INTRODUCTION: Despite the high prevalence of sexual dysfunction among male schizophrenia patients, there is still a paucity of research on this area.
AIMS: The study aims to determine the prevalence of sexual dysfunction and any association between male patients with schizophrenia in remission and the sociodemographic profile, medication, depression, anxiety, psychopathology of illness, body mass index, and waist circumference.
METHODS: A cross-sectional study with nonprobability sampling method was conducted in a psychiatric outpatient clinic in Taiping Hospital (Perak, Malaysia) over a 7-month period. A total of 111 remitted male schizophrenia patients were recruited. The validated Malay version of the International Index of Erectile Function (Mal-IIEF-15) was administered to the patients and assessed over 4-week duration in the domains of erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. Logistic regression analysis was employed.
MAIN OUTCOME MEASURES: Prevalence and associated factors for sexual dysfunction in each domain are the main outcome measures.
RESULTS: All five domains of sexual functioning in patients showed a high prevalence of dysfunction ranging from 78.4% to 97.1% with orgasmic dysfunction being the least impaired and intercourse satisfaction the worst impaired. Among the domains, only orgasmic dysfunction was significantly associated with race, i.e., Chinese at lower risk for impairment than the Malays (OR = 0.23; 95% CI: 0.07, 0.76; P = 0.018); education, i.e., patients with education higher than primary level were at higher risk for dysfunction (OR = 6.49; 95% CI: 1.32, 32.05; P = 0.022); and Positive and Negative Syndrome Scale (PANSS)-positive subscale, i.e., higher PANSS-positive score was a protective factor for orgasmic dysfunction (OR = 0.54; 95% CI: 0.33, 0.89; P = 0.015).
CONCLUSIONS: The prevalence of sexual dysfunction was generally high. Malay patients and those with education higher than primary level were at higher risk for orgasmic dysfunction whereas higher PANSS-positive score was protective against the impairment. The high rate of sexual dysfunction in schizophrenia patients warrants a routine inquiry into patients' sexuality and the appropriate problems being addressed.
Study site: Psychiatric clinic, Hospital Taiping, Perak, Malaysia
Decreased libido is recognized as one of the vegetative symptoms of depression. Increased libido has not been acknowledged as one of its symptoms, neither has it been reported, particularly in depressed bipolar patients.
Khat (Catha edulis) is an evergreen tree/shrub that is thought to affect sexual motivation or libido. Its positive effect on sexual desire is more frequently observed in females than in males and occurs when khat is chewed. Thus, khat's effects on sexual behavior may depend on the release mode of its active constituent.
Female sexual dysfunction (FSD) is a prevalent sexual health problem that has been inadequately investigated in Malaysia, a nation with a conservative multiethnic society.
The concept of a sexual response cycle (SRC) for women has gained interest lately with the reintroduction of terms with new definitions and a new model for the sexual response, especially the Basson's circular model.
Female sexual dysfunction (FSD) is a prevalent sexual health problem that does not spare the women in Malaysia, a nation with a conservative multiethnic society.
Hysterectomy and tubal sterilisation are two commonly performed gynaecological procedures in Malaysia. Little has been published about the psychological impact on sexuality of such operations in the Far East. Many Malaysian patients believe that surgery to the pelvic organs may be detrimental to the sexual health and needs of women. There is a widespread belief that the uterus is essential for the libido and sexual wellbeing of women. It is also believed that tubal sterilisation may result in the loss of libido and thus of sexual desire for her husband. Despite counselling to dispel these misconceptions, patients frequently refuse surgical management for fear of losing their libido and sexuality. Inability to satisfy and consummate marriage is a valid reason for the partner to find another wife (Muslims in Malaysia are legally allowed to have four wives). This fear of ultimately losing the husband to another woman due to lack of libido and loss of sexuality often causes women to refuse appropriate surgery. The recent availability of the levonorgestrel intra-uterine system (IUS) in Malaysia provides a suitable medical alternative to surgery in managing some of these patients. There is good evidence to suggest the effectiveness of the levonorgestrel IUS in the treatment of menorrhagia. The use of the levonorgestrel IUS in women whose cultural beliefs/misconceptions are not amenable to counselling, may help in the psychological preservation of their libido and sexuality.
