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Sexual Satisfaction (sexual + satisfaction)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Nursing General	12%
Urology	9%

Selected Abstracts

Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma

JOURNAL OF CLINICAL NURSING, Issue 1 2009
Sultan Ayaz
Aims and objectives., This study was carried out to assess the effectiveness of the PLISSIT model in solving sexual problems of individuals with stoma. Background., Creating a stoma due to intestinal cancer may prolong the life expectancy of individuals. However, the problems resulting from stoma may cause significant changes in an individual's life and adversely affect relations with family members and social and sexual life. Design., Experimental. Methods., The study consisted of individuals with stoma, living in Ankara. The sample consisted of 60 patients. The case group consisted of 30 patients living in Ankara; and the control group consisted of 30 patients living outside Ankara. In data collection, a questionnaire form, the PLISSIT model intervention plan and Golombok,Rust Inventory of Sexual Satisfaction (GRISS) were used. The individuals in the case group were paid eight home visits. During these visits, sexual problems of individuals with stoma were assessed and solutions sought under the guidance of the PLISSIT model intervention plan. Results., Increase of mean scores of Golombok,Rust Inventory of Sexual Satisfaction and subgroups before evaluating the sexual problems by the PLISSIT model and the sixth week scores which the sexual activity is anticipated to start have been observed, but after evaluating the sexual problems by using the model, the mean scores decreased. It was determined that negative effects of concerns related to sexual life; some physical and emotional features and physiological problems have been observed and difference between the groups is significant (p < 0·05). Conclusions., As a result, it can be claimed that decreasing sexual problems can be accomplished by using the PLISSIT model. Relevance to clinical practice., People with stoma can meet sexual problems. However, nurses experience some difficulties while handling sexual problems. It is thought that an intervention plan prepared within the framework of the PLISSIT model will guide nurses in solving sexual problems of individuals with stoma and providing integrated care and help individuals to express their sexual problems. [source]

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2010
Kyle R. Stephenson BS
ABSTRACT Introduction., Sexual satisfaction and sexual distress are common outcome measures in studies of sexual health and well-being. However, confusion remains as to if and how the two constructs are related. While many researchers have conceptualized satisfaction and distress as polar opposites, with a lack of satisfaction indicating high distress and vice versa, there is a growing movement to view satisfaction and distress as relatively independent factors and measure them accordingly. Aim., The study aimed to assess the level of independence between sexual satisfaction and distress in female clinical and nonclinical samples. Methods., Ninety-nine women (mean age = 25.3) undergoing treatment (traditional sex therapy and/or gingko biloba) for sexual arousal disorder with or without coexistent hypoactive sexual desire disorder and/or orgasmic disorder completed surveys assessing sexual satisfaction, sexual distress, sexual functioning, and relational functioning at pretreatment, mid-treatment, posttreatment, and follow-up. Two hundred twenty sexually healthy women (mean age = 20.25) completed similar surveys at 1-month intervals. Main Outcome Measures., Sexually dysfunctional women completed the Sexual Satisfaction Scale for Women (SSS-W), the Female Sexual Function Index (FSFI), and the Dyadic Adjustment Scale. Sexually healthy women completed the SSS-W, the FSFI, the Relationship Assessment Scale, and the Dimensions of Relationship Quality Scale. Results., Sexual satisfaction and distress were generally closely and inversely related; however, distress was more closely related to sexual functioning variables than was satisfaction in the clinical sample, and satisfaction was more closely related to relational variables than was distress in the nonclinical sample. Additionally, satisfaction and distress showed partially independent patterns of change over time, and scales of distress showed a larger change in response to treatment than did scales of satisfaction. Conclusion., Although sexual satisfaction and distress may be closely related, these findings suggest that they are, at least, partially independent constructs. Implications for research on sexual well-being and treatment outcome studies are discussed. Stephenson KR, and Meston CM. Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs? J Sex Med 2010;7:2458,2468. [source]

Menopause Leading to Increased Vaginal Wall Thickness in Women with Genital Prolapse: Impact on Sexual Response

THE JOURNAL OF SEXUAL MEDICINE, Issue 11 2009
Lúcia Alves Da Silva Lara MD
ABSTRACT Introduction., Hypoestrogenism causes structural changes in the vaginal wall that can lead to sexual dysfunction. A reduction in vaginal wall thickness has been reported to occur after menopause, although without precise morphometry. Aim., To measure vaginal wall thickness in women with genital prolapse in normal and hypoestrogenic conditions and to correlate sexual dysfunction with vaginal wall thickness and estradiol levels. Methods., Surgical vaginal specimens from 18 normoestrogenic and 13 postmenopausal women submitted to surgery for genital prolapse grades I and II were examined. Patients were evaluated for FSH, estradiol, prolactin, glycemia, and serum TSH levels. For histological analysis, samples were stained with Masson's trichrome and hematoxylin-eosin. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Main Outcome Measures., GRISS questionnaire, histological analysis, morphometric methods, Masson's trichrome. Results., The vaginal wall was thicker in the postmenopausal than premenopausal group (2.72 ± 0.72 mm and 2.16 ± 0.43, P = 0.01, and 2.63 ± 0.71 mm and 2.07 ± 0.49 mm, P = 0.01, for the anterior and posterior walls, respectively). These thicknesses seem to be due to the muscular layer, which was also thicker in the postmenopausal group (1.54 ± 0.44 and 1.09 ± 0.3 mm, P = 0.02, and 1.45 ± 0.47 and 1.07 ± 0.44 mm, P = 0.03, for the anterior and posterior wall, respectively). The vaginal epithelium was thinner in the middle segment than in the proximal one in the posterior wall (0.17 ± 0.07 mm, 0.15 ± 0.05 mm, 0.24 ± 0.09 mm, P = 0.02). There was no correlation between coital pain, vaginal wall thickness, and estradiol levels in either group. Conclusion., The vaginal wall is thicker after menopause in women with genital prolapse. In this study, vaginal thickness and estrogen levels were not related to sexual dysfunction. da Silva Lara LA, Ribeiro-Silva A, Rosa-e-Silva JC, Chaud F, Silva-de-Sá MF, Meireles e Silva AR, and Rosa-e-Silva ACJS. Menopause leading to increased vaginal wall thickness in women with genital prolapse: impact on sexual response. J Sex Med 2009;6:3097,3110. [source]

