女性性功能障碍

性功能障碍发病率较高 ,但通常不能客观确诊。Lau mann等调查发现 ,4 3%的女性患有性功能障碍 ,且发病率随年龄增长而增加 ,国内相关调查也显示 ,性功能障碍总发生率在已婚妇女达 70 %左右 ,其主要表现为性欲减退、性兴奋障碍、性高潮障碍、性交疼痛等。随着男性性功能障碍研究取得突破性进展 ,女性性功能障碍 (femalesexualdysfunction ,FSD)也逐渐引起了人们的注意。1　FSD的病因1.1　心理社会因素　欲望动机理论认为 ,性的生理心理需要产生性欲动机 ,性欲产生性交行为 ,所以 ,当女性长期受错误的传统观念教育时 ,对性生活持否定排斥的…     

腹腔镜辅助下阴式子宫切除治疗严重子宫内膜异位症17例临床分析

目的探讨腹腔镜辅助下阴式子宫切除治疗严重子宫内膜异位症患者的疗效及手术技巧.方法选择同期由同一手术组进行的腹腔镜辅助下阴式子宫切除术病例,其中子宫肌瘤患者26例,子宫内膜异位症Ⅲ期及以上17例,比较两组的手术时间、术中出血量、手术并发症、肛门排气时间、术后病率及术后住院天数.结果子宫肌瘤组手术时间77±19分钟,严重子宫内膜异位症组为131±34分钟,两组比较P＜0.05,差异有显著性;子宫肌瘤组术中出血量为105±35 ml,严重子宫内膜异位症组为125±35 ml,两组比较P＞0.05,差异无显著性.两组均无手术并发症.结论采用腹腔镜辅助下经阴道内手指分离子宫直肠陷凹的粘连,直肠内手指辅助指引,提高了严重子宫内膜异位症患者腹腔镜下经阴道子宫切除手术的安全性及成功率,扩大了腹腔镜的手术指征.     

NLR检测在子宫内膜异位疾病和子宫肌瘤的应用价值及意义

目的:探讨血中性粒细胞/淋巴细胞比值(NLR)检测在子宫内膜异位疾病和子宫肌瘤的应用价值及意义.方法:研究对象为在我院手术并经术后病理检查证实的子宫腺肌病102例(子宫腺肌病组)、子宫内膜异位症47例(子宫内膜异位症组)和子宫平滑肌瘤80例(子宫肌瘤组),以及在此期间健康体检的正常妇女72例(对照组).检测所有患者术前及对照组患者体检时的血NLR、白细胞数、淋巴细胞数、CA125、CA199值,并比较分析,评价NLR、CA125及CA199在3种疾病的诊断敏感性.结果:3种疾病组血NLR值均明显高于对照组(P＜0.05或P＜0.01).3种疾病组血NLR比较差异无统计学意义(P＞0.05).子宫内膜异位症组Ⅲ、Ⅳ期患者的血CA125值及阳性率明显高于Ⅰ、Ⅱ期患者,两者差异均有高度统计学意义(P＜0.01),但各期间血NLR及CA199值及阳性率差异无统计学意义(P＞0.05).结论:NLR在子宫腺肌病、子宫内膜异位症和子宫肌瘤都显著升高,表明免疫抑制是这3种疾病的共性.血NLR、CA125及CA1993种血清指标联合检测对这3种疾病的鉴别诊断有一定的价值.     

子宫肌瘤全子宫切除术后性生活质量调查研究

目的探讨子宫肌瘤患者行全子宫切除术对性生活的影响。方法选取2014-01-01—2016-08-01因子宫肌瘤在北京协和医院行全子宫双输卵管切除术的绝经前患者50例(手术组),其中开腹组23例,腹腔镜组27例;选取同期绝经前健康女性112例(健康组),用女性性功能指数(FSFI)量表对参与者的性生活情况进行评估。结果健康组与手术组FSFI总分分别为(24.58±4.35)分与(18.35±9.62)分,两组差异有统计学意义(P0.05)。FSFI主要测量性欲望、主观性唤起、性活动时阴道润滑性、性高潮、性生活满意度、性交痛6个方面。比较健康组和手术组的调查结果,显示两组在性欲望、主观性唤起、性高潮、性生活满意度方面差异有统计学意义(P0.05);在性活动时阴道润滑性、性交痛方面差异无统计学意义(P0.05)。开腹组与腹腔镜组FSFI总分分别为(17.11±10.30)分和(19.41±9.07)分,差异无统计学意义(P0.05)。结论全子宫切除术可明显影响子宫肌瘤患者术后性生活质量;腹腔镜与开腹手术对子宫肌瘤患者行全子宫切除术后的性生活影响无差异。     

