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Fortschr Neurol Psychiatr 2004; 72(3): 121-135
DOI: 10.1055/s-2004-818357
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© Georg Thieme Verlag Stuttgart · New York

Weibliche sexuelle Funktionsstörungen: Klassifikation, Diagnostik und Therapie

Female Sexual Dysfunction: A Systematic Overview of Classification, Pathophysiology, Diagnosis and TreatmentH.  Marthol1 , M.  J.  Hilz1, 2
  • 1New York University School of Medicine, Department of Neurology, New York, USA (Edwin H. Kolodny, M.D., Professor and Chairman)
  • 2Neurologische Klinik mit Poliklinik der Universität Erlangen-Nürnberg (Direktor: Prof. Dr. med. B. Neundörfer)
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Publication Date:
04 March 2004 (online)

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Zusammenfassung

Unter sexuellen Funktionsstörungen versteht man „Störungen im sexuellen Verlangen und psychophysiologische Veränderungen, die den sexuellen Reaktionszyklus charakterisieren und dadurch ein deutliches Leiden sowie zwischenmenschliche Schwierigkeiten hervorrufen”. Der sexuelle Reaktionszyklus wird in die drei Phasen, sexuelle Begierde, sexuelle Erregung und Orgasmus, unterteilt. An der Sexualfunktion der Frau sind die Vagina, Klitoris, Labia minora, Bulbus vestibuli sowie die Beckenbodenmuskulatur und der Uterus beteiligt. Während sexueller Erregung ist sowohl die Durchblutung als auch die Sensibilität im Bereich des weiblichen Genitales deutlich gesteigert. Darüber hinaus wird die Vaginalschleimhaut befeuchtet (Lubrikation). Schließlich kommt es während des Orgasmus zu rhythmischen Kontraktionen des Uterus und der Beckenbodenmuskulatur. Innerhalb des zentralen Nervensystems spielen Strukturen in Hypothalamus, Hippokampus und limbischem System eine zentrale Rolle. Man nimmt an, dass die sexuelle Erregung primär sympathisch vermittelt wird. Besonders sind aber so genannte nicht cholinerge, nicht adrenerge Neurotransmitter (NANC), z. B. vasoaktives intestinales Polypeptid (VIP) und Stickoxid (NO), von Bedeutung. Diese bewirken eine Relaxation der glatten Muskulatur und damit eine Steigerung der Durchblutung im Bereich des Genitales. Daneben beeinflussen verschiedene Hormone die Sexualfunktion der Frau. Östrogene sind für die Erhaltung der Vaginalschleimhaut sowie für die Sensibilität, Durchblutung und Lubrikation im Bereich des Genitale entscheidend. Androgene hingegen steigern vorwiegend die sexuelle Begierde, Erregung, Orgasmus und das allgemeine Wohlbefinden. Die international anerkannte Klassifikation weiblicher sexueller Funktionsstörungen unterscheidet zwischen Störungen der sexuellen Appetenz, Störungen mit sexueller Aversion, Störungen der sexuellen Erregung, Orgasmusstörungen und Störungen mit sexuell bedingten Schmerzen. Ursächlich sind vor allem vaskuläre Veränderungen, z. B. Arteriosklerose, und neurologische Erkrankungen, z. B. die diabetische Polyneuropathie, an der Entstehung sexueller Funktionsstörungen beteiligt. Daneben können aber auch hormonelle Veränderungen, Medikamente sowie psychische Belastungen die Sexualfunktion beeinträchtigen. Am Anfang der Diagnostik sollten eine ausführliche Anamneseerhebung und körperliche Untersuchung sowie Laborbestimmungen stehen. Organisch bedingte Störungen lassen sich zum Teil durch verschiedene Untersuchungsverfahren nachweisen. Messungen vor sowie nach sexueller Stimulation tragen dazu bei, pathologisch veränderte Reaktionen im Rahmen der sexuellen Erregungsphase aufzuzeigen. Mithilfe der Duplexsonographie, der Photoplethysmographie oder der Messung des transkutanen Sauerstoffpartialdruckes kann die Durchblutung im Bereich des weiblichen Genitale beurteilt werden. Daneben sollten der vaginale pH sowie die Compliance gemessen werden. Mittels neurophysiologischer Untersuchungsverfahren, z. B. dem Bulbokavernosus-Reflex, den somatosensibel evozierten Potenzialen des N. pudendus, der sympathischen Hautreaktion (SSR) und der Bestimmung der Warm-, Kalt- und Vibrationsempfindungsschwellen sowie der Empfindlichkeit gegenüber Druck und Berührung im Bereich des Genitales, können neurogene Ursachen teilweise ausgeschlossen werden. Bislang wurden überwiegend Hormonpräparate im Rahmen der Therapie weiblicher sexueller Funktionsstörungen eingesetzt. Östrogene können zur Linderung von Schmerzen und brennenden Missempfindungen während des Koitus beitragen. Die Wirksamkeit weiterer Medikamente, z. B. Sildenafil, L-Arginin, Yohimbin, Phentolamin, Apomorphin oder Prostaglandin E1, muss noch klinisch geprüft werden.