Gynura procumbens (GP) has been widely used in traditional medicine due to its ability in treating various types
of diseases. This study was carried out to determine the effects of GP on blood glucose level, fertility and libido of
streptozotocin-induced male rats. A total of 42 male rats were randomly sorted into six groups; normal, negative and
positive controls and three treated groups with different dosages of GP aqueous extract (GPAE); 150, 300 and 450 mg/kg.
Each group was treated via oral feeding for 14 consecutive days. The rats were sacrificed on day 15 for further analysis.
Administration of GPAE significantly lowered the fasting blood glucose (FBG) level and increased the plasma testosterone
level of diabetic-induced rats compared to the positive and negative control groups. There was also a significant increase
in the sperm quality as well as the fertility of GPAE treated groups compared to the negative and positive control groups.
Sexual behaviour analysis demonstrated that GPAE is able to facilitate the expression of sexual behaviour significantly;
increased mounting frequency and reduced mounting latency. These lines of evidence suggested that GPAE can act as
antihyperglycaemic, profertility and libido agents. However, its mechanism(s) remains unresolved.
Diabetes melitus telah terbukti mengganggu penghasilan testosteron dan menyebabkan masalah libido dalam kalangan
lelaki. Sehingga kini, tiada kajian mengenai potensi Lunasia amara dalam membaiki aktiviti seksual tikus jantan teraruh
diabetes. Oleh itu, kajian ini dijalankan untuk mengenal pasti potensi afrodisiak L. amara ke atas tikus jantan teraruh
diabetes. Empat kumpulan tikus teraruh diabetes masing-masing diberi perlakuan ekstrak L. amara (250 dan 500 mg/
kg berat tubuh), 500 mg/kg metformin dan air suling. Tikus kumpulan kawalan normal tanpa aruhan diabetes menerima
perlakuan air suling. Perlakuan diberikan secara suap paksa selama 30 hari untuk melihat kesan L. amara ke atas status
libido, aras testosteron serum, berat tubuh tikus, morfometri testis dan epididimis kauda serta aktiviti enzim antioksida
testis tikus teraruh diabetes berbanding kawalan. Keputusan kajian menunjukkan berlaku penurunan libido, aras
testosteron dan aktiviti khusus enzim antioksida (glutation peroksidase, katalase dan superoksida dismutase) testis tikus
teraruh diabetes secara signifikan (p<0.05) pada kedua-dua dos tersebut berbanding kawalan normal. Sementara itu,
perlakuan L. amara didapati tidak menjejaskan morfometri testis, epididimis kauda dan berat tubuh tikus yang menerima
perlakuan L. amara berbanding kawalan normal. Kajian ini membuktikan bahawa ekstrak akuas batang L. amara pada
dos 250 dan 500 mg/kg berat tubuh tidak berupaya memperbaiki aktiviti seksual tikus jantan teraruh diabetes.
Introduction: Teenage pregnancy is common and has become a key public health concern for all. This study aims to discover the meaning of lived experiences and to strategize in addressing the phenomenon from the previous or current unwed pregnant girls’ or young women’s perspective. Methods: A qualitative study was conducted among 10 girls or young women recruited during their stay at two shelters in Selangor but came from various state in Malay- sia; who have experienced becoming unwed mothers when they were between 10 to 19 years old. All participants gave informed consent. In-depth face-to-face interviews were conducted, audiotaped and transcribed. All quotes were encoded using Qualitative Data Analysis (QDA) Miner program. Data were analyzed using interpretative phe- nomenological analysis. Results: The themes emerged from the analyses; i) Trajectory of sexual activity, ii) struggles of motherhood to un-wed teenage mother. Most of these girls were pregnant due to consensual sexual intercourse although there were some refutes but their actions have led them for this to happen. They described how indirect relationship such as communication via telephone and the internet may have initiated the desire for sexual activity which led to a short first-time meeting and short term partnership, caused them to enact the sinful deed. They were overwhelmed with ambivalence feelings of wanting to terminate the pregnancy, abandon the newborn or to endure the journey of motherhood together with their ex-nuptial baby. Conclusion: The findings of this study showed that the strength of indirect relationship is able to evoke sexual desire that contributes to out-of-wedlock pregnancy. Max- imum support is needed from all; peers, parents, educators and the whole community structures.
