항정신약물을 복용 중인 조현병 환자에서 성기능 장애의 유병률 조사

정선화,강시현,박동연,윤해주,박은경,이종일 대한조현병학회 2016 대한조현병학회지 Vol.19 No.2

Objectives : Sexual dysfunction is said to affect the compliance of drug and quality of life. This study is a research to investigate the prevalence of sexual dysfunction and affecting factors that can occur when schizophrenic and schizoaffective patients have taken drugs. Methods : Subjects were 300 patients who have been taken inpatient or outpatient treatment in national seoul hospital. We used UKU-S, ASEX scale for evaluating the prevalence of sexual dysfunction and CGI-S, PANSS negative scale and CES-D for investigating the influence of psychopathology and depressive symptoms on sexual dysfunction. Results : It was reported sexual dysfunction 82.7% in male and 92.2% in female with 7 items of UKU-S. The prevalence of sexual dysfunction with criteria of ASEX was 47.72% in male and 65.05% in female. Sexual dysfunction was more prevalent in patients taking prolactin-elevation drugs. In the factor analysis for the sexual dysfunction it was investigated that age, onset time, CGI-S, PANSS negative scale, and CES-D can affect the sexual dysfunction in both male and female. Conclusion : This study reported that many patients complained of sexual dysfunction. On considering the influence of sexual dysfunction to compliance and quality of life, clinicians evaluate sexual side effects more actively because patients are more likely not spontaneously tell the sexual side effects in comparison to others.

Prevalence and Predictive Factors of Sexual Dysfunction in Iranian Women: Univariate and Multivariate Logistic Regression Analyses

Ashraf Direkvand-Moghadam,Zainab Suhrabi,Malihe Akbari,Azadeh Direkvand-Moghadam 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.5

Background: Female sexual dysfunction, which can occur during any stage of a normal sexual activity, is a serious condition for individuals and couples. The present study aimed to determine the prevalence and predictive factors of female sexual dysfunction in women referred to health centers in Ilam, the Western Iran, in 2014.Methods: In the present cross-sectional study, 444 women who attended health centers in Ilam were enrolled from May to September 2014. Participants were selected according to the simple random sampling method. Univariate and multivariate logistic regression analyses were used to predict the risk factors of female sexual dysfunction. Diffe rences with an alpha error of 0.05 were regarded as statistically significant.Results: Overall, 75.9% of the study population exhibited sexual dysfunction. Univariate logistic regression analysis demonstrated that there was a significant association between female sexual dysfunction and age, menarche age, gravidity, parity, and education (P<0.05). Multivariate logistic regression analysis indicated that, menarche age (odds ratio, 1.26), education level (odds ratio, 1.71), and gravida (odds ratio, 1.59) were independent predictive vari-ables for female sexual dysfunction.Conclusion: The majority of Iranian women suffer from sexual dysfunction. A lack of awareness of Iranian women’s sexual pleasure and formal training on sexual function and its influencing factors, such as menarche age, gravida, and level of education, may lead to a high prevalence of female sexual dysfunction.

노인 남성의 성기능장애 진단과 치료

박현준 대한의사협회 2019 대한의사협회지 Vol.62 No.6

Male sexual dysfunction refers to a phenomenon in which a man experiences difficulty at any stage during the process of sexual intercourse. In general, erectile dysfunction is regarded as the most representative form of sexual dysfunction, but various other diseases can also be categorized as male sexual dysfunction, including sexual arousal disorder, decreased libido, ejaculation disorder, and Peyronie’s disease. Causes of sexual dysfunction include chronic diseases, such as diabetes, hypertension, dyslipidemia, and obesity. In addition, some medications, surgical procedures, and traumas can cause sexual dysfunction. However, aging is the most important cause of male sexual dysfunction. To diagnose and treat elderly patients who complain of male sexual dysfunction, it is first necessary to become familiar with the characteristics of sexual dysfunction in elderly men. The prevalence rates of metabolic syndrome, hypertension, diabetes, dyslipidemia, coronary artery disease, stroke, and depression are higher among elderly men than among younger men; furthermore, the elderly are at a higher risk for the development of kidney, hepatic, spinal cord, and neurological diseases. Notably, anti-hypertensive agents can affect erectile function in elderly men: sexual dysfunction may be severe or the response to treatment may be poor. For satisfactory treatment, spousal factors should also be considered.

