fully antagonized by pretreatment with the new selective 5-HT1A receptor antagonist (R)-3-N,N-dicyclobutylamino-8-fluoro-3,4-dihydro-2H-1-benzopyran-5 -carboxamide hydrogen (2R,3R) tartrate monohydrate (NAD-299) (1.0 micromol kg(-1) s.c.). NAD-299 by itself (0.75-3.00 micromol kg(-1) s.c.) did not affect the male rat ejaculatory behaviour. 3. The 5-HT1B receptor agonist anpirtoline (0.25-4.00 micromol kg(-1) s.c.) produced a dose-dependent inhibition of the male rat ejaculatory behaviour, and this effect was fully antagonized by pretreatment with the 5-HT1B receptor antagonist isamoltane (16 micromol kg(-1) s.c.) as well as by the new and selective antagonist (R)-(+)-2-(3-morpholinomethyl-2H-chromene-8-yl)oxymethylmorphol ino methansulphonate (NAS-181) (16 micromol kg(-1) s.c.). Isamoltane (1.0-16.0 micromol kg(-1) s.c.) and NAD-181 (1.0-16.0 micromol kg(-1) s.c.) had no, or weakly facilitatory effects on the male rat ejaculatory behaviour. The non-selective 5-HT1 receptor antagonist (-)-pindolol (8 micromol kg(-1) s.c.), did not antagonize the inhibition produced by anpirtoline. 4. The present results demonstrate opposite effects, facilitation and inhibition, of male rat ejaculatory behaviour by stimulation of 5-HT1A and 5-HT1B receptors, respectively, suggesting that the SSRI-induced inhibition of male ejaculatory dysfunction is due to 5-HT1B receptor stimulation.
Topics: 8-Hydroxy-2-(di-n-propylamino)tetralin; Adrenergic beta-Antagonists; Animals; Benzopyrans; Ejaculation; Female; Male; Morpholines; Pindolol; Piperidines; Propanolamines; Pyridines; Rats; Rats, Wistar; Receptor, Serotonin, 5-HT1B; Receptors, Serotonin; Receptors, Serotonin, 5-HT1; Serotonin Agents; Serotonin Antagonists; Serotonin Receptor Agonists; Sexual Behavior, Animal; Time Factors
PubMed: 9886765
DOI: 10.1038/sj.bjp.0702239 -
Neuropsychopharmacology : Official... Jun 2009Sexual dysfunction is a major contributor to treatment discontinuation and nonadherence among patients treated with selective serotonin reuptake inhibitors (SSRIs). The... (Clinical Trial)
Clinical Trial
Sexual dysfunction is a major contributor to treatment discontinuation and nonadherence among patients treated with selective serotonin reuptake inhibitors (SSRIs). The mechanisms by which depressive symptoms in general, as well as SSRI exposure in particular, may worsen sexual function are not known. We examined genetic polymorphisms, including those of the serotonin and glutamate systems, for association with erectile dysfunction, anorgasmia, and decreased libido during citalopram treatment. Clinical data were drawn from a nested case-control cohort derived from the STAR(*)D study, a multicenter, prospective, effectiveness trial in outpatients with nonpsychotic major depressive disorder (MDD). Self-reports of erectile dysfunction, decreased libido, or difficulty achieving orgasm based on the Patient-Rated Inventory of Side Effects were examined among Caucasian subjects (n=1473) for whom DNA and adverse effect measures were available, and who were treated openly with citalopram for up to 14 weeks. Of 1473 participants, 799 (54%) reported decreased libido; 525 (36%) reported difficulty achieving orgasm. Of 574 men, 211 (37%) reported erectile dysfunction. Using a set-based test for association, single nucleotide polymorphisms in glutamatergic genes were associated with decreased libido (GRIA3; GRIK2), difficulty achieving orgasm (GRIA1), and difficulty achieving erection (GRIN3A) (experiment-wide permuted p<0.05 for each). Evidence of association persisted after adjustment for baseline clinical and sociodemographic differences. Likewise, evidence of association was similar when the cohort was limited to those who did not report a given adverse event at the first post-baseline visit (ie, those whose adverse events were known to be treatment emergent). These hypothesis-generating analyses suggest the potential for glutamatergic treatment targets for sexual dysfunction during major depressive episodes.
Topics: Adolescent; Adult; Aged; Antidepressive Agents, Second-Generation; Case-Control Studies; Citalopram; Cohort Studies; Depression; Female; Genotype; Humans; Male; Middle Aged; Polymorphism, Single Nucleotide; Receptors, AMPA; Retrospective Studies; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Statistics, Nonparametric; Young Adult
PubMed: 19295509
DOI: 10.1038/npp.2009.4 -
TheScientificWorldJournal Sep 2008The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential... (Comparative Study)
Comparative Study
The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis) through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM). The patients received 3 "e 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP) and complementary medicine (CAM bodywork, manual sexology similar to the inverted exclamation mark section signsexological examination inverted exclamation mark ). The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years) with chronic anorgasmia (for 12 years on average) who were participating in the inverted exclamation mark section signorgasm course for anorgasmic women inverted exclamation mark ; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 < NNT < 1.12, NNH > 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Clinical Medicine; Complementary Therapies; Female; Holistic Health; Humans; Masturbation; Middle Aged; Psychotherapy, Brief; Psychotherapy, Group; Retrospective Studies; Sexology; Sexual Dysfunctions, Psychological; Touch; Vibration; Vulvar Diseases
PubMed: 18836654
DOI: 10.1100/tsw.2008.116 -
Primary Care Companion To the Journal... 2009
PubMed: 19750073
DOI: 10.4088/PCC.08l00688 -
Psychosomatics 1989Seventy-six women who presented with a principal complaint of anorgasmia were partitioned into four distinct subtypes on the basis of psychosexual and psychological...