Depression and its treatment may influence all aspects of the female sexual function from desire to sexual satisfaction. This study aimed to examine the components of the female sexual response cycle (SRC) of women with major depression treated with Selective Serotonin Reuptake Inhibitors.
A 58-year-old male presented with persistent severe headache, lethargy, decline libido and no neurological deficits. Besides quadruple anterior pituitary hormonal deficiencies, magnetic resonance imaging (MRI) demonstrated an enlarged ring-enhanced non-homogenous pituitary. Following hormonal replacement, these symptoms improved but empty sella evolved. The challenges of diagnosis and management were discussed. Awareness of the unclear etiology and uncertain clinical course of autoimmune hypophysitis in a man in this age group is essential for prompt and appropriate management.
The effect of increasing doses of various fractions of Eurycoma longifolia Jack extracts on libido was examined in middle-aged male rats. The results showed that a high dose (800 mg/kg) of all E. longifolia Jack extracts significantly increased mount frequency (MF) (P < 0.05) over that of untreated controls, but had no effect on the frequency of intromission or ejaculation. Methanol, chloroform, water, and butanol fractions exhibited MF of 2.5 +/- 0.1, 2.6 +/- 0.3, 2.5 +/- 0.1 and 2.6 +/- 0.2, respectively, in adult, middle-aged male rats, and retired breeders versus 2.3 +/- 0.1 in untreated controls. This translated to a minor increase in MF of 8.7%, 13.0%, 8.7%, and 13.0% for these fractions, respectively, during the 20-minute observation period. The results of this study show that E. longifolia Jack extracts can increase libido in middle-aged male rats.
Labisia pumila (Kacip Fatimah) is a popular herb in Malaysia that has been traditionally used in a number of women's health applications such as to improve libido, relieve postmenopausal symptoms, and to facilitate or hasten delivery in childbirth. In addition, the constituents of this plant have been reported to possess anticancer, antioxidant, and anti-inflammatory properties. Clinical studies have indicated that cytochrome P450s (CYPs), P-glycoprotein (P-gp), and Pregnane X receptor (PXR) are the three main modulators of drug-drug interactions which alter the absorption, distribution, and metabolism of drugs. Given the widespread use of Kacip Fatimah in dietary supplements, the current study focuses on determining the potential of its constituents to affect the activities of CYPs, P-gp, or PXR using in vitro assays which may provide useful information toward the risk of herb-drug interaction with concomitantly used drugs. Six compounds isolated from the roots of L. pumila (2 saponins and 4 alkyl phenols) were tested, in addition to the methanolic extract. The extract of L. pumila showed a significant time dependent inhibition (TDI) of CYP3A4, reversible inhibition of CYP2C9 and 2C19 and a weak inhibition of 1A2 and 2D6 as well as an inhibition of P-gp and rifampicin-induced PXR activation. The alkyl phenols inhibited CYP3A4 (TDI), CYP2C9, and 2C19 (reversible) while saponins inhibited P-gp and PXR. In conclusion, L. pumila and its constituents showed significant modulation of all three regulatory proteins (CYPs, P-gp, and PXR) suggesting a potential to alter the pharmacokinetic and pharmacodynamic properties of conventional drugs if used concomitantly.
The effects of Eurycoma longifolia Jack were studied on the libido of sexually experienced male rats after dosing them with 200, 400 and 800 mg/kg body weight twice daily of different fractions of E. longifolia Jack for 10 days. Results showed that E. longifolia Jack produced a dose-dependent increase in mounting frequency of the treated animals with 400 mg/kg of chloroform, methanol, water and butanol fractions resulting in mounting frequencies of 5.3 +/- 1.2, 4.9 +/- 0.7, 4.8 +/- 0.7 and 5.2 +/- 0.1, and 800 mg/kg further increased them to 5.4 +/- 0.8, 5.4 +/- 0.8, 5.2 +/- 0.6 and 5.3 +/- 0.2 respectively but there were no erections, intromissions, ejaculations or seminal emissions during the 20-min observation period which allowed for the measurement of sexual arousal reflected by mounting frequency uninfluenced by other behavioural components. This study provides evidence that E. longifolia Jack is a potent stimulator of sexual arousal in sexually vigorous male rats in the absence of feedback from genital sensation.