重视妇科手术对女性性功能的影响

女性性功能障碍（FSD）是一种多因素疾病。多种妇科良性疾病（例如子宫肌瘤、子宫内膜异位症、压力性尿失禁、盆底器官脱垂）以及妇科恶性肿瘤对女性性功能均可造成不同程度的损害。临床上主要采用手术治疗,主要包括子宫切除手术、双侧输卵管卵巢切除手术、盆底重建手术及肿瘤根治手术。虽然手术可以治疗疾病并改善相关症状,但却可影响患者术后的性功能,甚至产生严重损害。尤其是对于妇科恶性肿瘤的治疗,包括生殖器官和性腺的切除手术、手术联合化疗和（或）放疗,显著损害了女性的性功能。女性性健康是一个值得高度关注的问题,妇产科医生和心理医生应加强对患者术前和术后的心理疏导,更多关注有关术后性功能障碍的治疗。     

RANTES在子宫内膜异位症在位内膜及异位内膜的表达及其意义

目的:探讨调节活化正常T细胞表达与分泌的趋化因子(RANTES)在子宫内膜异位症在位内膜及异位内膜的表达及在子宫内膜异位症发病中的作用.方法:以2010年1～10月因子宫内膜异位症在我院行手术治疗的30例患者的在位内膜及异位内膜为研究组,以同期在我院就诊取IUD的30例患者的正常子宫内膜作为对照组,检测3组标本中RANTES mRNA表达及蛋白水平.并检测3组培养上清液对单核细胞趋化活性的影响.结果:①IL-1β刺激48小时,异位内膜组细胞RANTES mRNA表达及蛋白水平均增加,与在位内膜组和正常内膜组细胞比较,差异均有统计学意义(P＜0.05).IL-1β刺激72小时,异位内膜组、在位内膜组细胞RAN-TES mRNA表达及蛋白水平均增加,异位内膜组细胞与在位内膜组和正常内膜组细胞比较,差异均有统计学意义(P＜0.05);在位内膜组细胞与正常内膜组细胞比较,差异也有统计学意义(P＜0.05).②异位内膜组及在位内膜组单核细胞趋化指数明显高于正常内膜组(P＜0.05).结论:子宫内膜异位症患者的在位内膜及异位内膜RANTES mRNA表达及蛋白水平均增加.RANTES通过促进单核细胞的趋化活性,可能在子宫内膜异位症的发病中发挥作用.     

HIF-1α和VEGF在增生期子宫内膜异位症中的表达及与血管生成的相关性

目的探讨HIF-1α和VEGF在子宫内膜异位症患者中的表达水平及与血管生成的相关性。方法选取苏州市第七人民医院子宫内膜异位症患者39例,另选取同期住院的子宫肌瘤患者37例作为对照组,检测前者的异位内膜及其在位内膜、后者的正常内膜中HIF-1α与VEGF蛋白表达,计算微血管密度(MVD)。结果HIF-1α、VEGF蛋白及MVD在异位内膜中的表达强度均明显高于其余两组,且在在位内膜中的表达强度均高于正常内膜,差异均有统计学意义(P0.05)。HIF-1α与VEGF在子宫异位内膜中的表达呈正相关(r=0.730,P0.05);HIF-1α与MVD的表达水平呈正相关(r=0.701,0.683,P0.05)。结论 HIF-1α和VEGF在子宫内膜异位症患者增生期内膜组织中的表达呈正相关,均可促进子宫内膜异位症血管的生成。     

女性性功能障碍的诊断

女性性功能障碍（female sexual dysfunction,FSD）根据精神障碍诊断下统计手册第4版（DSM-Ⅳ）标准主要分为：性欲障碍、性唤起障碍、性高潮障碍和性交疼痛。2013年5月DSM-Ⅴ正式发布,主要变化包括将性厌恶归为焦虑症,改变了女性性高潮障碍的定义,合并性欲障碍和性唤起障碍为性兴趣/唤起障碍,合并性交疼痛和阴道痉挛为生殖器-盆腔疼痛/插入障碍。妇科医生应能够做出女性性功能障碍基本诊断,将重点放在发现器质性病变以及对阴道痉挛患者的治疗,而对性欲障碍、性唤起障碍和性高潮障碍患者仍建议转诊至心理科治疗。     