ORIGINAL RESEARCH,PSYCHOLOGY: Age of First Sexual Intercourse and Acculturation: Effects on Adult Sexual Responding

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2008
Jane S.T. Woo MA
ABSTRACT Introduction., Although age of first intercourse and the emotional aspects of that experience are often a target in assessment because they are thought to contribute to later sexual functioning, research to date on how sexual debut relates to adult sexual functioning has been limited and contradictory. Aim., The goal of this study was to explore the association between age of first intercourse and adult sexual function in a sample of Euro-Canadian and Asian Canadian university students. In addition, culture-based comparisons of sexual complaints were made to clarify the role of culture in sexual response. Methods., Euro-Canadian (N = 299) and Asian Canadian (N = 329) university students completed the Golombok-Rust Inventory of Sexual Satisfaction and the Vancouver Index of Acculturation. Main Outcome Measures., Self-reported sexual problems and bidimensional acculturation. Results., Ethnic group comparisons revealed that Asians reported more sexual complaints including sexual avoidance, dissatisfaction and non-sensuality. Among the women, Asians reported higher scores on the Vaginismus and Anorgasmia subscales whereas the ethnic groups did not differ on the male-specific measures of sexual complaints. In the overall sample, older age of first intercourse was associated with more sexual problems as an adult, including more sexual infrequency, sexual avoidance, and non-sensuality. Among the Asian Canadians, less identification with Western culture was predictive of more sexual complaints overall, more sexual noncommunication, more sexual avoidance, and more non-sensuality. For Asian women, acculturation interacted with age of first intercourse to predict Vaginismus scores. Conclusions., Overall, these data replicate prior research that found that a university sample of individuals of Asian descent have higher rates of sexual problems and that this effect can be explained by acculturation. Earlier sexual debut was associated with fewer sexual complaints in adulthood. Woo JST, and Brotto LA. Age of first sexual intercourse and acculturation: Effects on adult sexual responding. J Sex Med 2008;5:571,582. [source]

The Male Sexual Quotient: A Brief, Self-Administered Questionnaire to Assess Male Sexual Satisfaction

THE JOURNAL OF SEXUAL MEDICINE, Issue 2 2007
Carmita H.N. Abdo MD
ABSTRACT Introduction., Sexual satisfaction is an important aspect of overall life satisfaction. The Male Sexual Quotient (MSQ) was designed to provide a versatile, user-friendly instrument to measure various aspects of male sexual function and satisfaction. Aim., Assess responses to the MSQ in men with sexual dysfunction (SD). Methods., Items for inclusion in the MSQ were developed through interviewing 612 randomly recruited men in São Paulo, Brazil, about factors considered to influence sexual quality of life. Validation of the MSQ was conducted in two phases in men with and without SD. Main Outcome Measure., The correlation between patients' total MSQ score and scores on the Sexual Health Inventory for Men (SHIM). Results., The resulting MSQ questionnaire contains 10 items that address sexual function and satisfaction and is scored on a 100-point scale, with higher scores indicating greater sexual function and satisfaction with such function. Patients' scores on the MSQ were positively correlated with scores on the SHIM (r = 0.86; P < 0.0001). Scores on MSQ item 8, which assesses ejaculatory control, indicated that 46% of patients may have premature ejaculation (PE). The mean time for patients to complete the MSQ was 11 minutes. Conclusions., The MSQ is a brief, comprehensive, and easily self-administered tool designed to help men identify aspects of their sexual experience that could be improved through partner dialogue, physician consultation, and appropriate treatment. MSQ scores correlated well with SHIM scores, and scores were inversely related to the severity of erectile dysfunction or PE and other male SDs. These preliminary findings suggest that the MSQ possesses good convergent validity. Nearly half of men reported problems with ejaculatory control, indicating an association between PE and other SD. Further validation of the MSQ in a double-blind trial is needed. The MSQ may aid in decision making for the treatment of SD. Abdo CHN. The Male Sexual Quotient: A brief, self-administered questionnaire to assess male sexual satisfaction. J Sex Med 2007;4:382,389. [source]

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

The Male Sexual Quotient: A Brief, Self-Administered Questionnaire to Assess Male Sexual Satisfaction

