Items in AFP with MESH term: Sexual Dysfunction, Physiological
ABSTRACT: A number of antidepressants have emerged in the U.S. market in the past two decades. Selective serotonin reuptake inhibitors have become the drugs of choice in the treatment of depression, and they are also effective in the treatment of obsessive-compulsive disorder, panic disorder, and social phobia. New indications for selective serotonin reuptake inhibitors include post-traumatic stress disorder, premenstrual dysphoric disorder, and generalized anxiety disorder. Extended-release venlafaxine has recently been approved by the U.S. Food and Drug Administration for the treatment of generalized anxiety disorder. Mirtazapine, which is unrelated to the selective serotonin reuptake inhibitors, is unique in its action--stimulating the release of norepinephrine and serotonin. The choice of antidepressant drug depends on the agent's pharmacologic profile, secondary actions, and tolerability. Sexual dysfunction related to the use of antidepressants may be addressed by reducing the dosage, switching to another agent, or adding another drug to overcome the sexual side effects. Augmentation with lithium or triiodothyronine may be useful in patients who are partially or totally resistant to antidepressant treatment. Finally, tapering antidepressant medication may help to avoid discontinuation syndrome or antidepressant withdrawal.
ABSTRACT: Testosterone treatment is controversial for men and even more so for women. Although long-term outcome data are not available, prescriptions for testosterone are becoming more common. Testosterone is used primarily to treat symptoms of sexual dysfunction in men and women and hot flashes in women. Potential benefits include improved libido, increased bone mass, and increased sense of well-being. In individuals with human immunodeficiency virus infection or other chronic diseases, testosterone has been shown to improve mood and energy levels, even in patients with normal testosterone levels. Testosterone can be administered by injection, patch, topical gel, pill, or implant. Side effects in men include polycythemia and acne. Side effects in women include acne, hepatotoxicity, and virilization and usually only occur when testosterone is used in supraphysiologic doses. Long-term studies of the effects of testosterone on prostate cancer, breast cancer, and heart disease have not been completed. Mammograms and monitoring of prostate-specific antigen, hematocrit, and lipid levels are recommended for patients taking testosterone.
ABSTRACT: Female sexual complaints are common, occurring in approximately 40 percent of women. Decreased desire is the most common complaint. Normal versus abnormal sexual functioning in women is poorly understood, although the concept of normal female sexual function continues to develop. A complete history combined with a physical examination is warranted for the evaluation of women with sexual complaints or concerns. Although laboratory evaluation is rarely helpful in guiding diagnosis or treatment, it may be indicated in women with abnormal physical examination findings or suspected comorbidities. The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) or ALLOW (Ask, Legitimize, Limitations, Open up, Work together) method can be used to facilitate discussions about sexual concerns and initiation of treatment. Developments in the treatment of male erectile dysfunction have led to investigation of pharmacotherapy for the treatment of female sexual dysfunction. Although sexual therapy and education (e.g., cognitive behavior therapy, individual and couple therapy, physiotherapy) form the basis of treatment, there is limited research demonstrating the benefit of hormonal and nonhormonal drugs. Testosterone improves sexual function in postmenopausal women with hypoactive sexual desire disorder, although data on its long-term safety and effectiveness are lacking. Estrogen improves dyspareunia associated with vulvovaginal atrophy in postmenopausal women. Phosphodiesterase inhibitors have been shown to have limited benefit in small subsets of women with sexual dysfunction.
ABSTRACT: Nearly two thirds of patients with cancer will undergo radiation therapy as part of their treatment plan. Given the increased use of radiation therapy and the growing number of cancer survivors, family physicians will increasingly care for patients experiencing adverse effects of radiation. Selective serotonin reuptake inhibitors have been shown to significantly improve symptoms of depression in patients undergoing chemotherapy, although they have little effect on cancer-related fatigue. Radiation dermatitis is treated with topical steroids and emollient creams. Skin washing with a mild, unscented soap is acceptable. Cardiovascular disease is a well-established adverse effect in patients receiving radiation therapy, although there are no consensus recommendations for cardiovascular screening in this population. Radiation pneumonitis is treated with oral prednisone and pentoxifylline. Radiation esophagitis is treated with dietary modification, proton pump inhibitors, promotility agents, and viscous lidocaine. Radiation-induced emesis is ameliorated with 5-hydroxytryptamine3 receptor antagonists and steroids. Symptomatic treatments for chronic radiation cystitis include anticholinergic agents and phenazopyridine. Sexual dysfunction from radiation therapy includes erectile dysfunction and vaginal stenosis, which are treated with phosphodiesterase type 5 inhibitors and vaginal dilators, respectively.
The Importance of Obtaining a Sexual History - Editorials