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Jiang X, Chen S, Qu S, Ma N, Wang W, Li Y, Yang Z. A New Modified Labiaplasty Combined with Wedge De-Epithelialization on the Medial Side and Edge Resection. Aesthetic Plast Surg 2021; 45:1869-1876. [PMID: 33683383 DOI: 10.1007/s00266-021-02137-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Labiaplasty (labia minora reduction) has been increasingly requested in recent years. The surgical procedures previously reported in the literature may have some complications that affect patient satisfaction. METHODS Patients who underwent a new bilateral labiaplasty procedure that combined wedge de-epithelialization on the medial side with edge resection on the lateral side were retrospectively reviewed. Satisfaction rates were assessed, and questionnaires, namely the Female Sexual Function Index (FSFI) and Genital Appearance Satisfaction (GAS) scale, were distributed and analyzed. The data from the study group were compared with data from cases who underwent traditional labiaplasty with wedge resection (control group). RESULTS From October 2015 to February 2020, fifty-one women underwent modified labiaplasty, while 26 women underwent traditional labiaplasty. A total of 94.1% (48/51) of patients in the modified group were satisfied with the genital appearance. Compared with the 96.2% (25/26) satisfaction rate in the control group, the difference was not statistically significant. A total of 43/55 valid questionnaires were returned, including 29 in the modified labiaplasty group and 14 in the control group. There was a significant improvement in the postoperative GAS scale compared to the preoperative scale in both groups (P<0.05). The new modified method had a significant FSFI improvement after the operation compared with preoperative scores (P<0.05), while the FSFI improvement was not significant in the control group (P>0.05). There was no significant difference in the FSFI score improvement, postoperative GAS score or postoperative FSFI between the two groups (P>0.05). CONCLUSION This new modified labiaplasty is a satisfying and safe method with low risks, and it may result in better sexual sensitivity for the patients LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Xudong Jiang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China
| | - Sen Chen
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China
| | - Siwei Qu
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China
| | - Ning Ma
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China
| | - Weixin Wang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China
| | - Yangqun Li
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China
| | - Zhe Yang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 33 Badachu road, Shijingshan District, Beijing, 100144, China.
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Marshall DC, Ghiassi-Nejad Z, Powers A, Reidenberg JS, Argiriadi P, Ru M, Dumane V, Buckstein M, Goodman K, Blank SV, Schnur J, Rosenstein B. A first radiotherapy application of functional bulboclitoris anatomy, a novel female sexual organ-at-risk, and organ-sparing feasibility study. Br J Radiol 2021; 94:20201139. [PMID: 34192475 PMCID: PMC8764912 DOI: 10.1259/bjr.20201139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The bulboclitoris (clitoris and vestibular bulbs) is the primary organ responsible for female sexual arousal and orgasm. Effects of radiotherapy on the bulboclitoris are unknown, as its structure/function has yet to be described in radiotherapy, and it overlaps only partially with the external genitalia structure. Our aim was to: describe bulboclitoris structure, function and delineation; compare volume of and dose delivered to the bulboclitoris vs external genitalia; and, compare bulboclitoris-sparing IMRT (BCS-IMRT) to standard IMRT (S-IMRT) to determine reoptimization feasibility. METHODS Our expert team (anatomist, pelvic radiologist, radiation oncologist) reviewed bulboclitoris anatomy and developed contouring guidance for radiotherapy. 20 female patients with anal cancer treated with chemoradiation were analyzed. Sexual organs at risk (OARs) included the external genitalia and the bulboclitoris. Volumes, dice similarity coefficients (DSCs) and dose received using S-IMRT were compared. Plans were reoptimized using BCS-IMRT. Dose-volume histograms (DVHs) for PTVs and all OARs were compared for BCS-IMRT vs S-IMRT. RESULTS Bulboclitoris structure, function and delineation are described herein. The bulboclitoris occupies 20cc (IQR:12-24), largely distinct from the external genitalia (DSC <0.05). BCS-IMRT was superior to S-IMRT in reducing the dose to the bulboclitoris, with the greatest reductions in V30 and V40, with no significant changes in dose to other OARs or PTV 1/V95. CONCLUSION The bulboclitoris can be contoured on planning imaging, largely distinct from the external genitalia. Compared with S-IMRT, BCS-IMRT dramatically reduced dose to the bulboclitoris in anal cancer planning. BCS-IMRT might safely reduce sexual toxicity compared with standard approaches. ADVANCES IN KNOWLEDGE The structure and function of the bulboclitoris, the critical primary organ responsible for female sexual arousal and orgasm, has yet to be described in the radiotherapy literature. Structure, function and delineation of the bulboclitoris are detailed, delineation and bulboclitoris-sparing IMRT were feasible, and sparing reduces the dose to the bulboclitoris nearly in half in female patients receiving IMRT for anal cancer, warranting further clinical study.