Phosphodiesterase 5 inhibitors in the treatment of premature ejaculation

INTERNATIONAL JOURNAL OF ANDROLOGY, Issue 5 2006
W. F. Wang
Summary To date, there is no FDA-approved therapy for premature ejaculation (PE). Recently, phosphodiesterase 5 inhibitors (PDE5 -Is) have been demonstrated to have encouraging results in the treatment of PE by a few studies. The aim of this review was to assess the updated manuscripts and thereafter present the practical recommendations and possible mechanisms concerning PDE5 -Is for treating PE. Using MEDLINE, we searched and assessed the peer manuscripts published from 1 January 1996 to 1 September 2005 about PDE5 -Is for treating PE. The results show that the number of patients in all the reports is very few and most of the studies do not employ double-blinded and placebo-controlled tests, though they are prospective and randomized. Therefore, the results and conclusions might be biased. PDE5 -Is are suggested to be used in PE with old age or associated with erectile dysfunction (ED), or to be employed alone or in combination with selective-serotonin reuptake inhibitors (SSRIs) when SSRIs fail to treat PE; behavioural therapy is proposed to be used for preventing the recurrence of PE following withdrawal of PDE5 -Is. In addition, for the PE patient with a definite aetiological cause, the aetiology should be cured first, if PE still exists, followed by PDE-Is prescription. Possible mechanisms that are involved include relaxing the smooth muscles of vas deferens, seminal vesicle, prostate and urethra; decreasing the central sympathetic output; inducing peripheral analgesia; prolonging the duration of erection; and increasing confidence, the perception of ejaculatory control, overall sexual satisfaction, and decreasing the post-orgasmic refractory time to achieve a second erection after ejaculation. Well-designed multicentre studies are urgently warranted to further elucidate the efficacies and safety as well as mechanisms of PDE5 -Is in the treatment of PE. [source]

The influence of caregiver burden on sexual intimacy and marital satisfaction in couples with an Alzheimer spouse

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2008
C. Simonelli
Summary Objective:, This study investigates affective and sexual dimensions in partners involved as caregivers of Alzheimer dementia (AD) subjects. A negative correlation between burden of the caregiver and sexual-affective quality of life was assumed. Design and methods:, Hundred participants with AD partner (33 male, 67 female), aged between 55 and 85 years were recruited and data were collected from the Caregiver Burden Inventory scale and a semi-structured interview that included demographic information, medical history, relationship and sexual satisfaction, and current sexual function. AD group was compared with a control group (CG) (N = 100) matched for age, sex, education and marital status on measures of the semi-structured interview. Data were analysed using frequency count, univariate analysis (chi-squared and ANOVA) and bivariate correlation. Results:, The findings revealed that mean burden level was 31.59 (SD 19.51). A difference between experimental and CGs was found for sexual and affective marital satisfaction (p < 0.05). The same variables showed a rather negative correlation with total burden levels (r = ,0.374, p < 0.001; r = ,0.448, p < 0.001). [source]

The female partner's satisfaction with sildenafil citrate treatment of erectile dysfunction

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2004
TAKAHARU ICHIKAWA
Abstract Background: Data on female partners' satisfaction are scarce, although there have been many articles on patient satisfaction after sildenafil citrate treatment. The aim of this study was to evaluate the satisfaction of female partners of patients receiving sildenafil citrate for their erectile dysfunction (ED) and to assess the female partners' sexual function. Methods: Ninety-eight patients with ED were treated. Their female partners were asked to answer a questionnaire we have prepared to evaluate the efficacy of treatment, sexual satisfaction and changes in quality of life. It also included a question about female sexual function. From the results, the relationship between their female partner's satisfaction and efficacy of treatment, as well as female sexual function, were assessed. Results: Thirty (31%) questionnaires were returned to us for analysis. Effectiveness of the treatment was acknowledged by 90% of the partners. An improvement in their partner's quality of life was noticed by 60% of the women. The majority (66.7%) of the female partners were satisfied with sildenafil citrate treatment and 20% were disappointed. Moreover, 20% of the female partners were concerned about adverse events. Regarding female sexual function, some form of sexual dysfunction affected 46.7% of the women. Furthermore, a significant number (P = 0.0230) of the female partners disappointed with the treatment had some kind of sexual dysfunction. Conclusions: The results indicated that female partners reported relatively high levels of treatment satisfaction. Female partners' sexual function and anxiety regarding adverse events should be evaluated when their satisfaction with sildenafil citrate treatment is poor despite an improvement of erectile function. [source]

A comparison of sexual satisfaction and post-natal depression in the UK and Taiwan

INTERNATIONAL NURSING REVIEW, Issue 3 2006
Y.C. Huang mmedsci
Aim:, To compare the sexual expression and sexual satisfaction of women in the UK and Taiwan before and after childbirth, to determine if there is an association between self reported sexual satisfaction and postnatal depression (PND) and the main sources of sexual information for women during this period. Method:, A comparative survey of postnatal women in the UK and Taiwan using a selfadministered questionnaire, a semi structured interview and the Edinburgh Postnatal Depression Scale (EPDS) to investigate sexual satisfaction, sexual expression and main sources of information as well the prevalence of postnatal depression. Results:, Seventy per cent of the UK women and 89% of the Taiwanese women were generally satisfied with their sex life during the postnatal period although in both countries women thought that sexual expression was not as important to themselves as to their partner. There were differences in ranking criteria for physical and emotional sexual satisfaction in the two countries. Eighty-three per cent of UK women had sufficient information about sex during the postnatal period compared to 60% of Taiwanese women. There was no significant difference in the prevalence of PND (18% UK, 19% Taiwan p < 0.01 ANOVA) but significant negative associations (correlation coefficient) between ,sexual self-confidence' and PND in the UK (p < 0.01) and Taiwan (p < 0.05). UK Women with an unsatisfactory sex life (p < 0.05), insufficient sexual information (p < 0.05) and sexual worries after birth (p < 0.05) were more likely to have symptoms of PND. There was a strong association between a poor relationship with her partner and PND (p < 0.001). Conclusions:, These associations may be either a consequence of or a contributing factor to PND. The observed differences between the two countries may be attributed to cross cultural factors and differences in health care systems although further investigation is required. [source]

Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010
J. WANG
Aliment Pharmacol Ther,31, 424,431 Summary Background, Quality of life among women with irritable bowel syndrome may be affected by pelvic floor disorders. Aim, To assess the association of self-reported irritable bowel syndrome with urinary incontinence, pelvic organ prolapse, sexual function and quality of life. Methods, We analysed data from the Reproductive Risks for Incontinence Study at Kaiser Permanente, a random population-based study of 2109 racially diverse women (mean age = 56). Multivariate analyses assessed the association of irritable bowel syndrome with pelvic floor disorders and quality of life. Results, The prevalence of irritable bowel syndrome was 9.7% (n = 204). Women with irritable bowel had higher adjusted odds of reporting symptomatic pelvic organ prolapse (OR 2.4; 95% CI, 1.4,4.1) and urinary urgency (OR 1.4; 95% CI, 1.0,1.9); greater bother from pelvic organ prolapse (OR 4.3; 95% CI, 1.5,11.9) and faecal incontinence (OR 2.0; 95% CI, 1.3,3.2); greater lifestyle impact from urinary incontinence (OR 2.2; 95% CI, 1.3,3.8); and worse quality of life (P < 0.01). Women with irritable bowel reported more inability to relax and enjoy sexual activity (OR 1.8; 95% CI, 1.3,2.6) and lower ratings for sexual satisfaction (OR 1.8; 95% CI, 1.3,2.5), but no difference in sexual frequency, interest or ability to have an orgasm. Conclusions, Women with irritable bowel are more likely to report symptomatic pelvic organ prolapse and sexual dysfunction, and report lower quality of life. [source]

Penile resurfacing with vascularized fascia lata

MICROSURGERY, Issue 6 2005
Andreas I. Gravvanis M.D., Ph.D.
Penis resurfacing is a challenging procedure, and should simultaneously ensure erectile function, tactile sensibility, sexual satisfaction, and aesthetic integrity. This article presents three cases with penile skin defects treated by means of a pedicled fascia lata attached either to the tensor fascia lata (one case) or an anterolateral thigh flap (two cases). The cause of the wounds included electrical burn, Fournier's gangrene, and self-mutilation. The size of flaps ranged from 10,13 cm in width and 15,30 cm in length. All flaps included vascularized fascia lata, which covered part or the circumference of the penis. All flaps survived completely. The lateral cutaneous nerve of the thigh was included in the designed flaps in all instances, and normal protective sensation was recorded postoperatively. The patients reported normal erectile function and ability to perform intercourse. The flaps, though relatively bulky and hairy, had a good color and texture match with the penis and suprapubic region. Based on our limited experience, we believe that the anterolateral thigh flap has greater dimensions with a longer pedicle, and allows for greater flexibility in flap design compared to the tensor fascia lata flap. An anterolateral thigh flap can be safely thinned in a second stage, and it is our flap of choice for penis resurfacing. © 2005 Wiley-Liss, Inc. Microsurgery 25:462,468, 2005 [source]

New Enhancements of the Scrotal One-Incision Technique for Placement of Artificial Urinary Sphincter Allow Proximal Cuff Placement

THE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010
Steven K. Wilson MD
ABSTRACT Introduction., Urinary incontinence impairs sexual functioning and sexual satisfaction. Traditional artificial urinary sphincter (AUS) implantation requires perineal incision for cuff placement and a second inguinal incision for reservoir and pump placement. We believed AUS could be placed easier and quicker through one scrotal incision. Aim., In an effort to effect more proximal placement of the cuff while keeping the advantages of the one scrotal incision technique, we report enhancements to the original surgical technique. Methods., Thirty patients have been operated upon using the enhanced technique. A modification of the SKW retractor system (AMS) facilitates deep bulbar exposure. Twenty patients were first time implantations and 10 were revisions with five of the revisions having had the original AUS placed by traditional two-incision technique. Two of the first time AUS patients received an inflatable penile prosthesis through the same incision. Main Outcome Measures., We evaluated site of cuff placement, sizes of cuffs used, postoperative continence status. Results., All of the virgin AUS required dissection of the bulbocavernosus muscle prior to cuff placement. In scrotally placed revisions, replacement cuffs were situated considerably proximal (4.5,7.5 cm) to the original cuff site. The perineal placed revisions were accomplished through a scrotal incision with replacement of two cuffs in the same site and the three other patients immediately distal. No intraoperative complications were seen. One patient developed scrotal hematoma requiring drainage. Only 15 patients are available for follow-up and all are socially continent (one pad or less). Conclusions., Transscrotal approach is used safely and efficiently for penile implants and AUS implantation. The new enhancements to the one-scrotal incision technique allow more proximal cuff placement as evidenced by the bulbocavernosus muscle dissection and use of larger cuffs. Continence rate is similar to rates achieved with perineal placement of cuff found in the literature. Wilson SK, Aliotta PJ, Salem EA, and Mulcahy JJ. New enhancements of the scrotal one incision technique for placement of artificial urinary sphincter allow proximal cuff placement. J Sex Med 2010;7:3510,3515. [source]

Differentiating Components of Sexual Well-Being in Women: Are Sexual Satisfaction and Sexual Distress Independent Constructs?