우울증 환자에서 성기능 장애

지익성,김영란,김정란 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

There are several possible causes of sexual dysfunction in depressed disorder. However, patients will rarely report sexual problem spontaneously. Therefore, it is very difficult to determine a cause of sexual dysfunction in depressive patients, and the differential diagnosis must include primary sexual dysfunction, sexual dysfunction associated with general medical and psychiatric disorder, and sexual dysfunction associated with treatment for psychiatric disorder. Various strategies are recommended to manage antidepressant-induced sexual dysfunction in depression, including waiting, reducing the antidepressant dosage, use of drung holidays, use of adjunctive pharmacotherapy, and switching antidepressant. Use of an antidepressant with a low prevalence of sexual side effects, such as bupropion, nefazodone, and mirtazapine, may be the best way to avoid sexual dysfunction.

Antidepressant-Induced Sexual Dysfunction among Newer Antidepressants in a Naturalistic Setting

이경욱,이영민,Ji-Min Nam,이해국,이정태,전태연,권용실 대한신경정신의학회 2010 PSYCHIATRY INVESTIGATION Vol.7 No.1

Objective: Antidepressants used to treat depression are frequently associated with sexual dysfunction. Sexual side effects affect the patient’s quality of life and, in long-term treatment, can lead to non-compliance and relapse. However, studies covering many antidepressants with differing mechanisms of action were scarce. The present study assessed and compared the incidence of sexual dysfunction among different antidepressants in a naturalistic setting. Methods: Participants were married patients diagnosed with depression, per DSM-IV diagnostic criteria, who had been taking antidepressants for more than 1 month. We assessed the participants via the Arizona Sexual Experiences Scale (ASEX), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI), and assessed their demographic variables, types and dosages of antidepressants, and duration of antidepressant use via their medical records. Results: One hundred and one patients (46 male, 55 female, age 42.2±7 years) completed the instruments. Thirteen were taking fluoxetine (mean dose 21.3±8.5 mg/day), 24 were taking paroxetine (mean dose 20.4±7.2 mg/day), 20 taking citalopram (mean dose 22.1±6.5 mg/day), 22, venlafaxine (mean dose 115.7±53.2 mg/day) and 22, mirtazapine (mean dose 18±8.7 mg/day). Mean ages, sex ratios, and BDI and STAI scores did not differ significantly across antidepressants. A substantial number of participants (46.5%, n=47) experienced sexual dysfunction. The prevalence of sexual dysfunction differed across drugs: citalopram 60% (n=12), venlafaxine 54.5% (n=12), paroxetine 54.2% (n=13), fluoxetine 46.2% (n=6), and mirtazapine 18.2% (n=4). Regression analyses revealed the significant factors for sexual dysfunction were being female, total scores on the BDI and SAI, and type of antidepressant (F=4.92, p<0.0001). Of the antidepressants, the mirtarzapine group’s total ASEX score was significantly lower than the scores of the citalopram, fluoxetine, and paroxetine groups. Conclusion: The incidence of sexual dysfunction was substantially high during antidepressant treatment. The incidence of sexual dysfunction differed among antidepressants having different mechanisms of action. Our study suggests the need for clinicians to consider the impact of pharmacotherapy on patients’ sexual functioning in the course of treatment with antidepressants.