美国妇产科医师协会《女性性功能障碍管理指南》解读

        性健康是当今女性身心健康的重要内容之一，目前认为调节女性性反应的中枢神经内分泌机制是一个兴奋和抑制因素相互平衡的动态过程，参与该过程的多种因素在维持平衡中起到关键作用，其中雌激素、盆底肌肉功能和关节活动度至关重要。女性性功能障碍（female sexual dysfunction，FSD）主要包括：性欲障碍、性兴奋障碍、性高潮障碍、性交疼痛［1］。据统计，在美国约43%的女性在不同年龄阶段会发生性功能障碍。尽管发生率高，但鉴于健康观念认知差异使其临床就诊率较低，加之医务人员对诊断、治疗的经验相对匮乏，因此在女性性功能障碍的规范化治疗方面仍存在不足。 浏览更多请关注本刊微信公众号及当期杂志。     

男性性功能障碍

男性性功能障碍６１００４１四川人类生殖医学院郑启明男与女是宇宙间一对最基本的矛盾和矛盾对立的统一体，与女性性功能相对应的男性性功能，表现为性欲唤起、阴茎勃起、射精动作、性高潮出现与性欲满足。从性欲状态到性欲满足任何环节上的障碍，都是男性性功能障碍。一...     

Disorders in sexual desire and sexual arousal in women, a 2010 state of the art

In this contribution, female sexual desire and arousal disorders are viewed from the perspective of incentive motivation and information processing models of sexual response. The effects of hormones, somatic disease, and medication on sexual arousability are discussed, as well as the influence of psychological factors, such as stimulus meaning, mood and cognition, and relational context on female sexual desire and arousal. Specific topics to attend to during the anamnesis of sexual desire and arousal problems, and empirically evaluated psychological and pharmacological treatments for these problems are discussed.     

Relationship between female sexual difficulties and mental health in patients referred to two public and private settings in Tehran, Iran

IntroductionSexual difficulty has various effects on patients suffering from this condition that can impact on interpersonal and marital relationships. Sexual function may be adversely affected by stress of any kind and emotional disorders. There have been limited studies focusing on the mental health of those suffering from this problem.AimTo determine the relationship between sexual difficulties and mental health in female patients seeking help in psychiatric clinics.MethodsThe study was based on the case–control design methodology in which the case group consisted of 165 outpatients of two psychiatric clinics, who were diagnosed with different mental disorders such as depression, anxiety, phobia, aggression, and somatic complaints (33 subjects for each type of disorder). The 33 subjects in the control group were chosen among the patients’ relatives and visitors who had no history of either seeking psychiatric help or taking psychiatric drugs. The subjects of both case and control groups were selected based on a convenience sampling method. Moreover, the data were collected based on two techniques of “interview” and “questionnaire;” the latter was of three different subcategories, each dealt with demographic characteristics, sexual difficulties, and a Symptom Check-List-90-Revised.Main Outcome MeasureAssessing female sexual difficulties associated with mental health and differences between women with and without psychiatric problems.ResultsThe obtained results indicated that there was a significant difference between the prevalence of sexual difficulties (e.g., sexual desire and orgasm disorders) in the case group and that of the control group. It was also revealed that there was a significant difference between the depressed, aggressive, as well as those with somatic complaints, and their control group counterparts.ConclusionsIn Iran, sexual difficulties seem to be more frequent in those seeking psychiatric help in clinics than in those within the normal population. Azar M, Noohi S, and Shafiee Kandjani AR. Relationship between female sexual difficulties and mental health in patients referred to two public and private settings in Tehran, Iran.     

FSFI Scores of Women with Persistent Genital Arousal Disorder Compared with Published Scores of Women with Female Sexual Arousal Disorder and Healthy Controls

IntroductionAlthough persistent genital arousal disorder (PGAD) has been mistaken for hypersexuality, there is no research documenting the sexual functioning of PGAD women to support or refute such an assumption.AimTo compare the Female Sexual Function Index (FSFI) scores of PGAD women to that of women diagnosed with female sexual arousal syndrome (FSAD) and healthy controls.MethodsThe FSFI scores of heterosexual women who met all five features qualifying for a diagnosis of PGAD (N = 172) on an online questionnaire were compared with previously published FSFI scores of women diagnosed with FSAD (N = 128) and healthy controls (N = 131).Main Outcome MeasureTotal and subscale scores on the FSFI.ResultsOn every subscale of the FSFI with the exception of desire, the PGAD women obtained scores between that of the FSAD and the healthy control group. The FSAD women displayed the greatest problems in desire, arousal, lubrication, orgasm, and pain while women with PGAD reported somewhat more desire than the control group but did not meet the cutoff score for sexual dysfunction. PGAD women are more similar to the normal control group than women with FSAD.ConclusionsThere is no evidence to support the belief that women who meet criteria for a diagnosis of PGAD are “hypersexual.” In fact, their overall sexual functioning falls within the normal range and is significantly better than that of women diagnosed with FSAD. Leiblum SR, and Seehuus M. FSFI scores of women with persistent genital arousal disorder compared with published scores of women with female sexual arousal disorder and healthy controls. J Sex Med 2009;6:469–473.     