ORIGINAL RESEARCH,SURGERY: A Large Multicenter Outcome Study of Female Genital Plastic Surgery

THE JOURNAL OF SEXUAL MEDICINE, Issue 4pt1 2010
Michael P. Goodman MD
ABSTRACT Introduction., Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? Aim., This study was designed to produce objective, utilizable outcome data regarding FGPS. Main Outcome Measures., 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. Methods., This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Results., Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6,42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients undergoing vaginal tightening/perineal support procedures. Complications were acceptable and not of major consequence. Conclusions., While emphasizing that these female genital plastic procedures are not performed to correct "abnormalities," as there is a wide range of normality in the external and internal female genitalia, both parous and nulliparous, many women chose to modify their vulvas and vaginas. From the results of this large study pooling data from a diverse group of experienced genital plastic surgeons, outcome in both general and sexual satisfaction appear excellent. Goodman MP, Placik OJ, Benson RH III, Miklos JR, Moore RD, Jason RA, Matlock DL, Simopoulos AF, Stern BH, Stanton RA, Kolb SE, and Gonzalez F. A large multicenter outcome study of female genital plastic surgery. J Sex Med 2010;7:1565,1577. [source]

ORIGINAL RESEARCH,SURGERY: Sexual Function after Loop Electrosurgical Excision Procedure for Cervical Dysplasia

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
Namfon Inna MD
ABSTRACT Introduction., Loop electrosurgical excision procedure (LEEP) is an effective tool for management of cervical dysplasia. However, removal of a part of the cervix might have a negative impact on sexual function. Aim., To examine the effect of LEEP on overall sexual satisfaction and other specific aspects of sexual function in women with cervical dysplasia. Methods., Eighty-nine premenopausal women with cervical dysplasia who had undergone LEEP at least 3 months previously were interviewed once on post-LEEP follow-up visits with a questionnaire on pre- and post-procedural sexual function. Data on frequency of sexual intercourse, the presence of dysmenorrhea, dyspareunia, and postcoital bleeding were compared using the McNemar test. Data on specific aspects of sexual function rated by the 6-point Likert scale were analyzed using Wilcoxon signed ranks test. Main Outcome Measure., The main outcome is the overall sexual intercourse satisfaction. Results., The mean age was 41.7 years. The median interval from LEEP to the time of interview was 29.3 weeks. The time of resumption of sexual intercourse after LEEP was 8.1 weeks on the average. The changes in the frequency of sexual intercourse, dysmenorrhea, and dyspareunia after LEEP were not statistically significant. The changes in overall satisfaction, vaginal elasticity, and orgasmic satisfaction appeared statistically significant (P < 0.05). Conclusion., Having LEEP done along with other "non-surgical" parts of cervical pre-cancer management is associated with small but statistically significant decreases in overall sexual satisfaction, vaginal elasticity, and orgasmic satisfaction when interviewed near to the procedure at 29.3 weeks post-operation. However, the changes on other aspects of sexual function are insignificant. The LEEP procedure itself appears to have a minimal, if any, clinically important adverse effect on sexual function. Inna N, Phianmongkhol Y, and Charoenkwan K. Sexual function after loop electrosurgical excision procedure for cervical dysplasia. J Sex Med 2010;7:1291,1297. [source]

Implants, Mechanical Devices, and Vascular Surgery for Erectile Dysfunction

THE JOURNAL OF SEXUAL MEDICINE, Issue 1pt2 2010
Wayne J.G. Hellstrom MD
ABSTRACT Introduction., The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim., To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. Methods., To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period. Main Outcome Measure., Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results., The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended. Conclusions., It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery. Hellstrom WJG, Montague DK, Moncada I, Carson C, Minhas S, Faria G, and Krishnamurti S. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 2010;7:501,523. [source]

Internet-Based Brief Sex Therapy for Heterosexual Men with Sexual Dysfunctions: A Randomized Controlled Pilot Trial

THE JOURNAL OF SEXUAL MEDICINE, Issue 8 2009
Jacques J.D.M. Van Lankveld PhD
ABSTRACT Introduction., Internet-based sex therapy for men with erectile dysfunction has been advocated as an easily accessible and cost-effective treatment. Aim., To test whether Internet-based sex therapy is superior to waiting list. Methods., Internet-based therapy was administered to heterosexual men with erectile dysfunction or premature ejaculation, without face-to-face contact, in a waiting-list controlled design, with pre-, post-, and follow-up measurements at 3 and 6 months posttreatment. Treatment was based on the sensate-focus model of Masters and Johnson, and supplemented with cognitive restructuring techniques. Main Outcome Measures., Self-reported improvement of sexual functioning, erectile functioning (men with ED), premature ejaculation (men with PE), sexual desire, overall sexual satisfaction, and sexual self-confidence. Results., Ninety-eight men participated (58 ED, 40 PE). Sexual functioning was much or somewhat improved in 40 participants (48%). In participants with ED, a near significant effect of treatment was found (P = 0.065), with higher levels of sexual desire (P < 0.05) and sexual self-confidence (P = 0.05) in treated men, in addition to improved erectile functioning (P = 0.01) and overall sexual satisfaction (P < 0.001) in both groups. In participants with PE, treatment was not superior to waiting list. In participants with ED, erectile functioning (P < 0.05) and overall sexual satisfaction (P = 0.002) improved significantly. In participants with PE, latency to ejaculation (P < 0.001), sexual desire (P < 0.05), and overall sexual satisfaction (P < 0.05) improved significantly from baseline to posttreatment, with no further changes at both follow-ups. Sexual self-confidence in men with PE remained unchanged during treatment until follow-up at 3 months posttreatment, and then was found to be improved at 6-months follow-up (P < 0.05). Conclusion., Internet-based sex therapy for male erectile dysfunction was efficacious for male erectile disorder. For men with premature ejaculation, however, treatment was not superior to waiting list. van Lankveld JJDM, Leusink P, van Diest S, Gijs L, and Slob AK. Internet-based brief sex therapy for heterosexual men with sexual dysfunctions: A randomized controlled pilot trial. J Sex Med 2009;6:2224,2236. [source]

ORIGINAL RESEARCH,ANATOMY/PHYSIOLOGY: Satisfaction (Sexual, Life, Relationship, and Mental Health) Is Associated Directly with Penile,Vaginal Intercourse, but Inversely with Other Sexual Behavior Frequencies

