Importance and Evolution of Nursing Profession
Nursing, a vital healthcare profession, has evolved significantly over time. From the foundational work of Florence Nightingale to the modern roles and responsibilities of nurses, this field continues to play a crucial role in promoting health, providing care, and improving quality of life for individuals, families, and communities.
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Hengameh Abdi Endocrine Research Center Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences 02 January 2020 Tehran
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 2
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 3
Model of sexual arousal Basson R, et al. Lancet 2007;369:409-24. 4
Dysfunctional sexual response Basson R, et al. Lancet 2007;369:409-24. 5
Sexual dysfunction in the context of endocrine disease In any given person, non-endocrine factors including psychological, relational, contextual, cultural, non-endocrine medical influences especially depression, hypertension, and neurologic disease may be more important. 6
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 8
Sexual dysfunction in diabetes mellitus Male: Erectile disorder: Up to 75% Meta-analysis studies men (age: 55.8 7.9 years): 52.5% (CI 48.8-56.2) Type 1 DM: 37.5% Type 2 DM: 66.3% Odds ratio: 3.62 (CI 2.53-5.16) Ejaculatory disorders Up to 1/3 Female: Overall prevalence: Meta-analysis of 25 studies including 3892 women with type 2 DM aged 18-70 years: 68.6% (CI 61.1-75.3) Type 1 DM: 18-71% Odds ratio: Type 1 DM: 2.27 Type 2 DM: 2.49 Any type: 2.02 of 145 including 88,577 Kouidrat Y, et al. Diabet Med 2017;34:1185-1192. Rahmanian E, et al. Diabetol Metab Syndr 2019;11:73. Pontiroli AE, et al. J Sex Med 2013;10:1044-1051. 9
Pathophysiology Multifactorial: Endothelial dysfunction Smooth muscle dysfunction Autonomic neuropathy Hypogonadism Psychological and interpersonal issues 10
ED, erectile dysfunction. AGEs, advanced glycation end-products. ETB, endothelin B. NO, nitric oxide. PKG-1, cyclic guanosine monophosphate (cGMP)-dependent kinase-1. 11 Moore CR, et al. Asian J Androl 2006;8(6):675-684.
Among men with diabetes, those with erectile dysfunction are more likely to: Be older Be smoker Have a longer duration of diabetes Have poor metabolic control Have untreated hypertension Have neuropathy Have albuminuria Have retinopathy Have coronary vascular disease Have diuretic use Have low testosterone levels Bhasin S & Basson R. Sexual dysfunction in men & women. Williams Textbook of Endocrinology 2020. 12
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 13
Biological (direct), comorbid, and psychological effects of obesity on men sexual health. 14 Rowland DL, et al. Sex Med Rev 2017;5(3):323-338.
Biological (direct), comorbid, and psychological effects of obesity on women sexual health. 15 Rowland DL, et al. Sex Med Rev 2017;5(3):323-338.
Sexual dysfunction in metabolic syndrome: Higher prevalence of erectile dysfunction Correlated with the number of components of metabolic syndrome Higher prevalence of female sexual dysfunction Independent of obesity and diabetes 16
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 17
Synopsis of hormonal changes in male and female thyrotoxicosis and hypothyroidism 18 Krassas GE, et al. Endocr Rev 2010;31:702-755.
Sexual dysfunction in thyroid disease in men Hypothyroidism: 59-63% Erectile dysfunction Delayed ejaculation Hypoactive sexual desire disorder Hyperthyroidism: 48-77% Erectile dysfunction Premature ejaculation Hypoactive sexual desire disorder Gabrielson AT, et al. Sex Med Rev 2019;7(1):57-70. 19
Hyperthyroidism before and after treatment 20 Krassas GE, et al. Endocr Rev 2010;31:702-755.
Hypothyroidism before and after treatment 21 Krassas GE, et al. Endocr Rev 2010;31:702-755.
Sexual dysfunction in thyroid disease in women Hypothyroidism: 22-46% Hyperthyroidism: 44-60% Impairments in desire, arousal/lubrication, orgasm, and satisfaction Pain during intercourse. Gabrielson AT, et al. Sex Med Rev 2019;7(1):57-70. 22
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 23
Sexual dysfunction in hyperprolactinemia Male: Hyperprolactinemia affects 1-5% of men who present with erectile dysfunction. About 75% of men with macroprolactinomas 50% of microprolactinomas reduced sexual desire or erectile dysfunction; almost all have nocturnal penile erections. Female: Hyperprolactinemic women without depression or other hormonal disorders have reported lower scores for sexual desire, lubrication, satisfaction controls. arousal, and have and with report orgasm, than men subnormal Bhasin, et al. Lancet 2007;369:597-611. Galdiero M, et al. J Endocrinol Invest 2012;35:782-794. 24
The interplay between dopamine (DA), prolactin (PRL), and testosterone (T) on different phases of sexual function Galdiero M, et al. J Endocrinol Invest 2012;35:782-794. 25
Hypothetical physiologic or pathologic role of prolactin on sexual function Galdiero M, et al. J Endocrinol Invest 2012;35:782-794. 26
Agenda Introduction Sexual dysfunction in diabetes mellitus Sexual dysfunction in obesity Sexual dysfunction in metabolic syndrome Sexual dysfunction in thyroid disease Sexual dysfunction in hyperprolactinemia Sexual dysfunction in growth hormone deficiency and acromegaly Concluding remarks 27
The physiological role of GH on sexual function is not fully elucidated. A decrease of desire and arousability both in men and women, together with an impairment of erectile function in men, have been described both in patients with GH deficiency and acromegaly. It is not clear whether they are dependent directly on the hormone defect or excess or they are consequence of the hypogonadism or the different clinical complications or the physical disfigurement and psychological imbalance, which are associated with the diseases, and are potentially affecting sexual function. Galdiero M, et al. J Endocrinol Invest 2012;35:782-794. 28
Conflicting data regarding female sexual dysfunction in: Hyperandrogenic disorders Adrenal insufficiency Estrogen deficiency syndromes 29
Conclusions Sexual dysfunction can herald serious underlying disease. Many common endocrine disorders have negative effects on sexual function. Sexual dysfunction in medical disorders has both organic and psychological origins. Physicians should consider the sexual enquiry as an integral component of medical assessment. 30