Impact of tubal sterilization and vasectomy on female marital sexuality: results of a controlled longitudinal study

To determine if female or male sterilization affects long-term female marital sexuality, we prospectively compared baseline data and 5 consecutive years of follow-up data from 152 tubal sterilization women, 106 vasectomy wives, and 83 women not planning sterilization. By follow-up year 5, no group of women expressed any change in satisfaction with their own sexual response; however, all groups showed a significant decrease across time in satisfaction with their sexual relationship, in coital desire, and in coital frequency. There were no group differences in overall net changes or in rates of change over the 5-year period. However, two short-term group differences were noted: a decrease in coital desire among women not planning sterilization between baseline and follow-up year 4, compared with increases for both sterilization groups, and an increase in coital frequency at the first follow-up year only in the tubal sterilization group. These data indicate that there are no detrimental effects and some short-term benefits of both sterilization procedures on female marital sexuality.     

ORIGINAL RESEARCH—WOMEN'S SEXUAL HEALTH: Conceptualizing Women's Sexual Function: Linear vs. Circular Models of Sexual Response

IntroductionThe lack of an adequate empirical base for models of female sexual response is a critical issue within the female sexual dysfunction (FSD) literature.AimThe current research compared the extent to which a linear model of sexual response and Basson's circular model of female sexual response represent the sexual function of women with and without FSD.Main Outcome MeasuresWomen's levels of sexual function/dysfunction were assessed with the Female Sexual Function Index and additional items measured women's endorsement of models of female sexual function as representing their own sexual experience.MethodsAn anonymous online survey assessing female sexual response and associated aetiological factors was completed by a random sample of 404 women.ResultsAlthough the linear model of sexual response was a good fit for women with and without sexual dysfunction, the relationship between sexual arousal and orgasm was mediated by sexual desire for women with FSD. The fit of the initial circular model of women's sexual response was poor for both groups. Following pathway modification, the modified circular model adequately represented the responses of both groups and revealed that a number of the relationships between sexual response variables were stronger for women with FSD.ConclusionsThe linear model was a more accurate representation of sexual response for women with normal sexual function than women with FSD and sexual arousal and orgasm was mediated by sexual desire for women with FSD. The modified circular model was a more accurate representation of the sexual response of women with FSD than women with normal sexual function. Giles KP, and McCabe MP. Conceptualizing women's sexual function: Linear vs. circular models of sexual response. J Sex Med 2009;6:2761–2771.     

What is the Impact on Sexual Function of Laparoscopic Treatment and Subsequent Combined Oral Contraceptive Therapy in Women with Deep Infiltrating Endometriosis?

IntroductionDeep infiltrating endometriosis (DIE) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface. It is a chronic disease which can impair women's sexual function. There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE.AimsThe aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives (COC) administration on sexual function in patients with DIE and to compare sexual function outcomes of women submitted to intestinal resection and nodule excision.MethodsIt is a prospective cohort study in a tertiary care university hospital on 106 sexually active women, with histologically confirmed DIE, managed by laparoscopy and subsequent COC therapy for 6 months. Patients filled preoperatively and 6‐month postoperatively a quality of sexual life questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW‐Q) and they ranked their symptom intensity using a 10‐point visual analogue scale (VAS).Main Outcome MeasuresSexual function was measured through the SHOW‐Q scores and pain symptoms through VAS scores. Intraoperative details, type of intervention and perioperative complications were noted.ResultsSix months after surgery and postoperative COC treatment, a significant improvement was observed in the SHOW‐Q domains of pelvic problem interference, sexual satisfaction and desire (P < 0.05). Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning (P = 0.7). No significant difference was found in SHOW‐Q scores between patients submitted to intestinal resection and patients submitted to intestinal nodule excision (P > 0.05).ConclusionsSexual desire, satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy. No difference in sexual outcomes was detected between patients submitted to intestinal resection and nodule excision. Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, Ferrini G, Vicenzi C, Raimondo D, Villa G, Zukerman Z, Alvisi S, and Seracchioli R. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med 2012;9:770–778.     