Abstract

Sexual dysfunction is defined as “disturbances in sexual desire and in the psychophysiological changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty”. The female sexual response cycle consists of three phases: desire, arousal, and orgasm. Various organs of the external and internal genitalia, e.g. vagina, clitoris, labia minora, vestibular bulbs, pelvic floor muscles and uterus, contribute to female sexual function. During sexual arousal, genital blood flow and sensation are increased. The vaginal canal is moistened (lubrication). During orgasm, there is rhythmical contraction of the uterus and pelvic floor muscles. Within the central nervous system, hypothalamic, limbic-hippocampal structures play a central role for sexual arousal. Sexual arousal largely depends on the sympathetic nervous system. Moreover, nonadrenergic/noncholinergic neurotransmitters (NANC), e.g. vasoactive intestinal polypeptide (VIP) and nitric oxide (NO), are involved in smooth muscle relaxation and enhancement of genital blood flow. Furthermore, various hormones may influence female sexual function. Estrogen has a significant role in maintaining vaginal mucosal epithelium as well as sensory thresholds and genital blood flow. Androgens primarily affect sexual desire, arousal, orgasm and the overall sense of well-being. The internationally accepted classification of female sexual dysfunction consists of hypoactive sexual desire disorders, sexual aversion disorders, sexual arousal disorders, orgasmic disorders and sexual pain disorders. Vascular insufficiency, e.g. due to atherosclerosis, and neurologic diseases, e.g. diabetic neuropathy, are major causes of sexual dysfunction. Additionally, sexual dysfunction may be due to changes in hormonal levels, medications with sexual side effects or of psychological origin. For the diagnosis of female sexual dysfunction, a detailed history should be taken initially, followed by a physical examination and laboratory studies. Physiologic monitoring of parameters of arousal potentially allows to diagnose organic diseases. Recordings at baseline and following sexual stimulation are recommended to determine pathologic changes that occur with arousal. Duplex Doppler sonography, photoplethysmography or the measurement of vaginal and minor labial oxygen tension may help to evaluate genital blood flow. Moreover, measurements of vaginal pH and compliance should be performed. Neurophysiological examination, e.g. measurement of the bulbocavernosus reflex and pudendal evoked potentials, genital sympathetic skin response (SSR), warm, cold and vibratory perception thresholds as well as testing of the pressure and touch sensitivity of the external genitalia, should be performed to evaluate neurogenic etiologies. Medical management of female sexual dysfunction so far is primarily based on hormone replacement therapy. Application of estrogen results in decreased pain and burning during intercourse. The efficacy of various other medications, e.g. sildenafil, L-arginine, yohimbine, phentolamine, apomorphine and prostaglandin E1, in the treatment of female sexual dysfunction is still under investigation.

