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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sexual assault of women in the United States may have a prevalence rate of 25% or more. Moreover, the majority of survivors of sexual assault know their assailants. Consequences of assault may be severe and long-term, including fear and anxiety, depression, suicide attempts, difficulties with daily functioning and interpersonal relationships, sexual dysfunction, and a whole range of somatic complaints. Recent evidence implicates societal factors, such as acceptance of rape myths, rigid sex role stereotyping beliefs, and acceptance of violence as a legitimate means for obtaining compliance in interpersonal relationships, in the etiology of sexual violence against women. I present a model for primary, secondary, and tertiary prevention of rape. Primary prevention represents a program of anticipatory guidance in a developmental framework. Secondary prevention entails identification of and early intervention in dysfunctional families. Tertiary prevention consists of the appropriate treatment of the survivor of sexual assault to prevent or minimize subsequent physical and psychological problems. This preventive framework may be incorporated into the practice of clinical preventive medicine and primary care.
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PMID:Sexual violence against women: prevalence, consequences, societal factors, and prevention. 179 44

Studies of sexual dysfunction in diabetic women have been less conclusive than those of sexual dysfunction in diabetic men. We examined the relationship between symptoms of sexual dysfunction, neuropathy, and depression in diabetic women. Diabetic women with neuropathy experienced significantly more symptoms of sexual dysfunction and depression than diabetic women without neuropathy. Furthermore, among women with neuropathy, there was a significant positive correlation between the degree of sexual dysfunction experienced and the degree of depression. These results indicate that depressive symptoms should be examined in studies of sexual dysfunction in diabetic women, and that a biopsychosocial approach is best for assessing sexual dysfunction in diabetic women.
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PMID:Symptoms of sexual dysfunction and depression in diabetic women. 183 Mar 17

Patients with type II diabetes mellitus were assessed for symptoms of depression using the Zung Self-Rated Depression Scale (Zung SDS) and the Beck Depression Inventory (BDI). The patients were classified according to the presence or absence of diabetic complications, and they were compared with a group of demographically matched, nonmedically ill control subjects. The patients with diabetic complications scored significantly higher on the depression inventories than did the patients without complications and the control subjects. Factor analysis of BDI responses revealed that cognitive symptoms of depression were prominent in the diabetic patients with complications. In this group, 74% of patients scored within the range of clinical depression on the BDI; 35% scored within the range of severe depression. Symptoms of sexual dysfunction were significantly correlated with symptoms of depression in diabetic women but not in diabetic men. The findings are discussed within the context of other research in the behavioral aspects of diabetes mellitus.
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PMID:Symptoms of depression in patients with type II diabetes mellitus. 188 19

The NIMH Diagnostic Interview Schedule (n = 43), and the Hopkins Symptom Checklist and Weissman Social Adjustment Scale (n = 35) was administered to assess the prevalence of psychiatric disorders and psychosocial maladjustment present in women seeking treatment in a multidisciplinary Premenstrual Syndrome Clinic. We found a 67 percent lifetime prevalence of DIS/DSM-III psychiatric disorders: 50 percent Major Affective Disorder (primarily Depression), 53 percent Anxiety Disorder (primarily Phobias or Generalized Anxiety Disorder), and 40 percent Psychosexual Dysfunction (notably Inhibited Sexual Desire or Excitement). Our group had significantly greater Major Depression, Dysthymia, and any one psychiatric disorder compared with female general population samples. Two-thirds of women with premenstrual symptoms had true Premenstrual Syndrome. In our sample, social maladjustment as well as psychiatric symptomatology was significantly greater than in normals and closer to that in psychiatric out-patient norms, and was independent of cycle phase. Presence or absence of PMS, social maladjustment and sexual dysfunction was each not significantly different in women with or without psychiatric disorder.
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PMID:Sexual dysfunction, social maladjustment, and psychiatric disorders in women seeking treatment in a premenstrual syndrome clinic. 189 58

