Disfunção sexual feminina: o que é importante saber

Media exposure regarding male sexual dysfunction and the growing number of viable treatment alternatives for erectile dysfunction has resulted in increasing numbers of men seeking clinical appointments and treatment for the condition, which has previously been considered taboo. Because these problems usually arise within the context of relationships, some investigators have alluded to increased rates of sexual dysfunction among the partners of these men. Also, since general practitioners, gynaecologists, geriatrists, and urologists are also seeing female patients for evaluation of various types of dysfunction, certain groups of these women with underlying chronic conditions have been noted to have high rates of concomitant sexual dysfunction. Physicians who have good rapport with these patients are in a privileged position to help with these intimate problems, which are often difficult for patients to discuss. Therefore, it is of extreme importance that these professionals become knowledgeable about and comfortable with the initial evaluation and possible treatment of female sexual dysfunction.A intensa exposição pela mídia do tema disfunção sexual masculina e o número crescente de tratamentos disponíveis para a disfunção erétil têm resultado num número crescente de homens que procuram consulta e tratamento clínico para este problema, antes considerado como "tabu". Uma vez que o problema geralmente surge no contexto do relacionamento, alguns investigadores aludem às taxas crescentes de disfunção sexual nas parceiras destes homens. Além disso, clínicos, ginecologistas, geriatras e urologistas igualmente estão avaliando pacientes do sexo feminino quanto a vários tipos de disfunção. Em alguns grupos de mulheres com condições crônicas subjacentes, também têm sido observado um aumento nas taxas de disfunção sexual concomitante. Médicos que tenham estabelecido uma boa relação médico-paciente estão em posição única para ajudar com este problema, que em virtude de sua própria característica de intimidade, geralmente é de difícil abordagem para os pacientes. Desta forma, é de extrema importância que estes profissionais tenham conhecimento e sintam-se à vontade para iniciar a avaliação e possivelmente o tratamento da disfunção sexual feminina

Resultados de anastomose microcirúrgica em homens com obstrução do trato seminal devido à herniorrafia inguinal

The incidence of vasal injury during inguinal herniorrhaphy is estimated at 0.5%. We sought to assess the patency rates and long-term fertility outcome after microsurgical repair of vasal obstruction related to prior inguinal herniorrhaphy. METHODS: Twenty procedures were performed on 13 men diagnosed with infertility and vasal injury secondary to previous inguinal herniorrhaphy. Eight of these men had undergone bilateral and 5 unilateral inguinal herniorrhaphy. Twelve procedures were vasovasostomies, 3 were crossover vasovasostomies, 2 were vasoepididymostomies, and 3 were crossover vasoepididymostomies. Eight patients were azoospermic, 2 were severely oligospermic (A incidência de trauma dos vasos deferentes durante uma herniorafia inguinal é estimada em 0.5%. Nós avaliamos as taxas de permeabilidade e o prognóstico da fertilidade a longo-prazo após o reparo microcirúrgico da obstrução dos vasos deferentes relacionados com herniorrafia inguinal prévia MÉTODOS: Vinte procedimentos foram realizados em 13 homens diagnosticados com infertilidade e trauma nos vasos deferentes secundário à herniorrafia inguinal prévia. Oito destes homens foram submetidos à herniorrafia inguinal bilateral e 5 à herniorrafia inguinal unilateral. Doze procedimentos foram vasovasostomias, 3 vasovasostomias cruzadas, 2 vasoepididimostomias e 3 vasoepididimostomias cruzadas. Oito pacientes estavam azoospérmicos, 2 com oligozosspermia grave (< 1 milhão/mL) 1 oligozoospérmico e 2 astenozoospérmicos. Dados de permeabilidade foram obtidos em 13 pacientes e dados de gravidez estavam disponíveis em 10 casais (77%) com um seguimento médio de 69,5 meses. RESULTADOS: A taxa de permeabilidade foi de 65%. No grupo de vasovasostomia, a taxa de permeabilidade foi de 60% (9/15) e no grupo de vasoepididimostomia foi de 80% (4/5). Entre os pacientes azoospérmicos, 13 procedimentos foram realizados. As taxas de permeabilidade foram de 42,9% para a vasovasostomia (3/7), e 100% para o procedimento de vasoepididimostomia (4/4). As taxas globais foram de 40%. Quatro de 5 (80%) homens que foram submetidos à vasoepididimostomia estabeleceram gravidez. CONCLUSÕES: Vasovasostomia microcirúrgica após trauma inguinal nos vasos deferentes resultam em taxas de permeabilidade razoáveis, mas uma taxa de gravidez baixa comparada à reversão de vasectomia. Quando a vasoepididimostomia microcirúrgica foi possível, ela resultou em altas taxas de permeabilidade e gravidez. A vasoepididimostomia cruzada, quando apropriada, pode ser uma alternativa útil à vasovasostomia inguinal