성기능에 관련된 증상을 주소로 내원한 남성들의 임상적 특성

전동찬,최영득,최형기 大韓泌尿器科學會 1998 Korean Journal of Urology Vol.39 No.4

The Clinical Effect of Androgen Replacement Therapy for Female Sexual Dysfunction

Lee, Seong Ju,Chung, Woo Sik,Yoon, Hana 이화여자대학교 의과학연구소 2011 EMJ (Ewha medical journal) Vol.34 No.2

Objectives: Androgen plays an important role in female sexual function, and its insufficiency causes a clinically significant sexual dysfunction. This study examines the association between sex hormones and the clinical effect of testosterone replacement therapy in female sexual dysfunction. Methods: This study examined 75 female patients who visited our hospital from March 2002 to June 2008 to treat sexual dysfunction. For the rest of the patients, we performed primary treatment and physiotherapy in accordance with the main cause of their sexual dysfunction. We also performed combination treatment of androgen replacement therapy for the patients who did not make medical progress after two months of primary treatment and for the patients whose free testosterone level is in the bottom group out of three normal range groups. Results: The mean age of target patients was 39.6±8.7 years (range, 35∼66 years) old. 10 patients out of 75 patients were postmenopausal women, and estrogen replacement therapy had been performed without androgen replacement therapy. We performed a combination treatment of androgen replacement therapy for the patients with sexual desire disorder, and 60% of them answered that they had an increased sexual response after they were given combination treatment of androgen replacement therapy. Conclusion: The results support the concepts that sex hormones significantly affect sexual response in women with sexual dysfunction. Clinically, it is effective and safe to perform a combination treatment of androgen replacement therapy in treating sexual dysfunction if medication is administered properly and carefully.

Serotonin Reuptake Inhibitor(SRI) 유발 성기능 장애를 가진 주요우울장애 환자에서 SRI를 Bupropion Sustained Release로 교체한 후의 성기능 장애 변화에 대한 연구

최진혁(Jin-Hyuk Choi),제영묘(Young-Myo Jae),이대수(Dae-Su Lee) 대한생물치료정신의학회 2005 생물치료정신의학 Vol.11 No.1

목적: SSRI 및 venlafaxine을 포함하는 SRI는 효과적인 항우울제이나, 흔히 성기능 장애가 병발하는 것으로 알려져 왔다. 본 연구는 이들 약제를 복용한 후 성기능 장애가 발생한 주요우울장애 환자를 대상으로 bupropion SR로 항우울제를 교체한 후 성기능 장애와 우울증상의 변화를 알아보고자 하였다. 방법: DSM-IV-TR 진단 기준에 의하여 주요우울장애로 진단되었고, SRI를 복용 후 치료적 반응을 보이고 있지만(HAM-D 점수<11), 성기능 장애를 호소하는 14명의 기혼자(남성 9명, 여성 5명)를 대상으로 우울증상과 성기능 장애 정도를 각각 HAM-D 및 성기능 장애 자가 평가 설문지(PRSexDQ)를 통하여 평가한 후 복용중인 항우울제에 bupropion SR을 추가하였ㅆ고, 연구 시작 2주 후부터 2주 동안 SRI를 서서히 줄여서 끊은 다음, 이후 4주 동안 bupropion SR만 단독으로 처방하였다. 연구 시작 2주, 4주, 8주 후의 우울증상과 성기능 장애 정도를 HAM-D와 PRSexDQ를 이용하여 평가하였으며, 대응표본 T 검증을 통하여 우울증상과 성기능 장애의 변화에 대한 통계처리를 하였다. 결과: 3명이 중도 탈락하였고, 11명(78.57%)이 연구를 완결하였으며, 연구 시작 시점(0주)과 연구 시작 후 2주 사이에는 유의미한 변화가 없었으나, 2주나 4주, 4주와 8주 사이에서 성기능 장애의 유의한 감소를 보였다. 하지만, 연구 기간 중 HAM-D 점수의 의미 있는 변화는 보이지 않았다. 결론: SRI로 치료받고 있는 주요우울장애 환자에서 약물 관련 성기능 장애가 발생하였을 때 복용 중인 항우울제를 bupropion SR로 교체하는 것은 효과적인 치료 전략이 될 수 있다. Objectives : Serotonin reuptake inhibitors(SRI), including selective serotonin reuptake inhibitors(SSRI) and venlafaxine, induce both therapeutic response and sexual dysfunction. This study was conducted to examine the changes in sexual dysfunction and depressive symptoms in the patients who had major depressive disorder and SRI-induced sexual dysfunction, after substitution of SRI with bupropion sustained release(SR). Methods : This study included 14 married adults(9 men and 5 women) who had a DSM-IV-TR diagnosis of major depressive disorder in remission (Hamilton Rating Scale for Depression [HAM-D] score<11) and were receiving an SRI. Depression(using HAM-D) and sexual dysfunction(using Psychotropic-Related Sexual Dysfunction Questionaire[PRSexDQ]) were assessed at baseline, and bupropion SR was added to the current antidepressant. SRI was tapered off after 2 weeks from baseline and then bupropion SR monotherapy was tried after 4 weeks. HAM-D and PRSexDQ were assessed at 2 weeks, 4 weeks, 8 weeks from baseline. Paired sample T tests were performed to assess changes in depressive symptoms and sexual dysfunction. Results : Three patients withdrew from this study and 11 patients(78.57%) completed the study. The patients showed no significant change from baseline to week 2, but sexual dysfunction decreased significantly from week 2 to week 4 and from week 4 to week 8. All patients showed no significant change in mean HAM-D scores during study period. Conclusions : Substitution of SRI with bupropion SR is one of the effective treatment strategies for patients with major depressive disorder and SRI-induced sexual dysfunction.