Literatur

  • 1 World Health Organization .ICD-10: International Statistical Classification of Diseases and Related Health Problems. Geneva: World Health Organization 1992
    Search in Google Scholar
  • 2 American Psychiatric Association .DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington D. C.: American Psychiatric Press 1994
    Search in Google Scholar
  • 3 Laumann E O, Paik A, Rosen R C. Sexual dysfunction in the United States: prevalence and predictors.  JAMA. 1999;  281 537-544
    CrossrefPubMedSearch in Google Scholar
  • 4 Tarcan T, Park K, Goldstein I, Maio G, Fassina A, Krane R J, Azadzoi K M. Histomorphometric analysis of age-related structural changes in human clitoral cavernosal tissue.  J Urol. 1999;  161 940-944
    PubMedSearch in Google Scholar
  • 5 Berman J R, Adhikari S P, Goldstein I. Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options.  Eur Urol. 2000;  38 20-29
    CrossrefPubMedSearch in Google Scholar
  • 6 Berman J R, Goldstein I. Female sexual dysfunction.  Urol Clin North Am. 2001;  28 405-416
    CrossrefPubMedSearch in Google Scholar
  • 7 Sjoberg I. The vagina. Morphological, functional and etiological aspects.  Acta Obstet Gynecol Scand. 1992;  71 84-85
    PubMedSearch in Google Scholar
  • 8 Weber A M, Walters M D, Schover L R, Mitchinson A. Vaginal anatomy and sexual function.  Obstet Gynecol. 1995;  86 946-949
    CrossrefPubMedSearch in Google Scholar
  • 9 Moore K L. Clinically Oriented Anatomy, ed 3. Baltimore: Williams & Wilkins 1992
    Search in Google Scholar
  • 10 Netter F H. The Ciba Collection of Medical Illustrations, Volume I: Nervous System. Summit, New Jersey: Ciba Pharmaceutical Products, Inc. 1953
    Search in Google Scholar
  • 11 Wagner G. Aspects of genital physiology and pathology.  Semin Neurol. 1992;  12 87-97
    PubMedSearch in Google Scholar
  • 12 Levin R J. The mechanism of human female sexual arousal.  Annu Rev Sex Res. 1992;  3 1-48
    PubMedSearch in Google Scholar
  • 13 Schiavi R C, Segraves R T. The biology of sexual function.  Psychiatr Clin North Am. 1995;  18 7-23
    PubMedSearch in Google Scholar
  • 14 Levin R J. The physiology of sexual function in women.  Clin Obstet Gynaecol. 1980;  7 213-252
    PubMedSearch in Google Scholar
  • 15 Levin R J. VIP, vagina, clitoral and periurethral glans - an update on human female genital arousal.  Exp Clin Endocrinol. 1991;  98 61-69
    PubMedSearch in Google Scholar
  • 16 April E W. Anatomy. Baltimore: Williams & Wilkins 1990
    Search in Google Scholar
  • 17 O'Connell H E, Hutson J M, Anderson C R, Plenter R J. Anatomical relationship between urethra and clitoris.  J Urol. 1998;  159 1892-1897
    PubMedSearch in Google Scholar
  • 18 Masters E H, Johnson V E. Human Sexual Response. Boston: Little, Brown 1966
    Search in Google Scholar
  • 19 Kaplan H S. The New Sex Therapy. London: Bailliere, Tindall 1974
    Search in Google Scholar
  • 20 Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J, Goldstein I, Graziottin A, Heiman J, Laan E, Leiblum S, Padma-Nathan H, Rosen R, Segraves K, Segraves R T, Shabsigh R, Sipski M, Wagner G, Whipple B. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.  J Urol. 2000;  163 888-893
    CrossrefPubMedSearch in Google Scholar
  • 21 Carlson K J. Outcomes of hysterectomy.  Clin Obstet Gynecol. 1997;  40 939-946
    CrossrefPubMedSearch in Google Scholar
  • 22 Brackett N L, Bloch W E, Abae M. Neurological Anatomy and Physiology of Sexual Function. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 1-43
    Search in Google Scholar
  • 23 Park K, Goldstein I, Andry C, Siroky M B, Krane R J, Azadzoi K M. Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency.  Int J Impot Res. 1997;  9 27-37
    PubMedSearch in Google Scholar
  • 24 Park K, Moreland R B, Goldstein I, Atala A, Traish A. Sildenafil inhibits phosphodiesterase type 5 in human clitoral corpus cavernosum smooth muscle.  Biochem Biophys Res Commun. 1998;  249 612-617
    CrossrefPubMedSearch in Google Scholar
  • 25 Graber B, Kline-Graber G. Female orgasm: role of pubococcygeus muscle.  J Clin Psychiatry. 1979;  40 348-351