THE JOURNAL OF SEXUAL MEDICINE, Issue 7 2009
Stuart Brody PhD
ABSTRACT Introduction., Some sex therapists and educators assume that many sexual behaviors provide comparable sexual satisfaction. Evidence is required to determine whether sexual behaviors differ in their associations with both sexual satisfaction and satisfaction with other aspects of life. Aims., To test the hypothesis that satisfaction with sex life, life in general, sexual partnership, and mental health correlates directly with frequency of penile,vaginal intercourse (PVI) and inversely with frequency of both masturbation and partnered sexual activity excluding PVI (noncoital sex). Methods., A representative sample of 2,810 Swedes reported frequency of PVI, noncoital sex, and masturbation during the past 30 days, and degree of satisfaction with their sex life, life in general, partnership, and mental health. Main Outcome Measures., Multivariate analyses (for the sexes separately and combined) considering the different satisfaction parameters as dependent variables, and the different types of sexual activities (and age) as putative predictors. Results., For both sexes, multivariate analyses revealed that PVI frequency was directly associated with all satisfaction measures (part correlation = 0.50 with sexual satisfaction), masturbation frequency was independently inversely associated with almost all satisfaction measures, and noncoital sex frequencies independently inversely associated with some satisfaction measures (and uncorrelated with the rest). Age did not confound the results. Conclusions., The results are consistent with evidence that specifically PVI frequency, rather than other sexual activities, is associated with sexual satisfaction, health, and well-being. Inverse associations between satisfaction and masturbation are not due simply to insufficient PVI. Brody S, and Costa RM. Satisfaction (sexual, life, relationship, and mental health) is associated directly with penile-vaginal intercourse, but inversely with other sexual behavior frequencies. J Sex Med 2009;6:1947,1954. [source]

Overactive Bladder Is Associated with Erectile Dysfunction and Reduced Sexual Quality of Life in Men

THE JOURNAL OF SEXUAL MEDICINE, Issue 12 2008
Debra E. Irwin MSPH
ABSTRACT Introduction., The prevalence of sexual dysfunction, including erectile dysfunction (ED), is greater in men with lower urinary tract symptoms (LUTS), including overactive bladder (OAB), than in men without LUTS. Aim., To evaluate the prevalence of ED, the impact of urinary symptoms on sexual activity and sexual enjoyment, and sexual satisfaction in men with OAB. Methods., A nested case-control analysis was performed on data from a subset of men with (cases) and without (controls) OAB frequency-matched for age (5-year age strata) and country from the EPIC study. Respondents were asked about OAB symptoms (using the 2002 International Continence Society [ICS] definitions) and sexual activity. Sexually active respondents were asked about ED, sexual enjoyment, and overall satisfaction with their sex lives. Conditional logistic regression was used to assess factors associated with ED. Main Outcome Measures., The percentage of cases and controls reporting ED, a reduction in the frequency of sexual activity or enjoyment of sexual activity because of urinary symptoms, and overall satisfaction with their sex lives was determined for cases and controls. Results., A total of 502 cases and 502 controls were matched for age strata and country. Significantly more cases (14%) reported reduced sexual activity because of urinary symptoms compared with controls (4%; P , 0.05). Among sexually active respondents, cases were significantly more likely to have ED than were controls (prevalence odds ratio, 1.5; 95% confidence interval, 1.1,2.2); the prevalence of ED was similar to that for men with hypertension or diabetes. Significantly more cases (15%) reported decreased enjoyment of sexual activity because of urinary symptoms relative to controls (2%; P , 0.05), and significantly fewer cases were satisfied with their sex lives (81% vs. 90%; P , 0.05). Conclusions., OAB, as defined by the ICS, was significantly associated with increased prevalence of ED, reduced sexual activity and sexual enjoyment because of urinary symptoms, and reduced sexual satisfaction. Irwin DE, Milson I, Reilly K, Hunskaar S, Kopp Z, Herschorn S, Coyne KS, Kelleher CJ, Artibani W, and Abrams P. Overactive bladder is associated with erectile dysfunction and reduced sexual quality of life in men. J Sex Med **;**:**,**. [source]

Sexual Function and Obstructive Sleep Apnea,Hypopnea: A Randomized Clinical Trial Evaluating the Effects of Oral-Appliance and Continuous Positive Airway Pressure Therapy

THE JOURNAL OF SEXUAL MEDICINE, Issue 4ii 2007
Aarnoud Hoekema DMD
ABSTRACT Introduction., The obstructive sleep apnea,hypopnea syndrome (OSAHS) is associated with sexual dysfunction. Although successful treatment with continuous positive airway pressure (CPAP) has been demonstrated to improve sexual function, the effects of oral-appliance therapy are unknown. Aim., The aims of this study were to determine to what extent untreated male OSAHS patients experience sexual dysfunctions compared with control subjects, and second, to evaluate the effects of oral-appliance and CPAP therapy on sexual functioning. Methods., Sexual functioning was determined in 48 OSAHS patients with the Golombok Rust inventory of sexual satisfaction (GRISS) and a testosterone measurement. GRISS outcomes were compared with 48 age-matched male controls without any sexual problems. Patients were randomized for either oral-appliance or CPAP therapy. After 2,3 months of treatment, the GRISS and testosterone measurements were repeated. Main Outcome Measure., The outcomes on the GRISS were used as the main outcome measure. Results., Compared with controls, OSAHS patients had significantly more erectile dysfunction (mean ± standard deviation; OSAHS 8.7 ± 3.8 vs. controls 6.8 ± 2.6) and sexual dissatisfaction (mean ± standard deviation; OSAHS 9.7 ± 4.2 vs. controls 8.1 ± 2.6) as indicated by the GRISS. No significant changes in the GRISS or testosterone levels were observed in the 20 and 27 patients completing the follow-up review for oral-appliance and CPAP therapy. A correlation was demonstrated between the extent of erectile dysfunction at baseline and improvements in erectile function following treatment (r = ,0.547, P = 0.000). Conclusions., This study confirms that male OSAHS patients show more sexual dysfunctions compared with age-matched control subjects. Although significant improvements in sexual functioning in neither the oral-appliance nor CPAP-treated group could be established, our findings suggest that untreated OSAHS patients with pronounced erectile dysfunction experience some improvement following treatment. Hoekema A, Stel A-L, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, and de Bont LGM. Sexual function and obstructive sleep apnea,hypopnea: A randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med 2007;4:1153,1162. [source]