Female sexual response: the role of drugs in the management of sexual dysfunction

A large component of women's sexual desire is responsive rather than spontaneous. Therefore, women's motivation and ability to find and respond to sexual stimuli to experience sexual arousal and subsequent sexual desire is crucial, but complex. In ongoing relationships, a woman's motivation appears to be largely influenced by her emotional intimacy with her partner and her wish to enhance it. Drugs (including androgen replacement therapy) aimed at increasing women's spontaneous sexual wanting (less characteristic of women in long-term relationships) or their arousability may have a role if other psychologic factors affecting arousability are addressed in tandem. A woman's sexual arousal is composite and complex, correlating well with how mentally exciting she finds the sexual stimulus and its context and poorly with objective genital blood flow changes. Drugs aimed at increasing the latter, including phosphodiesterase inhibitors, may have a role if there is prior careful enquiry as to whether genital engorgement is present but not attended to or is physically absent. Psychophysiologic studies to date suggest the former is common in women presenting with arousal disorder.     

Sexual function in women treated with dilators for vaginal agenesis

OBJECTIVE: To discover the sexual satisfaction of young women treated with vaginal dilators for vaginal agenesis. DESIGN: Anonymous questionnaire study. MAIN OUTCOME MEASURES: Comparison of sexual desire arousal lubrication, orgasm satisfaction and pain with a normal population. RESULTS: There was no significant difference between the study population and controls for the domains of sexual desire, sexual arousal, and satisfaction with a sexual relationship. There was, however, a significant difference for vaginal lubrication and orgasm where the Rokitansky patients scored lower. 22.3% of patients reported some degree of dyspareunia following vaginal penetration. However, this did not affect their enjoyment of the sexual act. CONCLUSION: The use of graduated vaginal dilators for patients with Mullerian agenesis is highly successful in creating a neovagina. Although the lack of adequate lubrication, pain and difficulty in reaching orgasm is significantly higher in this group, the patients subsequently enjoy sexual satisfaction that is comparable to a normal population.     

Endometriosis doubles the risk of sexual dysfunction: a cross-sectional study in a large amount of patients

Introduction: Endometriosis affects several aspects of a woman’s life, including sexual function, but which specific aspects of sexual function remains unclear.

Methods: A cross-sectional study was performed involving 1001 women divided into two groups, according to the presence or absence of endometriosis. We assessed sexual function, anxiety and depression of patients and correlated these findings with symptoms, locations and types of endometriosis and the affected domains of sexual function. Eighteen completed the forms incorrectly, 294 women (29.9%) were excluded due to severe anxiety and depression. One hundred and six patients had symptoms that could have any relation to endometriosis, so they were also excluded. The final cohort was composed of 254 patients with endometriosis and 329 patients without the disease. Sexual function score was assessed using the female sexual quotient (FSQ); Beck inventories were used to assess anxiety and depression.

Results: Patients with endometriosis were affected in all phases of sexual response: desire, sexual arousal, genital–pelvic pain/ penetration and orgasm/ sexual satisfaction. In the overall assessment, 43.3% of patients with endometriosis had sexual dysfunction, while the population without endometriosis sexual dysfunction occurred in 17.6% of women.

Conclusions: Patients with endometriosis have more than twice sexual dysfunctions as compared to women without the disease.     

Prevalence and differences between type 1 and type 2 diabetes mellitus regarding female sexual dysfunction: a cross-sectional Egyptian study

Objective: To evaluate the female sexual dysfunction in both type 1 and type 2 diabetes mellitus (DM).

Methods: This cross-sectional study was carried out at Suez Canal University Hospitals from the start of February 2015 to the end of May 2016 among 189 married premenopausal women attending endocrinology and diabetology outpatient clinic for regular follow-up; 25 of whom refused to participate and 18 more were excluded due to incomplete data sets resulting in a final sample of 146 diabetic females. Ninety healthy women were recruited from the administrative staff at the hospital as a control group. Sexual dysfunction was assessed using female sexual function index (FSFI), a validated 19-item, self-administered, screening questionnaire comprising the six major sexual domains: desire, arousal, lubrication, orgasm, satisfaction and pain. Responses to each question were reported and scored on 0–5 scale with 0 representing no sexual activity and 5 suggestive of normal sexual activity.

Results: Prevalence of sexual dysfunction was significantly higher in both type 1 and 2?DM groups (44 and 25%, respectively) than in the control group (9%). FSFI mean total score was significantly lower in type 1?DM (21.1?±?3.9) than type 2?DM (26.4?±?4.2) and both were significantly lower than the control group (31.5?±?5.8). With regard to FSFI domains, mean values for desire, arousal, lubrication, orgasm, satisfaction and pain were significantly lower in both type 1 and type 2?DM groups when compared with the controls.

Conclusion: FSD is a significant health problem among premenopausal diabetic Egyptian women. Type 1?DM women were more affected than type 2?DM that in turn was more affected than healthy control females.