    PubMedSearch in Google Scholar
  • 26 Martinez-Arizala A, Brackett N L. Sexual Dysfunction in Spinal Injury. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 135-153
    Search in Google Scholar
  • 27 Fox C A, Fox B. Blood pressure and respiratory patterns during human coitus.  J Reprod Fert. 1969;  19 405-415
    PubMedSearch in Google Scholar
  • 28 Wiedeking C, Ziegler M G, Lake C R. Plasma noradrenaline and dopamine-beta-hydroxylase during human sexual activity.  J Psychiatr Res. 1979;  15 139-145
    CrossrefPubMedSearch in Google Scholar
  • 29 Meston C M. Sympathetic nervous system activity and female sexual arousal.  Am J Cardiol. 2000;  86 30F-34F
    PubMedSearch in Google Scholar
  • 30 Tuiten A, Honk J van, Koppeschaar H, Bernaards C, Thijssen J, Verbaten R. Time course of effects of testosterone administration on sexual arousal in women.  Arch Gen Psychiatry. 2000;  57 149-153; discussion 155 - 156
    PubMedSearch in Google Scholar
  • 31 Hoyle C H, Stones R W, Robson T, Whitley K, Burnstock G. Innervation of vasculature and microvasculature of the human vagina by NOS and neuropeptide-containing nerves.  J Anat. 1996;  188 633-644
    PubMedSearch in Google Scholar
  • 32 Hsueh W A. Sexual dysfunction with aging and systemic hypertension.  Am J Cardiol. 1998;  61 18H-23H
    PubMedSearch in Google Scholar
  • 33 Thomas G, Ramwell P W. Nitric Oxide, Donors & Inhibitors. In: Katzung BG (Hrsg.). Basic & Clinical Pharmacology. Stamford, Connecticut: Appleton & Lange 1998: 319-324
    Search in Google Scholar
  • 34 Traish A, Moreland R B, Huang Y H, Kim N N, Berman J, Goldstein I. Development of human and rabbit vaginal smooth muscle cell cultures: effects of vasoactive agents on intracellular levels of cyclic nucleotides.  Mol Cell Biol Res Commun. 1999;  2 131-137
    PubMedSearch in Google Scholar
  • 35 Reid I A. Vasoactive Peptides. In: Katzung BG (Hrsg.). Basic & Clinical Pharmacology. Stamford, Connecticut: Appleton & Lange 1998: 287-303
    Search in Google Scholar
  • 36 Stenchever M A, Drogenmueller W, Herbst A L, Mishell Jr D R. Comprehensive Gynecology. St. Louis: Mosby, Inc. 2001
    Search in Google Scholar
  • 37 Berman J R, Berman L, Goldstein I. Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options.  Urology. 1999;  54 385-391
    CrossrefPubMedSearch in Google Scholar
  • 38 Sarrell P M. Ovarian hormones and vaginal blood flow: Using laser Doppler velocimetry to measure effects in a clinical trial of postmenopausal women.  Int J Impot Res. 1998;  10 S91-S93
    PubMedSearch in Google Scholar
  • 39 Sarrell P M. Sexuality and menopause.  Obstet Gynecol. 1990;  75 26s
    PubMedSearch in Google Scholar
  • 40 Arlt W, Callies F, Allolio B. DHEA replacement in women with adrenal insufficiency - pharmacokinetics, bioconversion and clinical effects on well-being, sexuality and cognition.  Endocr Res. 2000;  26 505-511
    PubMedSearch in Google Scholar
  • 41 Traish A M, Kim N, Min K, Munarriz R, Goldstein I. Role of androgens in female genital sexual arousal: receptor expression, structure, and function.  Fertil Steril. 2002;  77 11-18
    PubMedSearch in Google Scholar
  • 42 Kaplan H S, Owett T. The female androgen deficiency syndrome.  J Sex Marital Ther. 1993;  19 3-24
    PubMedSearch in Google Scholar
  • 43 Davis S. Testosterone and sexual desire in women.  J Sex Education Ther. 2000;  25 25-32
    PubMedSearch in Google Scholar
  • 44 Sourla A, Flamand M, Belanger A, Labrie F. Effect of dehydroepiandrosterone on vaginal and uterine histomorphology in the rat.  J Steroid Biochem Mol Biol. 1998;  66 137-149
    CrossrefPubMedSearch in Google Scholar
  • 45 Kennedy T G, Armstrong D T. Induction of vaginal mucification in rats with testosterone and 17beta-hydroxy-5alpha-androstan-3-one.  Steroids. 1976;  27 423-430
    CrossrefPubMedSearch in Google Scholar
  • 46 Kennedy T G. Vaginal mucification in the ovariectomized rat in response to 5alpha-pregnane-3,20-dione, testosterone and 5alpha-androstan-17beta-ol-3-one: test for progestogenic activity.  J Endocrinol. 1974;  61 293-300
