1/10. case management of the anemic patient. Epoetin alfa: focus on sexual dysfunction.Sexual dysfunction is a common problem for patients with ESRD. This article discusses the nature of the problem, along with the improvement in sexual function that has been noted after beginning therapy with Epoetin alfa. The assessment and management of patients with sexual dysfunction are described, and the role of the nurse is emphasized.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Sexual dysfunction: treat or refer.Sexual dysfunction is common in postmenopausal women, but because this problem may be caused by several factors, the primary need for these patients is an initial assessment and accurate diagnosis by the primary care provider. Listening to the patient and clarifying her concerns are important for defining the nature of the problem, its severity and duration, and her motivation for treatment. A complete physical evaluation, including a pelvic examination and measurement of postmenopausal hormone levels, may provide important information for structuring a treatment plan to address the patient's concerns. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual needs. Alleviation of some menopause-related sexual function difficulties with prescription medications may be warranted, and referral to a specialist for further treatment and counseling may often be the best course of action for a primary care provider. Sexual problems in postmenopausal women are usually amenable to fairly simple interventions that are within the competence of primary care professionals. This paper provides the primary care provider with a perspective on the appropriateness of treatment compared with referral for women experiencing postmenopausal sexual dysfunction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Caring for the orthopaedic patient with sickle cell disease.Sickle cell disease (SCD) is an inherited, chronic, painful condition seen primarily in blacks and populations from the Mediterranean and Caribbean areas. The crescent or sickle shaped red blood cells have a shorter lifespan causing severe anemia; they are sticky and easily clump together causing intravascular occlusions which eventually damage vital organs. Providing nursing care for patients with sickle cell disease can be very challenging because of the chronic nature of the illness. Understanding the disease phenomena can facilitate nursing assessments and help nurses individualize care for these clients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. A longitudinal study of sexuality and gynecologic health in abused women.Although the nature of the sexual dysfunctions that result from rape and abuse may vary, the study reported here suggests that the dysfunctions become chronic. Sexually violent assaults alter a woman's affective as well as her gynecologic and physiologic life. The author determined the frequency of sexual dysfunction in 100 women: 30 rape victims, 35 abuse victims, and 30 case-matched controls. The sexual inventory evaluated for sexual fears, sexual desire, sexual arousal, and orgasm. To evaluate the impact of the abuse on the gynecologic health of the victims, the gynecologic examination and interview focused on pain, dyspareunia, vaginismus, dysfunctional uterine bleeding, vaginitis, and pelvic surgery. Over a period of two to four years after the violent event, 61% of the raped and abused women had some sexual dysfunction. Almost the same percentage had gynecologic problems. Studies of this nature are difficult because the victims are reluctant to participate and resistant to cooperate. Only 45% of the victims in the rape-crisis centers were willing to cooperate, while only 25% of those in the shelter for abused women were willing to provide a sexual history and consent to an interview and pelvic examination. Such factors need to be kept in mind when interpreting the data.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
5/10. Psychosexual dysfunction in patients with immobilized jaws.The purposes of this study were to determine and evaluate the psychosexual behavior of selected patients whose jaws were immobilized. Data for this pilot study were collected by using a standardized interview protocol with ten patients whose jaws were immobilized. The interview questions were designed to ascertain whether sexual problems existed, the nature and management of these problems, and the suggested role the operating surgeon might assume in assisting the patient. The data revealed that sexual difficulties were experienced by nine of these patients, and many of their problems were similar. The chief complaints included: (1) shortness of breath during sexual intercourse, (2) difficulty in oral foreplay, (3) poor verbal communication, (4) altered self-image, (5) sexual dysfunctions induced by pain medication, (6) depression, and (7) a lack of ability to exercise oral-genital sexual contact. Nine of the ten patients agreed that the operating surgeon should inform his or her patients with immobilized jaws of potential sexual disability. We believe that additional studies of these problems could enhance the management of patients with oral and maxillofacial injuries.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Marital sexual dysfunction: female dysfunctions.The diagnosis, treatment, and referral of married women with sexual dysfunctions require information about the current physiologic deficit, previous sexual capacity, level of sexual desire, masturbatory experience, means of orgasmic attainment, preferred sexual partner, quality of marriage, husband's sexual capacities, and method of contraception. For classification purposes, the three basic physiologic deficits--excitement phase dysfunction, orgasmic phase dysfunction, and vaginismus--are subdivided into primary and secondary types. Primary dysfunctions represent longstanding developmental problems and are usually purely psychological in origin. Secondary dysfunctions occur after a period of normal sexual functioning and may be organic or psychological in origin. The actual determinants of dysfunctions are not well understood, but those factors commonly associated are discussed. The lack of knowledge about the nature of sexual desire, prevalence of dysfunctions, and significance of the inability to attain orgasm with coitus is emphasized. The physician's role in giving advice and treatment is defined.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. cimetidine blocks testosterone synthesis.Although an assortment of endocrine dysfunctions are reported in men treated with cimetidine hydrochloride, gonadotropin and sex steroid levels are usually normal. A 66-year-old man with previously normal sexual function presented with breast tenderness and sexual dysfunction after receiving cimetidine. His plasma testosterone level was low, and elevated gonadotropin levels suggested a primary testicular disorder. His sexual dysfunction improved and his plasma testosterone level rose to normal after cimetidine therapy was discontinued. Readministration of cimetidine therapy resulted in the prompt recurrence of his sexual problems and low testosterone level. A reversible defect in 17-beta-hydroxysteroid dehydrogenase is the mechanism postulated to have caused his low testosterone level. While the frequency of this abnormality is uncertain, its reversible nature and the wide use of cimetidine make it an important cause of sexual dysfunction in men.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Sexual dysfunctions in multiple sclerosis.The nature, incidence, prevalence, etiology and management of sexual problems in MS has not been well defined yet. Sexual dysfunctions in MS seem to be related to a combination of the neurological consequences of MS and the personal, partner and social reactions to this condition. A sexual history is valuable in defining the specific areas of concern, and bringing into focus the patient's and the couple's sexual resources. physical examination and investigations may assist in clarifying the extent of the sexual impairment and disability, and its relationship to MS. Treatment strategies include: relevant information, education, physical rehabilitation and supportive therapy in combination with medical intervention, and when indicated, surgical treatment or sex therapy. Long-range prognosis with or without treatment is not clear yet.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. The conus demyelination syndrome in multiple sclerosis.Bowel, bladder and sexual dysfunction are common in multiple sclerosis and are generally attributed to the widespread nature of the involvement of the neuroaxis by the demyelinating plaques. Recently we encountered a specific subset of patients within this group who had characteristic clinical complaints of hesitancy, straining and incomplete voiding, perineal hypesthesia on examination, areflexia by cystometry and colonometry and electrophysiological parameters suggesting involvement of the conus medullaris. This heretofore postulated but undocumented mechanism of neurovisceral dysfunction in multiple sclerosis is detailed and discussed in 2 patients in this report.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Sexual dysfunction in female patients with multiple sclerosis.This paper reports on sexual dysfunction experienced by 25 women with relatively mild multiple sclerosis (MS), previous accounts having been largely confined to problems encountered by males. The study included a matched comparison group of 25 women with migraine. All subjects were investigated neurologically, with particular reference to the lower segment of the spinal cord. Two case histories help to illustrate the results, and it is concluded that major sexual problems of organic nature are common and early symptoms in MS. The implications for treatment are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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