Female Sexual Dysfunction: Treatment
General An open discussion with the patient is important as couples may need to be educated about normal anatomy and physiologic responses, including role of orgasm in sexual encounters. Physiologic changes associated with aging and/or disease should be explained. Couples may need to be reminded that clitoral stimulation rather than coital intromission may be more beneficial.
Behavioral modification and nonpharmacologic therapies should be a first step. Patient and partner counseling may improve communication and relationship strains.
Male Sexual Dysfunction: Treatment
Patient Education Patient and partner education is essential in the treatment of ED. In goaldirected therapy, education facilitates understanding of the disease, results of the tests, and selection of treatment. Discussion of treatment options helps to clarify how treatment is best offered and stratify first- and second-line therapies. Patients with high-risk lifestyle issues, such as smoking, alcohol abuse, or recreational drug use, should be counseled on the role these factors play in the development of ED.
Approach to the Patient: Erectile Dysfunction
A good physician-patient relationship helps to unravel the possible causes of ED, many of which require discussion of personal and sometimes embarrassing topics. For this reason, a primary care provider is often ideally suited to initiate the evaluation. A complete medical and sexual history should be taken in an effort to assess whether the cause of ED is organic, psychogenic, or multifactorial (Fig. 492). Initial questions should focus on the onset of symptoms, the presence and duration of partial erections, and the progression of ED.
Physiology of the Female Sexual Response
The female sexual response requires the presence of estrogens. A role for androgens is also likely but less well-established. In the CNS, estrogens and androgens work synergistically to enhance sexual arousal and response. A number of studies report enhanced libido in women during preovulatory phases of the menstrual cycle, suggesting that hormones involved in the ovulatory surge (e.g., estrogens) increase desire.
Sexual motivation is heavily influenced by context, including the environment and partner factors.
The area of treatment of sexual disorders has undergone an enormous expansion
during the last few decades. The introduction of pharmacological treatment of
these disorders (e.g., sildenafil for erectile dysfunction or antidepressants for
paraphilias) rekindled the interest of physicians from different disciplines
(psychiatrists, urologists, gynecologists) in sexual dysfunctions. Physicians are
finding these disorders amenable to pharmacotherapy
Disorders that affect the sacral spinal cord or the autonomic fibers to the penis preclude nervous system relaxation of penile smooth muscle, thus leading to ED. In patients with spinal cord injury, the degree of ED depends on the completeness and level of the lesion. Patients with incomplete lesions or injuries to the upper part of the spinal cord are more likely to retain erectile capabilities than those with complete lesions or injuries to the lower part.
Pathways that control erection and detumescence. A. Erection is mediated by cholinergic parasympathetic pathways, and nonadrenergic,
noncholinergic (NANC) pathways, which release nitric oxide (NO). Endothelial cells also release NO, which induces vascular smooth-muscle cell relaxation, allowing enhanced blood flow, and leading to erection. Detumescence is mediated by sympathetic pathways that release norepinephrine and stimulate α-adrenergic pathways, leading to contraction of vascular smooth-muscle cells. Endothelin, released from endothelial cells, also induces contraction.
If a patient fails to respond to oral agents, a reasonable next choice is intraurethral or self-injection of vasoactive substances. Intraurethral prostaglandin E1 (alprostadil), in the form of a semisolid pellet (doses of 125–1000 µg), is delivered with an applicator. Approximately 65% of men receiving intraurethral alprostadil respond with an erection when tested in the office, but only 50% of those achieve successful coitus at home.
The modern era in sexual medicine started in the
1970s when a few devoted pioneers and visionaries
began to revolutionize our thinking and understanding
in this field.
Prior to that time, sexual dysfunctions in men,
particularly erectile disorders, were thought to be
purely psychogenic or in rare cases caused by testosterone
deficiency. Treatment of sexual disorders was
considered to be predominantly the business of sextherapists
or rarely of endocrinologists.
After researching literature on addiction and film,
I chose the films for the study and viewed each one many
times, specifically looking for socioeconomic representations
of characters, treatment of different races, sexes, and sexual
preferences, methods of production as they relate to addicted
characters and drug usage, and the depiction of treatment/
self-help groups. I then outlined the narrative of each film
and compared the uses and meanings brought to addicts,
addiction, and substances. I found that these movies construct
a fairly unified image of treatment.
In the traditional region of Northern Nigeria, Pathfinder has struggled to promote the use of modern
contraceptive methods to delay and space pregnancies. Traditional communities in this area generally see
children as a gift from God and, assured that He will provide for their families, resist limiting their family size
or spacing women’s pregnancies. Sexuality is not openly discussed, so reaching families with RH/FP information
and services has been difficult.
The purpose of this book is to help nurses provide the level of psychosexual
care described above. Although this book was written with practitioners
who work in primary care and specialist sexual health services specifically
in mind, it is hoped that it will be of benefit to practitioners working in all
areas of health care.
The principles and recommendations of the Kyiv Declaration on Women’s Health in Prison are
important steps towards improving health systems and addressing the health needs of women
involved in the criminal justice system. I hope that this report, which outlines the evidence and
the expert opinions considered at the special conference held in Kyiv in November 2008, will
convince all Member States to adopt and implement the Kyiv Declaration in fulfilment of their
commitment to human rights and health promotion for all. ...
The Gale Encyclopedia of Mental Health is a valuable
source of information for anyone who wants to
learn more about mental health, disorders, drugs and
treatments. This collection of approximately 450
entries provides in-depth coverage of specific disorders
recognized by the American Psychiatric
Association (as well as some disorders not formally
recognized as distinct disorders), diagnostic procedures
and techniques, therapies, psychiatric medications,
and biographies of several key people who
are recognized for their important work in the field
of mental health.
The nucleocapsid complex is surrounded
by a protein shell called capsid to form the viral core. A layer of matrix protein, which is
formed outside the capsid, interacts with the envelope (env) which consists of lipid
envelope derived from the host cell and viral envelope glycoproteins. Viral glycoproteins
are made of two units: a transmembrane portion, which attaches the protein into the lipid
bilayer, and a surface portion, which binds to the cellular receptor.
A fundamental element of sustainable development is environmental sustainability.
Hence, this series was created in 2007 to cover current and emerging issues
in order to promote debate and broaden the understanding of environmental
challenges as integral to achieving equitable and sustained economic growth. The
series will draw on analysis and practical experience from across the World Bank
and from client countries.
The Texas Women’s Health Program (WHP) provides family planning and preventive
health services to low-income women under a Medicaid family planning waiver program. As of
February 2012, the WHP provided care to about 127,000 low-income Texas women.
program cost was $35.6 million in 2011, of which the federal government paid $32 million –
about 90% of the total cost -- while the state paid $3.6 million.
Advertising can be expensive, but
there are plenty of budget-conscious options, too.
No matter what you’re spending, your approach
should be strategic—don’t squander opportunities to
talk with your markets. n Start with your
markets/needs list developed in “Get Prepared: Step
2.” What are the media reaching these markets?
Radio stations, newspapers, newsletters, etc.
Contact them to get their ad rates and schedules.
Advertising salespeople can help you with good
editorial matches (for example, perhaps there’s a
back-to-school segment featuring homework tips for
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