    PubMedSearch in Google Scholar
  • 47 Kennedy T G. Proceedings: Vaginal mucification in the ovariectomized rat in response to 5alpha-pregnan-3,20-dione, testosterone and 5alpha-androstan-17beta-ol-3-one: test for progestagenic activity.  J Reprod Fertil. 1974;  36 488-489
    PubMedSearch in Google Scholar
  • 48 Sherwin B B, Gelfand M M. Differential symptom response to parenteral estrogen and/or androgen administration in the surgical menopause.  Am J Obstet Gynecol. 1985;  151 153-160
    PubMedSearch in Google Scholar
  • 49 Sherwin B B, Gelfand M M. The role of androgen in the maintenance of sexual functioning in oophorectomized women.  Psychosom Med. 1987;  49 397-409
    PubMedSearch in Google Scholar
  • 50 Davis S R. Androgens and female sexuality.  J Gend Specif Med. 2000;  3 36-40
    PubMedSearch in Google Scholar
  • 51 Heiman J R. Female Sexual Dysfunction: Definitions, History-Taking Techniques, and Work-Up. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 61-75
    Search in Google Scholar
  • 52 Moynihan R. The making of a disease: female sexual dysfunction.  BMJ. 2003;  326 45-47
    CrossrefPubMedSearch in Google Scholar
  • 53 Bancroft J. The medicalization of female sexual dysfunction: the need for caution.  Arch Sex Behav. 2002;  31 451-455
    CrossrefPubMedSearch in Google Scholar
  • 54 Goldstein I, Berman J R. Vasculogenic female sexual dysfunction: vaginal engorgement and clitoral erectile insufficiency syndromes.  Int J Impot Res. 1998;  10 S84-S90; discussion S98 - S101
    PubMedSearch in Google Scholar
  • 55 Myers L S, Morokoff P J. Physiological and subjective sexual arousal in pre- and postmenopausal women and postmenopausal women taking replacement therapy.  Psychophysiology. 1986;  23 283-292
    PubMedSearch in Google Scholar
  • 56 Hilz M J, Hecht M, Kölsch C. Erektile Dysfunktion.  Akt Neurol. 2000;  27 1-12
    PubMedSearch in Google Scholar
  • 57 Zemel P. Sexual dysfunction in the diabetic patient with hypertension.  Am J Cardiol. 1988;  61 27H-33H
    CrossrefPubMedSearch in Google Scholar
  • 58 Kolodny R C. Sexual dysfunction in diabetic females.  Diabetes. 1971;  20 557-559
    PubMedSearch in Google Scholar
  • 59 Hatzichristou D G, Seftel A D, deTejada I S. Sexual Dysfunction in Diabetes and Other Autonomic Neuropathies. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 167-198
    Search in Google Scholar
  • 60 Jensen S B. Diabetic sexual dysfunction: a comparative study of 160 insulin treated diabetic men and women and an age-matched control group.  Arch Sex Behav. 1981;  10 493-504
    CrossrefPubMedSearch in Google Scholar
  • 61 Torrens M J. Neurologic and neurosurgical disorders associated with impotence. In: Krane RJ, Siroky MB, Goldstein I (Hrsg.). Male Sexual Dysfunction. Boston, MA: Little, Brown 1983
    Search in Google Scholar
  • 62 Brown R G, Jahanshahi M, Quinn N, Marsden C D. Sexual function in patients with Parkinson's disease and their partners.  J Neurol Neurosurg Psychiatry. 1990;  53 480-486
    PubMedSearch in Google Scholar
  • 63 Koller W C, Vetere-Overfield B, Williamson A, Busenbark K, Nash J, Parrish D. Sexual dysfunction in Parkinson's disease.  Clin Neuropharmacol. 1990;  13 461-463
    PubMedSearch in Google Scholar
  • 64 Rinne U K, Sonninen V, Siirtola T. L-Dopa treatment in Parkinson's Disease.  Eur Neurol. 1970;  4 348-369
    PubMedSearch in Google Scholar
  • 65 Singer C, Weiner W J. Sexual Dysfunction in Parkinson's Disease. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 119-134
    Search in Google Scholar
  • 66 Dewis M E, Thornton N G. Sexual dysfunction in multiple sclerosis.  J Neurosci Nurs. 1989;  21 175-179
    PubMedSearch in Google Scholar
  • 67 Miller A E. Sexual Dysfunction in Multiple Sclerosis. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 155-165
    Search in Google Scholar
  • 68 Valleroy M L, Kraft G H. Sexual dysfunction in multiple sclerosis.  Arch Phys Med Rehabil. 1984;  65 125-128
    PubMedSearch in Google Scholar
  • 69 Minderhoud J M, Leemhuis J G, Kremer J, Laban E, Smits P M. Sexual disturbances arising from multiple sclerosis.  Acta Neurol Scand. 1984;  70 299-306