노인의 성건강과 성생활의 실태

박광성,정호석 대한의사협회 2019 대한의사협회지 Vol.62 No.6

The increase in life expectancy has caused attention to be focused on quality of life in the elderly. Sexual health is an important part of physical health and quality of life, and poor health is associated with both a decline in sexual activity with age and sexual dysfunction. Herein, we review the topics of sexual function, sexual activity, the prevalence rate of sexual dysfunction and its risk factors, changes in sexuality-related attitudes, the relationship between sexual health and physical health, and the effects of sexual health on quality of life in the elderly. Sexual activity is associated with physical health, and is also an important component of enjoying life. Sexual activities include sexual intercourse and physical intimacy, which are indicators of sexual health in the elderly. Good physical health, stable sexual partners, and regular sexual activity are important for maintaining sexual health in old age Therefore, sexual health needs to be considered as part of the management of geriatric patients.

정신분열병 외래환자에서의 성기능 장애

김성(Seong Kim),김철권(Chul Kwon Kim) 대한사회정신의학회 2008 사회정신의학 Vol.13 No.1

목 적 사회에서 생활하고 있는 정신분열병 환자들을 대상으로 성별에 따른 성기능장애를 조사하고 일반인과 비교함으로써, 정신분열병 환자의 성기능장애의 빈도와 양상을 알아보기 위함이다. 방 법 정신과에서 통원치료를 받고 있는 증상이 안정된 정신분열병 환자 93명과 일반 대조군 101명을 대상으로 성행위 설문지를 이용하여 성기능장애를 조사하였다. 결 과 1) 남자에서 정신분열병 환자군과 일반인 대조군 비교 정신분열병 남자 환자 61명과 일반인 남자 66명을 비교한 결과 섹스 또는 자위행위 동안 사정지연(9번 문항, p=0.0828)을 제외한 나머지 10개의 문항에서 환자군이 대조군에 비하여 유의한 저하를 보였다. 구체적으로 환자군은 대조군에 비하여 섹스 욕구(1번 문항, p=0.0002), 섹스빈도(2번 문항, p<0.0001), 자위행위 빈도(3번 문항, p=0.0336), 섹스 또는 자위행위 동안 쉽게 흥분되는 정도(4번 문항, p=0.0004), 섹스 또는 자위행위를 즐기는 정도(5번 문항, p<0.0001), 섹스 또는 자위행위에 대한 만족도(6번 문항, p<0.0001), 섹스 또는 자위행위 동안 발기 정도(7번 문항, p<0.0001), 섹스 또는 자위행위동안 발기 지속 정도(8번 문항, p<0.0001), 섹스 또는 자위행위 동안 조루 정도(10번 문항, p=0.0019), 섹스 또는 자위행위 동안 오르가즘의 강도에 대한 만족도(11번 문항, p<0.0001)에서 유의한 기능장애를 보였다. 성기능장애를 부족하다(Less, 성기능장애가 어느 정도 있다)와 많다(More, 성기능장애가 별로 없다)로 나누어 각 문항을 비교한 결과 자위행위 빈도(3번 문항, χ 2 =0.92, p=0.34), 섹스 또는 자위행위 동안 사정지연 정도(9번 문항, χ 2 =2.90, p=0.09) 를 제외한 나머지 문항들에서 정신분열병 환자군은 일반 대조군에 비하여 유의한 기능장애를 보였다. 2) 여자에서 정신분열병 환자군과 일반인 대조군 비교 정신분열병 여자 환자 32명과 일반인 여자 35명을 비교한 결과 섹스빈도(2번 문항, p=0.049)와 생리의 규칙성(10번 문항, p=0.0227)을 제외한 나머지 8개 문항에서 두 군 간에 유의한 차이를 보이지 않았다. 성기능장애를 부족하다(Less, 성기능장 애가 어느 정도 있다)와 많다(More, 성기능장애가 별로 없다)로 나누어 각 문항을 비교한 결과 모든 문항에서 정신분열병 환자 군과 일반 대조군간에 유의한 차이를 보이지 않았다. 