Anatomie et physiologie de la sexualité

Sexual disorders post-stroke: Description of a cohort of patients followed in rehabilitation

INTRODUCTION

The impairments resulting from a stroke can be multiple, including urinary and/or sexual dysfunctions. This acquired brain injury disrupts neurological control of sexual responses.

MAIN OBJECTIVE

to describe sexual disorders, after a first episode of stroke, in a population followed in a physical medicine and rehabilitation (PMR) center.

SECONDARY OBJECTIVES

to gather patients' expectations and PMR physicians' opinions on this subject.

METHOD

Observational, retrospective study in two PRM centers. Post-stroke sexuality was assessed using two validated questionnaires [for men: International Index of Erectile Function 15 (IIEF15) and for women: Female Sexual function Index (FSFI)]. Patients were asked 3 questions to approximate their expectations, and PRM physicians were asked 2 questions for their opinions.

RESULTS

Twenty-four subjects included (17 men/7 women). Thirteen had no post-stroke sexuality. Erectile function was analysable in 4 subjects, 3 of whom had moderate to severe erectile dysfunction. In women, female sexual dysfunction concerned 6/7 women, including lubrication. Ninety-six percent of subjects had never discussed sexuality with their PRM physician. Only 33% would have liked information on this subject. Our PRM physicians rarely discuss post-stroke sexual disability.

CONCLUSION

Post-stroke sexual disorders occur in both sexes. All areas of sexuality may be affected. A large-scale, prospective, controlled, multicenter study is needed to establish stroke as the direct neurological cause of sexual impairment.

EEG study on implicit beliefs regarding sexuality: Psychophysiological measures in relation to self-report measures

In this exploratory, correlational study, several psychophysiological measures were assessed and the relation between these measures and an experimental self-report questionnaire to measure the seven implicit beliefs of sexual offenders (the Questionnaire for Implicit Theories of Sexual Offenders (QITSO)) was established in a sample of Dutch participants recruited from the healthy population (N = 28) using correlational analyses. After analyzing task performance, electroencephalogram (EEG) data and electrocardiogram (ECG) data, the psychophysiological variables were correlated with the experimental QITSO subscales. The subscale “children as sexual beings” correlated positively with the P300 amplitude at electrode Pz. The subscale “women are unknowable” correlated positively with resting-state beta activity during eyes closed and eyes open, and with alpha activity during eyes open. Additionally, the subscale “entitlement’ correlated positively with low frequency heart rate variability power during eyes closed and eyes open, and with high frequency power during eyes closed. This study is a first exploratory step towards establishing a psychophysiological profile underlying the self-report questionnaire QITSO.

Sexual incentive motivation, sexual behavior, and general arousal: Do rats and humans tell the same story?

Sexual incentive stimuli activate sexual motivation and heighten the level of general arousal. The sexual motive may induce the individual to approach the incentive, and eventually to initiate sexual acts. Both approach and the ensuing copulatory interaction further enhance general arousal. We present data from rodents and humans in support of these assertions. We then suggest that orgasm is experienced when the combined level of excitation surpasses a threshold. In order to analyze the neurobiological bases of sexual motivation, we employ the concept of a central motive state. We then discuss the mechanisms involved in the long- and short-term control of that state as well as those mediating the momentaneous actions of sexual incentive stimuli. This leads to an analysis of the neurobiology behind the interindividual differences in responsivity of the sexual central motive state. Knowledge is still fragmentary, and many contradictory observations have been made. Nevertheless, we conclude that the basic mechanisms of sexual motivation and the role of general arousal are similar in rodents and humans.

[Sexuality of patients with neurological disability: Perception of healthcare professionals of a neurologic rehabilitation hospital unit]

Sexual disorders are common after neurological diseases. The reconstruction of sexuality is a major issue after neurologic disability. Why is this topic not covered in rehabilitation medicine except specialized service? The aim of this pilot study was to assess the perception of the healthcare professionals (HCPs) and to understand why this topic was not addressed. We conducted a pilot, observational, monocentric study from February to March 2016 in HCPs from a neurologic rehabilitation hospital unit.

RESULTS

The sexuality was essential for 14/28 (50%) HCPs in general and for 7/28 (25%) in neurologic disability. The hospital inhibits sexuality rebuilding in 21/28 (75%). The question of exercise of sexuality in hospital was considered as legitimate question for 13/28 (46%). Twenty-third (82%) have talked about sexuality with patients or colleagues, 5/19 (27%) thought that their response was satisfactory when patient asked about it. The question of sexuality had been managed for 10/28 (36%) during their training; 22/28 (79%) considered it was a prime importance for their job.

CONCLUSION

In this monocentric study, sexuality was often poorly managed in rehab center. The professionals did not dare talking about it with patients and answered with difficulties when they are asked about sexual disorders. They were not trained for this topic. A specialized medical education in hospital and during studies would be of great value to improve neurologic rehabilitation of these patients.

LEVEL OF EVIDENCE

4.

[Study of the sexuality of women after a total hysterectomy versus subtotal hysterectomy by laparoscopy in Nantes CHU]

OBJECTIVE

To research the differences in the sexuality and sexual satisfaction for 2 groups of women after a hysterectomy only by laparoscopy for benign pathologies, with or without conservation of the cervix.

METHODS

Retrospective monocentric study, in Nantes CHU, of 46 women divided into two groups. Three validated questionnaires were used (PISQ-12, DSFI, ultra-short Questionnaire of depression).

RESULTS

There is no difference in the scores between the 2 tests in sexuality post-surgically between the 2 groups. But there exists a significant improvement in the postoperative sexuality according to the questionnaire PISQ-12 in the hysterectomy subtotal group, which is not found in the hysterectomy total group. The score of the questions about the orgasm also seems to improve in the hysterectomy subtotal group with some features statistically significant.

CONCLUSION

This study confirms the improvement of the sexual function after hysterectomy. In spite of the absence of proof of interest in the conservation of the cervix in the literature, our study seems to show an improvement on certain criteria in the evaluation of sexuality in the hysterectomy subtotal group, in particular on the orgasm. A proposal for a future study with a more detailed questionnaire on the orgasm would allow to better specify the role of the cervix.