    PubMedSearch in Google Scholar
  • 70 Lilius H G, Valtonen E J, Wikstrom J. Sexual problems in patients suffering from multiple sclerosis.  J Chronic Dis. 1976;  29 643-647
    CrossrefPubMedSearch in Google Scholar
  • 71 McGuire E J. Sexuality and urology. In: Leyson JFJ (Hrsg.). Sexual Rehabilitation of the Spinal-Cord-Injured Patient. Clifton, NJ: Humana Press 1991: 55-67
    Search in Google Scholar
  • 72 Griffith E R, Trieschmann R B. Sexual functioning in women with spinal cord injury.  Arch Phys Med Rehabil. 1975;  56 18-21
    PubMedSearch in Google Scholar
  • 73 Berard E J. The sexuality of spinal cord injured women: physiology and pathophysiology. A review.  Paraplegia. 1989;  27 99-112
    PubMedSearch in Google Scholar
  • 74 Nygaard I, Bartscht K D, Cole S. Sexuality and reproduction in spinal cord injured women.  Obstet Gynecol Surv. 1990;  45 727-732
    PubMedSearch in Google Scholar
  • 75 Verduyn W H. Spinal-cord-injuried women. In: Leyson JFJ (Hrsg.). Sexual Rehabilitation of the Spinal-Cord-Injuried Patient. Clifton, NJ: Humana Press 1991: 197-206
    Search in Google Scholar
  • 76 Sipski M L, Alexander C J, Rosen R C. Orgasm in women with spinal cord injuries: a laboratory-based assessment.  Arch Phys Med Rehabil. 1995;  76 1097-1102
    CrossrefPubMedSearch in Google Scholar
  • 77 Cummings J L, Miller B L. Disorders of Sexual Behavior in Neurological Disease. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 199-218
    Search in Google Scholar
  • 78 Kalliomaki J L, Markkanen T K, Mustonen V A. Sexual behavior after cerebral vascular accident.  Fertil Steril. 1961;  12 156-159
    PubMedSearch in Google Scholar
  • 79 Coslett H B, Heilman K M. Male sexual function. Impairment after right hemisphere stroke.  Arch Neurol. 1986;  43 1036-1039
    CrossrefPubMedSearch in Google Scholar
  • 80 Shukla G D, Srivastava O N, Katiyar B C. Sexual disturbances in temporal lobe epilepsy: a controlled study.  Br J Psychiatry. 1979;  134 288-292
    PubMedSearch in Google Scholar
  • 81 Cogen P H, Antunes J L, Correll J W. Reproductive function in temporal lobe epilepsy: the effect of temporal lobectomy.  Surg Neurol. 1979;  12 243-246
    PubMedSearch in Google Scholar
  • 82 Johnson J. Sexual impotence and the limbic system.  Br J Psychiatry. 1965;  111 300-303
    PubMedSearch in Google Scholar
  • 83 Shapira J, Cummings J L. Alzheimer's disease: changes in sexual behavior.  Med Aspects Human Sex. 1989;  23 32-35
    PubMedSearch in Google Scholar
  • 84 McCoy N L, Davidson J M. A longitudinal study of the effects of menopause on sexuality.  Maturitas. 1985;  7 203-210
    CrossrefPubMedSearch in Google Scholar
  • 85 Sarrel P M, Bajulaiya P. A survey of menopause related symptoms in Nigeria. In: 5th International Congress on Menopause. Orlando, FL 1984
    Search in Google Scholar
  • 86 Wilsnack S C. Drinking, sexuality and sexual dysfunction in women. In: Wilsnack SC, Beckman LJ (Hrsg.). Alcohol Problems in Women: Antecedents, Consequences, and Interventions. New York, NY: Guilford Press 1984: 349-368
    Search in Google Scholar
  • 87 Condra M, Morales A, Owen J A, Surridge D H, Fenemore J. Prevalence and significance of tobacco smoking in impotence.  Urology. 1986;  27 495-498
    CrossrefPubMedSearch in Google Scholar
  • 88 Brown G W. Epidemiological studies of depression: definition and case finding. In: Becker J, Kleinman A (Hrsg.). Psychosocial Aspects of Depression. Hillsdale, NJ: Lawrence Erlbaum 1991: 1-38
    Search in Google Scholar
  • 89 McCabe M P, Delaney S M. An evaluation of therapeutic programs for the treatment of secondary inorgasmia in women.  Arch Sex Behav. 1992;  21 69-89
    CrossrefPubMedSearch in Google Scholar
  • 90 Rosen R C, Beck J G. Patterns of sexual arousal: psychophysiological processes and clinical applications. New York: Guilford Press 1988
    Search in Google Scholar
  • 91 Laan E, Everaerd W. Physiological measures of vaginal vasocongestion.  Int J Impot Res. 1998;  10 S107-S110; discussion S124 - S125