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zahra Ghiassi-Nejad
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allison Powers
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joy S Reidenberg
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela Argiriadi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meng Ru
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Vishruta Dumane
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Buckstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Karyn Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephanie V Blank
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julie Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Nummenmaa L, Suvilehto JT, Glerean E, Santtila P, Hietanen JK. Topography of Human Erogenous Zones. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1207-1216. [PMID: 27091187 DOI: 10.1007/s10508-016-0745-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
Touching is a powerful means for eliciting sexual arousal. Here, we establish the topographical organization of bodily regions triggering sexual arousal in humans. A total of 704 participants were shown images of same and opposite sex bodies and asked to color the bodily regions whose touching they or members of the opposite sex would experience as sexually arousing while masturbating or having sex with a partner. Resulting erogenous zone maps (EZMs) revealed that the whole body was sensitive to sexual touching, with erogenous hotspots consisting of genitals, breasts, and anus. The EZM area was larger while having sex with a partner versus while masturbating, and was also dependent on sexual desire and heterosexual and homosexual interest levels. We conclude that tactile stimulation of practically all bodily regions may trigger sexual arousal. Extension of the erogenous zones while having sex with a partner may reflect the role of touching in maintenance of reproductive pair bonds.
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Affiliation(s)
- Lauri Nummenmaa
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, 00076 Aalto, Espoo, Finland.
- Turku PET Centre and Department of Psychology, University of Turku, Turku, Finland.
| | - Juulia T Suvilehto
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, 00076 Aalto, Espoo, Finland
| | - Enrico Glerean
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, 00076 Aalto, Espoo, Finland
| | - Pekka Santtila
- Department of Psychology and Logopedics, Åbo Akademi University, Turku, Finland
| | - Jari K Hietanen
- Human Information Processing Laboratory, School of Social Sciences and Humanities/Psychology, University of Tampere, Tampere, Finland
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Verstraelen H, De Zutter E, De Muynck M. Genitofemoral neuralgia: adding to the burden of chronic vulvar pain. J Pain Res 2015; 8:845-9. [PMID: 26664155 PMCID: PMC4670020 DOI: 10.2147/jpr.s93107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The vulva is a particularly common locus of chronic pain with neuropathic characteristics that occurs in women of any age, though most women with neuropathic type chronic vulvar pain will remain undiagnosed even following multiple physician visits. Here, we report on an exemplary case of a middle-aged woman who was referred to the Vulvovaginal Disease Clinic with debilitating vulvar burning and itching over the right labium majus that had been persisting for 2 years and was considered intractable. Careful history taking and clinical examination, followed by electrophysiological assessment through somatosensory evoked potentials was consistent with genitofemoral neuralgia, for which no obvious cause could be identified. Adequate pain relief was obtained with a serotonin–noradrenaline reuptake inhibitor and topical gabapentin cream. We briefly discuss the epidemiology, diagnosis, and treatment of genitofemoral neuralgia and provide a series of clues to guide clinicians in obtaining a presumptive diagnosis of specific neuropathic pain syndromes that may underlie chronic vulvar pain. We further aim to draw attention to the tremendous burden of chronic, unrecognized vulvar pain.