결 론 정신분열병 환자들의 성기능장애 종류와 빈도를 알아보기 위하여 남녀별로 일반인 대조군과 비교한 결과 정신분열병 남자환 자가 일반 남자에 비해 다양한 성기능장애를 현저히 보이는 반면, 여자 정신분열병 환자는 남자 환자와 비교시 성기능장애의 종류가 훨씬 적었다. 따라서 임상 상황에서 정신과 약물을 복용하고 있는 정신분열병 환자의 경우 남자환자의 성기능에 더 많은 관심을 가져야 할 필요성을 시사한다. Objectives:The purpose of this paper is to measure of sexual dysfunction in outpatients with schizophrenia compared with the general population. Method:Sexual dysfunction was assessed by a self-completed gender-specific questionnaire. Ninety-three patients with schizophrenia and 101 persons as control participated in this study. Results:1) Men:Sixty-one male patients with schizophrenia and 66 persons as control were compared, and male patients showed significantly higher frequency or degree most of sexual dysfunctions. Specifically, desire for sex, frequency of sexual intercourse or masturbation, excitation during sex or masturbation, enjoyment of sex or masturbation, satisfaction with own sex or masturbation, erection during sex or masturbation, maintaining erection during sex or masturbation, premature ejaculation during sex or masturbation, and satisfaction with intensity of orgasm during sex or masturbation were significantly impaired than control group. There were no difference in the delayed ejaculation during sex or masturbation between patient and control group. 2) Women:Thirty-two female patients with schizophrenia and 35 persons as control were compared, female patients showed significantly impaired sexual dysfunctions in the frequency of sexual intercourse and regularity of menstruation. There were no difference in the desire for sex, frequency of masturbation, excitation during sex or masturbation, enjoyment of sex or masturbation, satisfaction with own sex or masturbation, satisfaction with intensity of orgasm during sex or masturbation, ease of orgasm during sex or masturbation, and dyspareunia between patient and control group. Conclusions:Male patients with schizophrenia report much higher rates of sexual dysfunction than do the general population. Men and women with schizophrenia have a different pattern and degree of sexual dysfunction. There were fewer differences between female patients and controls. These results suggest that clinician should have more attention to assess the sexual dysfunction of the male schizophrenic patients.