    PubMedSearch in Google Scholar
  • 92 Meuwissen I, Over R. Multidimensionality of the content of female sexual fantasy.  Behav Res Ther. 1991;  29 179-189
    PubMedSearch in Google Scholar
  • 93 Rosen R C. Assessment of female sexual dysfunction: review of validated methods.  Fertil Steril. 2002;  77 89-93
    CrossrefPubMedSearch in Google Scholar
  • 94 Sommer F, Caspers H P, Esders K, Klotz T, Engelmann U. Measurement of vaginal and minor labial oxygen tension for the evaluation of female sexual function.  J Urol. 2001;  165 1181-1184
    PubMedSearch in Google Scholar
  • 95 Berman J, Berman L. For Women Only: A Revolutionary Guide to Overcoming Sexual Dysfunction and Reclaiming Your Sex Life. New York: Henry Holt and Company, Inc. 2001
    Search in Google Scholar
  • 96 Yang C C, Bowen J R, Kraft G H, Uchio E M, Kromm B G. Cortical evoked potentials of the dorsal nerve of the clitoris and female sexual dysfunction in multiple sclerosis.  J Urol. 2000;  164 2010-2013
    CrossrefPubMedSearch in Google Scholar
  • 97 Yilmaz U, Soylu A, Ozcan C, Caliskan O. Clitoral electromyography.  J Urol. 2002;  167 616-620
    PubMedSearch in Google Scholar
  • 98 Fabra M, Frieling A, Porst H, Schneider E. Single potential analysis of corpus cavernosum electromyography for the assessment of erectile dysfunction: provocation, reproducibility and age dependence - findings in 36 healthy volunteers and 324 patients.  J Urol. 1997;  158 444-450
    PubMedSearch in Google Scholar
  • 99 Vardi Y, Gruenwald I, Sprecher E, Gertman I, Yartnitsky D. Normative values for female genital sensation.  Urology. 2000;  56 1035-1040
    CrossrefPubMedSearch in Google Scholar
  • 100 Romanzi L J, Groutz A, Feroz F, Blaivas J G. Evaluation of female external genitalia sensitivity to pressure/touch: a preliminary prospective study using Semmes-Weinstein monofilaments.  Urology. 2001;  57 1145-1150
    CrossrefPubMedSearch in Google Scholar
  • 101 Semmes J, Weinstein S, Ghent L, Teuber H L. Somatosensory Changes After Penetrating Brain Wounds in Man. Cambridge: Harvard University Press 1960
    Search in Google Scholar
  • 102 Weinstein S. Tactile sensitivity of the phalanges.  Percept Mot Skills. 1962;  14 351-354
    PubMedSearch in Google Scholar
  • 103 Lightner D J. Female sexual dysfunction.  Mayo Clin Proc. 2002;  77 698-702
    PubMedSearch in Google Scholar
  • 104 Hirshfield R M. Management of sexual side effects of antidepressant therapy.  J Clin Psychiatry. 1999;  60 27-30
    PubMedSearch in Google Scholar
  • 105 Hilz M J. Erektile Dysfunktion.  MMW Fortschr Med. 2002;  144 41-44
    PubMedSearch in Google Scholar
  • 106 Porst H. Manual der Impotenz. Erektions-, Ejakulations- und Hormonstörungen, Peniserkrankungen, weibliche Sexualstörungen. Bremen: UniMed 2000
    Search in Google Scholar
  • 107 Dennerstein L, Burrows G D, Wood C, Hyman G. Hormones and sexuality: effect of estrogen and progestogen.  Obstet Gynecol. 1980;  56 316-322
    PubMedSearch in Google Scholar
  • 108 McClure R D, Marshall L. Endocrinologic Sexual Dysfunction. In: Singer C, Weiner WJ (Hrsg.). Sexual Dysfunction: A Neuro-Medical Approach. Armonk, NY: Futura Publishing Company, Inc. 1994: 245-273
    Search in Google Scholar
  • 109 Rossouw J E, Anderson G L, Prentice R L, LaCroix A Z, Kooperberg C, Stefanick M L, Jackson R D, Beresford S A, Howard B V, Johnson K C, Kotchen J M, Ockene J. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial.  JAMA. 2002;  288 321-333
    CrossrefPubMedSearch in Google Scholar
  • 110 Sherwin B B, Gelfand M M, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause.  Psychosom Med. 1985;  47 339-351
    PubMedSearch in Google Scholar
  • 111 Shifren J L, Braunstein G D, Simon J A, Casson P R, Buster J E, Redmond G P, Burki R E, Ginsburg E S, Rosen R C, Leiblum S R, Caramelli K E, Mazer N A. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy.  N Engl J Med. 2000;  343 682-688
    CrossrefPubMedSearch in Google Scholar
  • 112 Couzinet B, Meduri G, Lecce M G, Young J, Brailly S, Loosfelt H, Milgrom E, Schaison G. The postmenopausal ovary is not a major androgen-producing gland.  J Clin Endocrinol Metab. 2001;  86 5060-5066