Seventy-six women who presented with a principal complaint of anorgasmia were partitioned into four distinct subtypes on the basis of psychosexual and psychological symptoms using hierarchical cluster analysis, a mathematical taxonomic method. The classification was accomplished with data from the Derogatis Sexual Functioning Inventory (DSFI) and the Brief Symptom Inventory (BSI). Comparisons involving age, race, marital status, and social class demonstrated no significant differences between the four subtypes; however, statistical analyses of psychosexual, psychological symptom, and chart-review variables (including psychiatric diagnosis) revealed very significant distinctions between the four groups. From the resulting typology, anorgasmic subtypes were presumptively identified as "low desire" (n = 21), "histrionic/marital conflict" (n = 20) "psychiatric disorder" (n = 12) and "constitutional" (n = 16). Implications of the typology for etiologic and optimal treatment decisions concerning anorgasmia are discussed.
Topics: Adult; Female; Humans; Orgasm; Psychological Tests; Psychometrics; Sexual Dysfunctions, Psychological
PubMed: 2710915
DOI: 10.1016/S0033-3182(89)72298-2 -
Sexual Medicine Mar 2016Male orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve...
INTRODUCTION
Male orgasmic disorder is common, with few treatment options. Cabergoline is a dopamine agonist that acts centrally to normalize serum prolactin that could improve orgasmic dysfunction.
AIMS
To determine whether cabergoline increases the potential for orgasm in men with orgasmic disorder.
METHODS
A retrospective chart review of men treated in a single andrology clinic for delayed orgasm or anorgasmia in a pilot study using cabergoline 0.5 mg twice weekly was performed. Duration of treatment and response were noted. Medical records were examined for other factors including history of prostatectomy and concomitant androgen supplementation.
MAIN OUTCOME MEASURES
Subjective improvement in orgasmic function resulting from cabergoline treatment.
RESULTS
Of 131 men treated with cabergoline for orgasmic disorder, 87 (66.4%) reported subjective improvement in orgasm and 44 (33.6%) reported no change in orgasm. Duration of therapy (P = .03) and concomitant testosterone therapy (P = .02) were associated with a significant positive response to cabergoline treatment. No differences were found between injectable and non-injectable testosterone formulations (P = .90), and neither age (P = .90) nor prior prostatectomy (P = .41) influenced the outcome of cabergoline treatment. Serum testosterone levels before (P = .26) and after (P = .81) treatment were not significantly different in responders vs non-responders.
CONCLUSION
Cabergoline is a potentially effective and easy-to-administer treatment for male orgasmic disorder, the efficacy of which appears to be independent of patient age or orgasmic disorder etiology. Prospective randomized trials are needed to determine the true role of cabergoline in the treatment of this disorder.
PubMed: 26944776
DOI: 10.1016/j.esxm.2015.09.001 -
Proceedings of the National Academy of... Oct 2019The ovulatory homolog model of female orgasm posits that the neuro-endocrine mechanisms underlying female orgasm evolved from and are homologous to the mechanisms...
The ovulatory homolog model of female orgasm posits that the neuro-endocrine mechanisms underlying female orgasm evolved from and are homologous to the mechanisms mediating copulation-induced ovulation in some mammals. This model predicts that pharmacological agents that affect human orgasm, such as fluoxetine, should also affect ovulation in animals with copulation-induced ovulation, such as rabbits. We tested this prediction by treating rabbits with daily doses of fluoxetine for 2 wk and found that fluoxetine treatment reduces the number of ovulations postcopulation by 30%. In a second experiment we tested whether this result was mediated by an effect on the brain or via peripheral serotonin functions. We treated animals with fluoxetine and induced ovulation with a single injection of human chorionic gonadotropin. In this experiment ovulation rate was nominally reduced by only 8%, which is statistically not significant. We conclude that the effect of fluoxetine on copulation-induced ovulation rate supports the ovulatory homolog model of female orgasm, suggesting that female orgasm has very deep evolutionary roots among the early eutherian mammals.
Topics: Animals; Biological Evolution; Chorionic Gonadotropin; Copulation; Female; Fluoxetine; Male; Ovulation; Rabbits; Reproductive Control Agents; Selective Serotonin Reuptake Inhibitors
PubMed: 31570579
DOI: 10.1073/pnas.1910295116