Detecção de câncer de testículo em homens com infertilidade

PURPOSE: Infertility is one of the less common presenting features associated with testicular tumors. We evaluated the histologic and biochemical findings, and pregnancy outcome in patients presenting with infertility who were found to have testicular tumors. METHODS: Seven patients with infertility were found to have testicular cancer over a 15-year period. All patients had a testicular ultrasound evaluation. The indications for the ultrasound were testicular pain in 2 patients, suspicious palpable mass in 4, and to rule out the presence of germ cell neoplasia in a patient with carcinoma in situ detected on a previous biopsy. Physical exam, histological findings, hormonal levels, tumor markers, and pregnancy outcome results were recorded from the patients medical charts. RESULTS: Two men had elevated serum follicle stimulant hormone and luteinizing hormone levels, 1 of them had an abnormally low serum testosterone level. Tumor markers were normal in all patients. In 4 patients the tumor was on the right side and in 3 on the left. The histological diagnoses were seminoma (n = 5), Leydig cell tumor (n = 1), and carcinoma in situ (n = 1). Of the 7 patients, 5 underwent adjuvant radiation therapy. Two patients had sperm cryopreserved. Follow up on fertility status was available in 6 cases. One patient has established a pregnancy and 5 did not achieve a pregnancy after treatment for their cancer. CONCLUSIONS: Most of the men who have testicular cancer and male infertility have a seminona. Therefore, men who present with infertility should be thoroughly investigated to rule out such serious, concomitant diseases along with their infertility.PROPÓSITO: Infertilidade é um dos padrões incomuns associados com tumores de testículo. Nós avaliamos os achados histológicos, bioquímicos, e gravidez em pacientes com infertilidade nos quais foram detectados tumores de testículo. MÉTODOS: Sete pacientes com infertilidade nos quais câncer de testículo foi detectado em um período acima de 15 anos. Todos os pacientes foram avaliados com ultra-sonografia. As indicações para ultra-sonografia foram dor testicular em dois pacientes, suspeita de massa palpável em quatro, e descartar a presença de neoplasia de células germinativas em um paciente com carcinoma in situ detectado em biópsia prévia. Exame físico, achados histológicos, níveis hormonais, marcadores tumorais, e resultados de gravidez foram avaliados nos prontuários dos pacientes. RESULTADOS: Dois homens tinham níveis séricos elevados de hormônio folículo-estimulante e hormônio luteinizante; um destes tinha níveis anormalmente baixos de testosterona. Marcadores tumorais estavam normais em todos os pacientes. Em quatro pacientes, o tumor estava localizado no testículo direito e em três no esquerdo. Os diagnósticos histológicos foram seminoma (n = 5), tumor de células de Leydig (n = 1) e carcinoma in situ (n = 1). Dos sete pacientes, cinco foram submetidos à radioterapia. Dois pacientes congelaram seus espermatozóides. Acompanhamento no estado de fertilidade estava disponível em seis pacientes. Um paciente estabeleceu gravidez e cinco não conseguiram engravidar após tratamento do câncer. CONCLUSÕES: A maioria dos homens com câncer de testículo e infertilidade possui um seminoma. Homens que se apresentam com infertilidade devem ser cuidadosamente investigados para descartar doenças concomitantes e sérias juntamente com a infertilidade

The male biological clock is ticking: a review of the literature

The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8% when the man is 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases

Female sexual dysfunction: the important points to remember

Media exposure regarding male sexual dysfunction and the growing number of viable treatment alternatives for erectile dysfunction has resulted in increasing numbers of men seeking clinical appointments and treatment for the condition, which has previously been considered taboo. Because these problems usually arise within the context of relationships, some investigators have alluded to increased rates of sexual dysfunction among the partners of these men. Also, since general practitioners, gynaecologists, geriatrists, and urologists are also seeing female patients for evaluation of various types of dysfunction, certain groups of these women with underlying chronic conditions have been noted to have high rates of concomitant sexual dysfunction. Physicians who have good rapport with these patients are in a privileged position to help with these intimate problems, which are often difficult for patients to discuss. Therefore, it is of extreme importance that these professionals become knowledgeable about and comfortable with the initial evaluation and possible treatment of female sexual dysfunction

Vasectomia no sistema público de saúde: Características dos candidatos e variáveis associadas

Objective: This study aimed to characterize candidates undergo vasectomy in the public health system, Araçatuba- SP and to study related variables. Methods: We surveyed 300 medical patients and vasectomized contacted by telephone to assess several characteristics. The variables analyzed for the study were age, marital status, education, religion, monthly family income and per capita, number of living children, reason for seeking treatment method, contraceptive use, marital relationship quality, decision time (date of intent to perform the procedure) and not because of the procedure. Data were pooled for the analysis of results. Results: The age of the candidates ranged from 23 to 65 years (mean 36.86 years) and average 2.56 living sons. The average monthly family income was R$1.079,15, with average per capita income of R$ 249,07. The couple's contraception before the procedure was on account of the woman who used oral anti-conception (84%). The complication rate with the method was around 6.04%, the biggest complication was dehiscence (77.7% of cases of complications), these being mainly during the first 100 cases. Conclusion: Vasectomy is a very effective contraceptive method, with low complication rate and low cost, should be encouraged by the public health system as a means of family planning policy