Eurycoma longifolia is reputed as an aphrodisiac and remedy for decreased male libido. A randomized, double-blind, placebo controlled, parallel group study was carried out to investigate the clinical evidence of E. longifolia in men. The 12-week study in 109 men between 30 and 55 years of age consisted of either treatment of 300 mg of water extract of E. longifolia (Physta) or placebo. Primary endpoints were the Quality of Life investigated by SF-36 questionnaire and Sexual Well-Being investigated by International Index of Erectile Function (IIEF) and Sexual Health Questionnaires (SHQ); Seminal Fluid Analysis (SFA), fat mass and safety profiles. Repeated measures ANOVA analysis was used to compare changes in the endpoints. The E. longifolia (EL) group significantly improved in the domain Physical Functioning of SF-36, from baseline to week 12 compared to placebo (P = 0.006) and in between group at week 12 (P = 0.028). The EL group showed higher scores in the overall Erectile Function domain in IIEF (P < 0.001), sexual libido (14% by week 12), SFA- with sperm motility at 44.4%, and semen volume at 18.2% at the end of treatment. Subjects with BMI ≥ 25 kg/m(2) significantly improved in fat mass lost (P = 0.008). All safety parameters were comparable to placebo.
Although few clinical trials examined the efficacy of bupropion to treat sexual dysfunction among female patients, a comprehensive and objective synthesis of the best available evidence is still lacking. To date, to the best of our knowledge, there are no published systematic reviews or meta-analyses specifically focusing on the role of bupropion in the treatment of female sexual dysfunction. The main objective of the present study was to evaluate the efficacy of bupropion in the treatment of female sexual dysfunction, and we hypothesized that bupropion is efficient in treating female patients with sexual dysfunction. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search for published literature was performed using Ovid, Medline, Scopus, Cochrane Library, Science Direct, and PubMed databases. In our study, we found that bupropion was almost three-fold more favorable in improving problems with sexual desire (pool estimate 2.845, 95% CI: 0.215 to 5.475, I2= 95.6%, p=0.034). A meta-regression was performed to explore heterogeneity and we found that only the dosage of bupropion was statistically significant in explaining the variance, i.e., the lower the dosage (150 mg vs. 300 mg), the better the improvement in the sexual desire of women with hypoactive sexual desire disorder (HSDD). Based on the results of this systematic review and metaanalysis, there is a potential role of bupropion as an effective treatment for women with HSDD.
Sexual desire includes complex motivation and drive. In the context of biological and cognitive- emotive state art of science, it is often a neglected field in medicine. In regard to the treatment, study on women's sexual function received less attention compared to the men's sexuality. In the past, this endeavor was relatively not well disseminated in the scientific community. Recently, there was a revolutionized surge of drug targets available to treat women with low sexual desire. It is timely to review the relevant biological approach, especially in the context of pharmacotherapy to understand this interesting clinical entity which was modulated by numerous interactive psychosocial inter-play and factors. The complex inter-play between numerous dimensional factors lends insights to understand the neural mechanism, i.e. the rewards centre pathway and its interaction with external psychosocialstimulus, e.g. relationship or other meaningful life events. The function of hormones, e.g. oxytocin or testosterone regulation was described. The role of neurotransmitters as reflected by the introduction of a molecule of flibenserin, a full agonist of the 5-HT1A and partial agonist of the D4 to treat premenopausal women with low sexual desire was deliberated. Based on this fundamental scientific core knowledge, we suggest an outline on know-how of introduction for sex therapy (i.e. "inner-self" and "outer-self") where the role of partner is narrated. Then, we also highlighted on the use of pharmacological agent as an adjunct scope of therapy, i.e. phosphodiasterase-5 (PDE-5) inhibitors and hormonal treatment in helping the patient with low sexual desire.