The Male Sexual Quotient: A Brief, Self-Administered Questionnaire to Assess Male Sexual Satisfaction

Endocrine Aspects of Female Sexual Dysfunction

THE JOURNAL OF SEXUAL MEDICINE, Issue 1 2004
Susan R. Davis MD
ABSTRACT Introduction., Various endogenous hormones, including estrogen, testosterone, progesterone and prolactin, may influence female sexual function. Aim., To provide recommendations for the diagnosis and treatment of women with endocrinologic sexual difficulties. Methods., The Endocrine Aspects of Female Sexual Dysfunction Committee was part of a multidisciplinary International Consultation. It included four experts from two countries and several peer reviewers. Main Outcome Measure., Expert opinion was based on committee discussion, a comprehensive literature review and evidence-based grading of available publications. Results., The impact of hormones on female sexual function and their etiological roles in dysfunction is complex. Research data are limited as studies have been hampered by lack of precise hormonal assays and validated measures of sexual function in women. Sex steroid insufficiency is associated with urogenital atrophy and may also adversely affect central sexual thought processes. Systemic estrogen/estrogen progestin therapy alleviates climacteric symptoms but there is no evidence that this therapy specifically improves hypoactive sexual desire disorder (HSDD) in premenopausal or postmenopausal women. Exogenous testosterone has been shown in small randomized controlled trials (RCT) to improve sexual desire, arousal and sexual satisfaction in both premenopausal and postmenopausal women. However, as there is no biochemical measure that clearly identifies who to treat, use of exogenous testosterone should be considered only after other causes of HSDD have been excluded, such as depression, relationship problems and ill health. The clinical assessment of HSDD should include detailed medical, gynecologic, sexual and psychosocial history and physical examination including the external/internal genitalia. Hormonal therapy should be individualized and risks/benefits fully discussed, and all treated women should be carefully followed up and monitored for therapeutic side effects. Conclusions., There is a need for prospective, multi-institutional clinical trials to define safe and effective endocrine treatments for female sexual dysfunction. [source]

Antenatal Perineal Massage for Reducing Perineal Trauma

BIRTH, Issue 2 2006
M.M. Beckmann
Background:, Perineal trauma following vaginal birth can be associated with significant short- and long-term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the incidence of perineal trauma. Objectives:, To assess the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2005), PubMed (1966 to January 2005), EMBASE (1980 to January 2005) and reference lists of relevant articles. Selection criteria:, Randomised and quasi-randomised controlled trials evaluating any described method of antenatal perineal massage undertaken for at least the last four weeks of pregnancy. Data collection and analysis:, Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information. Main results:, Three trials (2434 women) comparing digital perineal massage with control were included. All were of good quality. Antenatal perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (three trials, 2417 women, relative risk (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat (NNT) 16 (10 to 39)). This reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.90 (95% CI 0.84 to 0.96), NNT 14 (9 to 35)). Women who practised perineal massage were less likely to have an episiotomy (three trials, 2417 women, RR 0.85 (95% CI 0.75 to 0.97), NNT 23 (13 to 111)). Again this reduction was statistically significant for women without previous vaginal birth only (three trials, 1925 women, RR 0.85 (95% CI 0.74 to 0.97), NNT 20 (11 to 110)). No differences were seen in the incidence of 1st or 2nd degree perineal tears or 3rd/4th degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.68 (95% CI 0.50 to 0.91) NNT 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage. Authors' conclusions:, Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage. *** The preceding report is an Abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464,780X). The Cochrane Database of Systematic Reviews 2006 Issue 1. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [source]

The effect of hysterectomy or levonorgestrel-releasing intrauterine system on sexual functioning among women with menorrhagia: a 5-year randomised controlled trial

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2007
K Halmesmäki
Objective, To compare among women with menorrhagia the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on sexual functioning . Design, A randomised controlled trial. Setting, Five university hospitals in Finland. Sample, A total of 236 women, aged 35,49 years. Methods, Of the women, 117 were treated by hysterectomy and 119 by LNG-IUS. Main outcome measures, Sexual functioning was evaluated by modified McCoy sexual scale at baseline and at 6 months, 12 months, and 5 years after initiation of treatment (hysterectomy or application of LNG-IUS). Results, Among women treated by hysterectomy, sexual satisfaction increased and sexual problems decreased. Among LNG-IUS users, satisfaction with partner decreased. In addition to treatment modality (P= 0.02), estrogen therapy (P= 0.01), smoking (P= 0.001), night sweats (P= 0.03), vaginal dryness (P= 0.04), hot flushes (P= 0.01), and having someone to ask for advice (P= 0.03) and to share worries (P= 0.01) explained changes in sexual functioning. Conclusions, Among women with menorrhagia, hysterectomy improves sexual functioning, whereas LNG-IUS does not have such a positive effect. [source]