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Affiliation(s)
- Hans Verstraelen
- Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium
| | - Eline De Zutter
- Department of Obstetrics and Gynaecology, Vulvovaginal Disease Clinic, Ghent University Hospital, Ghent, Belgium
| | - Martine De Muynck
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, Ghent, Belgium
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Meerts SH, Strnad HK, Schairer RS. Paced mating behavior is affected by clitoral-vaginocervical lidocaine application in combination with sexual experience. Physiol Behav 2015; 140:222-9. [DOI: 10.1016/j.physbeh.2014.12.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022]
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Recreation and procreation: A critical view of sex in the human female. Clin Anat 2014; 28:339-54. [DOI: 10.1002/ca.22495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 01/25/2023]
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Markos AR, Dinsmore W. Persistent genital arousal and restless genitalia: sexual dysfunction or subtype of vulvodynia? Int J STD AIDS 2013; 24:852-8. [PMID: 23970620 DOI: 10.1177/0956462413489276] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a literature review of patients' conditions described under persistent genital arousal disorder and restless genital syndrome, vulvodynia and male genital skin pain of unknown aetiology (penoscrotodynia). Our aim is to improve the understanding of the condition, unify nomenclature and promote evidence-based practice. The most prominent symptom in persistent genital arousal disorder and restless genital syndrome is a spontaneous, unwelcomed, intrusive and distressing vulval sensation. There are similarities between the clinical presentation of vulvodynia, penoscrotodynia, persistent genital arousal disorder and restless genital syndrome patients. The aetiology of persistent genital arousal disorder and restless genital syndrome, similar to vulvodynia, could be better explained in terms of neuro-vascular dysfunction, genital peripheral neuropathy and/or dysfunctional micro-vascular arterio-venous shunting. Erythromelalgia lends itself to explain some cases of restless genital syndrome, who have concurrent restless legs syndrome; and therefore draw parallels with the red scrotum syndrome. The published literature supports the concept of classifying restless genital syndrome as a sub-type of vulvodynia rather than sexual dysfunction.
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Affiliation(s)
- A R Markos
- HIV and Sexual Medicine, Mid Staffordshire NHS Foundation Trust, Stafford Hospital, Stafford, UK
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Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. Clin Anat 2012; 26:134-52. [DOI: 10.1002/ca.22177] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 09/10/2012] [Indexed: 12/31/2022]
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Mahran MA, Rashid M, Leather A. Exploring the psychosexual drive, before genital cosmetic surgery. Eur J Obstet Gynecol Reprod Biol 2011; 158:369-70. [DOI: 10.1016/j.ejogrb.2011.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 04/23/2011] [Accepted: 05/13/2011] [Indexed: 11/25/2022]
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Sakakibara R, Kishi M, Ogawa E, Tateno F, Uchiyama T, Yamamoto T, Yamanishi T. Bladder, bowel, and sexual dysfunction in Parkinson's disease. PARKINSONS DISEASE 2011; 2011:924605. [PMID: 21918729 PMCID: PMC3171780 DOI: 10.4061/2011/924605] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Revised: 05/06/2011] [Accepted: 05/30/2011] [Indexed: 12/14/2022]
Abstract
Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called “pelvic organ” dysfunctions) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and “prokinetic” drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan
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Schober J, Weil Z, Pfaff D. How generalized CNS arousal strengthens sexual arousal (and vice versa). Horm Behav 2011; 59:689-95. [PMID: 20950622 DOI: 10.1016/j.yhbeh.2010.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 09/23/2010] [Accepted: 10/02/2010] [Indexed: 12/22/2022]
Abstract
Heightened states of generalized CNS arousal are proposed here to facilitate sexual arousal in both males and females. Genetic, pharmacologic and biophysical mechanisms by which this happens are reviewed. Moreover, stimulation of the genital epithelia, as triggers of sex behavior, is hypothesized to lead to a greater generalized arousal in a manner that intensifies sexual motivation. Finally, launched from histochemical studies intended to characterize cells in the genital epithelium, a surprising idea is proposed that links density of innervation with the efficiency of wound healing and with the capacity of that epithelium to stimulate generalized CNS arousal. Thus, bidirectional arousal-related mechanisms that foster sexual behaviors are envisioned as follows: from specific to generalized (as with genital stimulation) and from generalized to specific.
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Affiliation(s)
- Justine Schober
- Laboratory of Neurobiology and Behavior, The Rockefeller University, NY, USA
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Tajkarimi K, Burnett AL. The Role of Genital Nerve Afferents in the Physiology of the Sexual Response and Pelvic Floor Function. J Sex Med 2011; 8:1299-312. [DOI: 10.1111/j.1743-6109.2011.02211.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reproductive behaviors: new developments in concepts and in molecular mechanisms progress in brain research, Luciano Martini, editor, January 19, 2010. PROGRESS IN BRAIN RESEARCH 2010. [PMID: 20478431 DOI: 10.1016/s0079-6123(08)81003-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
New developments in the analysis of mechanisms for reproductive behaviors are reviewed. Conceptually, the concept of generalized arousal (GA) of the central nervous system (CNS) is considered. Breeding for high and low GA, we show an impact of GA on sexual arousal of male mice, and also find that the structure of GA in the CNS of males and females is not the same. Further, we propose, theoretically, that among epithelial tissues in humans, there are correlations among their innervation densities and their ability to trigger arousal. In new technical developments, we analyze transcriptional effects of estrogens in the hypothalamic neurons that regulate lordosis behavior. The rapid effect of estradiol to increase acetylation of histones in ventromedial hypothalamic neurons could be tied into transcriptional activation, but the effect of estradiol to increase methylation of histone 3, lysine 9 (H3K9) is puzzling. This work seeks to discover the coactivator dynamics underlying transcriptional effects of estrogens on sex behavior.