    CrossrefPubMedSearch in Google Scholar
  • 113 Labrie F, Belanger A, Cusan L, Gomez J L, Candas B. Marked decline in serum concentrations of adrenal C19 sex steroid precursors and conjugated androgen metabolites during aging.  J Clin Endocrinol Metab. 1997;  82 2396-2402
    CrossrefPubMedSearch in Google Scholar
  • 114 Longcope C, Franz C, Morello C, Baker R, Johnston Jr C C. Steroid and gonadotropin levels in women during the peri-menopausal years.  Maturitas. 1986;  8 189-196
    CrossrefPubMedSearch in Google Scholar
  • 115 Zumoff B, Strain G W, Miller L K, Rosner W. Twenty-four-hour mean plasma testosterone concentration declines with age in normal premenopausal women.  J Clin Endocrinol Metab. 1995;  80 1429-1430
    CrossrefPubMedSearch in Google Scholar
  • 116 Spark R F. Dehydroepiandrosterone: a springboard hormone for female sexuality.  Fertil Steril. 2002;  77 19-25
    PubMedSearch in Google Scholar
  • 117 Allolio B, Arlt W. DHEA treatment: myth or reality?.  Trends Endocrinol Metab. 2002;  13 288-294
    PubMedSearch in Google Scholar
  • 118 Arlt W, Callies F, Vlijmen J C van, Koehler I, Reincke M, Bidlingmaier M, Huebler D, Oettel M, Ernst M, Schulte H M, Allolio B. Dehydroepiandrosterone replacement in women with adrenal insufficiency.  N Engl J Med. 1999;  341 1013-1020
    CrossrefPubMedSearch in Google Scholar
  • 119 Lovas K, Gebre-Medhin G, Trovik T S, Fougner K J, Uhlving S, Nedrebo B G, Myking O L, Kampe O, Husebye E S. Replacement of dehydroepiandrosterone in adrenal failure: no benefit for subjective health status and sexuality in a 9-month, randomized, parallel group clinical trial.  J Clin Endocrinol Metab. 2003;  88 1112-1118
    CrossrefPubMedSearch in Google Scholar
  • 120 Caruso S, Intelisano G, Lupo L, Agnello C. Premenopausal women affected by sexual arousal disorder treated with sildenafil: a double-blind, cross-over, placebo-controlled study.  BJOG. 2001;  108 623-628
    CrossrefPubMedSearch in Google Scholar
  • 121 Shen W W, Urosevich Z, Clayton D O. Sildenafil in the treatment of female sexual dysfunction induced by selective serotonin reuptake inhibitors.  J Reprod Med. 1999;  44 535-542
    PubMedSearch in Google Scholar
  • 122 Berman J R, Berman L A, Lin H, Flaherty E, Lahey N, Goldstein I, Cantey-Kiser J. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder.  J Sex Marital Ther. 2001;  27 411-420
    PubMedSearch in Google Scholar
  • 123 Sipski M L, Behnegar A. Neurogenic female sexual dysfunction: a review.  Clin Auton Res. 2001;  11 279-283
    PubMedSearch in Google Scholar
  • 124 Rosen R C, Phillips N A, Gendrano N C 3rd, Ferguson D M. Oral phentolamine and female sexual arousal disorder: a pilot study.  J Sex Marital Ther. 1999;  25 137-144
    PubMedSearch in Google Scholar
  • 125 Meston C M, Gorzalka B B, Wright J M. Inhibition of subjective and physiological sexual arousal in women by clonidine.  Psychosom Med. 1997;  59 399-407
    PubMedSearch in Google Scholar
  • 126 Meston C M, Heiman J R. Ephedrine-activated physiological sexual arousal in women.  Arch Gen Psychiatry. 1998;  55 652-656
    PubMedSearch in Google Scholar
  • 127 Meston C M, Gorzalka B B. Differential effects of sympathetic activation on sexual arousal in sexually dysfunctional and functional women.  J Abnorm Psychol. 1996;  105 582-591
    CrossrefPubMedSearch in Google Scholar
  • 128 Padma-Nathan H, Giuliano F. Oral drug therapy for erectile dysfunction.  Urol Clin North Am. 2001;  28 321-334
    CrossrefPubMedSearch in Google Scholar
  • 129 Dula E, Bukofzer S, Perdok R, George M. Apomorphine S L Study Group . Double-blind, crossover comparison of 3 mg apomorphine SL with placebo and with 4 mg apomorphine SL in male erectile dysfunction.  Eur Urol. 2001;  39 558-563; discussion 564
    CrossrefPubMedSearch in Google Scholar

Prof. Dr. med. M. J. Hilz

Neurologische Klinik mit Poliklinik der Universität Erlangen-Nürnberg

Schwabachanlage 6

91054 Erlangen

Phone: 09131-853 4444

Fax: 09131-853 4328

Email: max.hilz@neuro.imed.uni-erlangen.de