Assessment of male sexual function by the Brief Sexual Function Inventory

BJU INTERNATIONAL, Issue 2 2006
ARNSTEIN MYKLETUN
OBJECTIVE To present normative data from Norway using the Brief Male Sexual Function Inventory (BSFI, the first patient self-administered questionnaire to assess male sexuality, and used in the USA) in men aged 20,79 years, examine the psychometric properties of the BSFI, explore the impact of sexual function and other variables on overall sexual satisfaction, and compare American and Norwegian normative data. SUBJECTS AND METHODS From public official address lists 3500 men aged 20,79 years were invited to take part in an anonymous questionnaire study, including the BSFI. Altogether 1185 (34%) responded, and the response rates varied with age. RESULTS There was increasingly reduced sexual function concerning drive, erection, ejaculation, and problem assessment with age, and most of the age-effect started at >50 years old. Overall sexual satisfaction followed the same trend, but with a weaker association with age. Analyses of factor structure and internal consistency of the BSFI supported a one-factor solution with good internal consistency. Drive, erection, ejaculation, and problem assessment explained 28% of the variance in overall sexual satisfaction. Being younger and having a sexual partner were also associated with high scores of overall sexual satisfaction. American and Norwegian normative data in the BSFI dimensions were markedly similar. CONCLUSION The BSFI is a short and discrete screening tool for sexual function, and for most clinical and research purposes we recommend using the BSFI as a one-dimensional scale. [source]

Urinary symptoms, quality of life and sexual function in patients with benign prostatic hypertrophy before and after prostatectomy: a prospective study

BJU INTERNATIONAL, Issue 3 2003
M. Gacci
OBJECTIVE To evaluate urinary symptoms, sexual dysfunction and quality of life in patients with benign prostatic hypertrophy (BPH) before and after open prostatectomy, using the International Prostate Symptom Score (IPSS), the International Continence Society (ICS)-,BPH' (ICS- male, ICS- sex and ICS- QoL) and International Index of Erectile Function (IIEF) questionnaires. PATIENTS AND METHODS Sixty men with BPH (mean age 68 years) underwent a digital rectal examination, transurethral ultrasonography, measurement of total prostatic specific antigen serum level and uroflowmetry. Their urinary symptoms, sexual function and quality of life were fully evaluated using the IPSS, ICS-,BPH' and IIEF before and 6 months after suprapubic prostatectomy. The body mass index (BMI) was also calculated for each patient. Univariate analysis was used to examine the relationship between symptom scores and age, tobacco use, alcohol intake and BMI. RESULTS In a univariate analysis, age was the most important prognostic factor for both urinary and sexual symptoms. Prostatectomy resulted in a significant improvement in obstructive (mean 9.68 to 3.38) and irritative symptom (6.70 to 3.06), and quality-of-life scores (3.41 to 1.34). ICS- male scores were both significantly decreased, the mean voiding score from 13.72 to 10.28 and the incontinence score from 10.43 to 7.81. There was also a significant decrease in the ICS- QoL symptom score (from 9.20 to 7.27). Comparative results between IIEF and ICS- sex showed no improvement in sexual scores after open surgery, but there was a significant increase in sexual desire and overall satisfaction (both P = 0.035). CONCLUSIONS The combined use of the IPSS, ICS-,BPH' and IIEF allows an evaluation of the relationship between age, prostatic symptoms and sexual dysfunction. Age may be considered both a direct and indirect (BPH-related) prognostic factor for sexual activity. Suprapubic prostatectomy resolves obstructive symptoms, and maintains sexual desire, overall sexual satisfaction and an improvement in quality of life. However, irritative symptoms, erection, orgasm and sexual intercourse satisfaction are not significantly altered. [source]

Pilot intervention to enhance sexual rehabilitation for couples after treatment for localized prostate carcinoma,

CANCER, Issue 12 2005
Andrea L. Canada Ph.D.
Abstract BACKGROUND The majority of prostate carcinoma survivors experience enduring sexual difficulties and associated distress in the years after definitive treatment. A counseling intervention aimed at improving levels of sexual satisfaction and increasing successful utilization of medical treatment for erectile dysfunction (ED) was developed and pilot-tested for both the survivor of prostate carcinoma and his partner. METHODS All male participants were 3-month to 5-year survivors of localized prostate carcinoma who had been treated with radical prostatectomy or radiation therapy, and were married or in a committed relationship. Couples were randomized to attend four sessions of counseling together or to have the man attend alone. In both groups, partners completed behavioral homework. The sessions included education on prostate carcinoma and sexual function and options to treat ED as well as sexual communication and stimulation skills. Standardized questionnaires at baseline, posttreatment, and at 3-month and 6-month follow-up assessed sexual function, marital adjustment, psychologic distress, and utilization of treatments for ED. RESULTS Fifty-one of 84 couples randomized to treatment completed the intervention (61%). Attendance by the partner did not affect outcomes. Participants completing the intervention demonstrated improvment in male overall distress (P < 0.01), male global sexual function (P < 0.0001), and female global sexual function (P < 0.05) at 3-month follow-up, but regression toward baseline was noted at 6-month follow-up. However, utilization of ED treatments increased from 31% at the time of study entry to 49% at the 6-month follow-up (P = 0.003). CONCLUSIONS The results of this brief pilot counseling intervention demonstrated significant gains in sexual function and satisfaction and increased utilization of treatments for ED. However, modifications are needed in future randomized trials to reduce the rate of premature termination and to improve long-term maintenance of gains. Cancer 2005. © 2005 American Cancer Society. [source]