Clomipramine is a newly marketed tricyclic antidepressant drug prescribed for obsessive-compulsive disorder (OCD). It selectively blocks neuronal uptake of serotonin. Clomipramine has been prescribed in Europe and Canada for 20 years in management of depression. Studies have now shown clomipramine to be effective in treating OCD. Dry mouth, visual disturbances, constipation, sexual dysfunction, somnolence, tremors, and dizziness are among the commonly reported side effects. Like other tricyclics, clomipramine exhibits a potential for cardiotoxicity, especially by impairing conduction and/or orthostasis. It also has the effect of lowering seizure threshold. Overdose risk is considerable. Careful medical supervision and adherence to prescribing guidelines are presumed to reduce medication risk factors. The outstanding benefit of this drug is its proved efficacy in the management of obsessive-compulsive disorder, as the first pharmacotherapy approved for this previously rather treatment-resistant condition.
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PMID:Clomipramine for obsessive-compulsive disorder: prescribing guidelines. 192 26

A series of 36 patients who had been hospitalized following closed head injury (CHI) were followed up 4.06 (SD 3.71) years after the injury. Measures were taken of degree of psychosexual dysfunction (Golombok Rust Inventory of Sexual Satisfaction-GRISS), general psychiatric morbidity (General Health Questionnaire-GHQ), and clinical anxiety and depression (Hospital Anxiety and Depression Scale-HAD). These measures were completed by patients and partners. Resulting data revealed that 50% of male patients with current sexual partners produced psychosexual profiles that fell within the dysfunctional range. For both male patients and their partners, the chief psychosexual complaint was infrequency. Of the patients studied, 61% were classified (using the GHQ) as having degrees of emotional distress that would fall within the range of psychiatric 'caseness', while 25% of patients achieved HAD criteria for clinical anxiety and 22% met HAD criteria for depression. Of the partners, 41% met GHQ criteria for psychiatric 'caseness', 18% being classified using the HAD as anxiety cases and 6% as depression cases. No effects of severity of injury were observed on any of the main outcome measures. Age and time since injury were related to measures of psychosexual dysfunction. These results are discussed in relation to the existing literature on psychosocial outcome in closed head injury, and recommendations for therapeutic intervention are made.
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PMID:Psychosexual and psychosocial sequelae of closed head injury. 193 79

These data, in combination with the literature reviewed above, demonstrate several important points for those who work in clinics where elders with sexual problems are seen: 1. The currently available literature on the relation of sexual dysfunction to psychiatric disorder in the elderly is not extensive, and much of the literature is limited by methodologic flaws. There is a clear need for improved research methods and a broader data base. Nonetheless, the existing studies indicate that psychologic disorders are found in conjunction with sexual dysfunction commonly enough that clinicians must regularly assess for their presence. 2. The cause of sexual problems is seldom simple or entirely clear. Diagnoses of psychologic concerns and disorders that might relate to sexual dysfunction are common, and most older patients' sexual dysfunction will have a mixed cause, with both medical and psychologic factors playing an important role in the development and maintenance of sexual dysfunction. In our series of patients, 52.8% had diagnosable psychologic difficulties that were assumed to be related to the sexual difficulties. Another large group (39.9%) had psychologic factors (although not diagnosable disorders) that were assumed to contribute to the current manifestation of sexual dysfunction. Thus, it should not be assumed, as it was in years past, that when one likely causative factor is identified (e.g, diabetes, performance anxiety, or depression), the cause of the dysfunction has been identified. 3. The types of psychopathology seen in sex clinics are typically fairly limited, with the largest proportions by far being alcohol abuse or depression (50.1% and 62.1%, respectively, of all psychologic diagnoses in our clinic). Major psychopathology is relatively underrepresented. We suspect this underrepresentation does not reflect a true population characteristic but, rather, a selection difference; patients with major psychopathology such as schizophrenia either do not complain of sexual dysfunction to their therapists or are not referred for treatment by their therapists. 4. The presenting complaints of patients with a psychologic disorder do not differ significantly from those of patients without a psychologic disorder in a general sexual dysfunction clinic. 5. Treatment outcome, especially the rate of successful treatment, does not differ between those with and those without psychologic diagnoses when physicians and psychologists work together on an interdisciplinary team to offer treatment.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Psychologic disorder and sexual dysfunction in elders. 200 86