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Fatton B, Savary D, Accoceberry M, Velemir L, Amblard J, Jacquetin B. Chirurgie sexuelle chez la femme. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11608-008-0195-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Crouch NS, Liao LM, Woodhouse CRJ, Conway GS, Creighton SM. Sexual function and genital sensitivity following feminizing genitoplasty for congenital adrenal hyperplasia. J Urol 2008; 179:634-8. [PMID: 18082214 DOI: 10.1016/j.juro.2007.09.079] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Female sex assignment followed by cosmetic genitoplasty to feminize the genitalia in infancy remains standard practice in the clinical management of ambiguous genitalia. The effects of surgery on genital sensitivity have never been objectively evaluated. To our knowledge the current study is the first to evaluate genital sensitivity and sexual function in women with congenital adrenal hyperplasia. MATERIALS AND METHODS A total of 28 women with congenital adrenal hyperplasia and 10 normal controls were recruited. Details of prior genital surgery were obtained from medical records. Sensitivity thresholds for the clitoris and upper vagina were measured using a GenitoSensory Analyzer (Medoc, Ramat, Israel). Sexual function was assessed using a standardized measure. RESULTS Of 28 women with congenital adrenal hyperplasia 24 had undergone feminizing genital surgery. In women who underwent surgery there was significant impairment to sensitivity in the clitoris compared to controls. No difference was observed for the sensitivity threshold in the upper vagina, where surgery had not been done in any of the women. Data on the 4 women with congenital adrenal hyperplasia who had not undergone surgery were similar to those in controls. Sexual function difficulties were more severe in women who underwent surgery, especially vaginal penetration difficulties and intercourse frequency. Linear relationships were observed for impairment to sensitivity and severity of sexual difficulties. CONCLUSIONS Genital sensitivity is impaired in areas where feminizing genital surgery had been done and impairment to sensitivity are linearly related to difficulties in sexual function. The new information may help inform clinicians and parents making difficult decisions about genital surgery for infants with ambiguous genitalia.
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Affiliation(s)
- Naomi S Crouch
- Middlesex Centre, University College London Institute of Women's Health, Elizabeth Garrett Anderson and Obstetric Hospital, and Institute of Urology, University College London Hospital (CRJW), London, United Kingdom
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Abstract
Our understanding of the process and initiation of sexual arousal is being enhanced by both animal and human studies, inclusive of basic science principles and research on clinical outcomes. Sexual arousal is dependent on neural (sensory and cognitive) factors, hormonal factors, genetic factors and, in the human case, the complex influences of culture and context. Sexual arousal activates the cognitive and physiologic processes that can eventually lead to sexual behavior. Sexual arousal comprises a particular subset of central nervous system arousal functions which depend on primitive, fundamental arousal mechanisms that cause generalized brain activity, but are manifest in a sociosexual context. The neurophysiology of sexual arousal is seen as a bidirectional system universal to all vertebrates. The following review includes known neural and genomic mechanisms of a hormone-dependent circuit for simple sex behavior. New information about hormone effects on causal steps related to sex hormones' nuclear receptor isoforms expressed by hypothalamic neurons continues to enrich our understanding of this neurophysiology.
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Affiliation(s)
- Justine M Schober
- Hamot Medical Center, 333 State Street, Suite 201, Erie, PA 16507, USA.
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Abstract
Demand for cosmetic genitoplasty is increasing. Lih Mei Liao and Sarah M Creighton argue that surgery carries risks and that alternative solutions to women's concerns about the appearance of their genitals should be developed
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Affiliation(s)
- Lih Mei Liao
- Middlesex Centre, UCL Institute for Women's Health, Elizabeth Garrett Anderson and Obstetric Hospital, London WC1E 6DH.
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