Older women may experience sexual dysfunction due to many different causes. Some problems related to menopausal hormonal change may be easily treated with estrogen supplements. Other problems involve intricate interpersonal relations between the woman and her sexual partner and may require a combination of medical therapy and sexual counseling. Gynecologic cancer and cancer treatments are often accompanied by problems in sexual functioning. These problems may then impair relations and self-image, leading to a vicious circle of deteriorating social function. Some recommendations for the clinician follow. The clinician should maintain an attitude of openness to the possibility of sexual concerns in older women. Such concerns should be taken seriously and should not be dismissed as part of aging. Routine periodic health examinations can include a question such as "Do you have any concerns about your sexual life that you would like to discuss?" In follow-up visits for procedures with a high likelihood of causing sexual dysfunction, questions that would open the door to a discussion of sexuality should be asked. Sexual dysfunction should be recognized as a couple-oriented phenomenon. A woman's anxiety about her appearance, postoperative depression, or dyspareunia may be perceived by her partner as a sexual rejection and may initiate a cycle of decreasing contact or may even lead to erectile dysfunction. Sexual counseling should include both partners. When a surgical procedure that will probably have an impact on sexual function is contemplated, provide the patient and her partner with advance counseling. Descriptions of surgery should not be simply a statement of body parts to be removed but should specifically address the anticipated sexual effects. Counseling should include a description of basic anatomy and function of the genital organs. Illustrations and appropriate demonstration during the physical examination should be used to ensure the patient's understanding. Descriptions should be accurate without being either frightening or falsely reassuring. The patient should be counseled about the benefits of including her partner in discussions. Then, when possible, the sexual partner of the patient should be invited to sessions of advance counseling on contemplated procedures. Clinicians should remain open to the possibility that the sexual partner will be a nontraditional one, e.g., an unmarried male partner or another woman. The clinician should be alert to remediable causes of dysfunction. For example, decreased vaginal lubrication may be managed with use of water-soluble lubricants.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Gynecologic factors in sexual dysfunction of the older woman. 200 90

The term quality of life implies more than adverse effects that make treatment intolerable. It is not new but has only relatively recently become a parameter to be measured in patients treated for cardiovascular disease. Lessons can be learned from other conditions in which the Karnovsky Index and the Arthritis Impact Measurement Scale have been used. Several investigators have used questionnaires to assess quality of life during antihypertensive therapy. However, assessment of the effect of angiotensin converting enzyme (ACE) inhibition on quality of life has only been done recently. The largest and best known study, of 625 white men with mild hypertension, reported that patients given captopril showed a significant improvement after 6 months in general well-being, work performance, and those skills associated with cognitive function. No such improvement was found with methyldopa and there was significant worsening in measures associated with depression, sexual dysfunction, and life satisfaction. The propranolol group, while showing improvement in cognitive functioning and social participation, manifested worsening of sexual function and physical symptoms. Diuretic therapy had a greater negative impact on the quality of life of hypertensive patients than captopril, propranolol, or methyldopa alone. Whether these results will be seen in other patient populations, and the pharmacological basis for these results, remains to be determined. As newer agents become available (eg, beta-blockers with ancillary properties, calcium channel blockers with allegedly more selective actions on various vascular beds), comparative studies between these agents and ACE inhibitors old and new are awaited with interest.
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PMID:Angiotensin converting enzyme inhibitors and quality of life. 200 55

Most evaluations of the contributions of possible alterations in serotonergic neurotransmission to the etiology and treatment of neuropsychiatric disorders preceded the recent explosion of information regarding multiple serotonin (5-HT) receptors and brain 5-HT subsystems. This review provides an appraisal of some examples where drugs acting at different 5-HT receptor subtypes have provided new treatment or have contributed to the development of knowledge regarding various neuropsychiatric disorders, including anxiety, panic disorder, obsessive-compulsive disorder, depression, schizophrenia, alcoholism, migraine, sexual dysfunction, and Alzheimer's disease.
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PMID:Neuropsychiatric disorders and the multiple human brain serotonin receptor subtypes and subsystems. 207 79


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