Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-02-04T09:15:08Z No. of bitstreams: 2 Dissertação - Carolina Rodrigues de Mendonca - 2014.pdf: 3841382 bytes, checksum: 079c00331419687a5cc6570935d83e03 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-02-05T14:11:04Z (GMT) No. of bitstreams: 2 Dissertação - Carolina Rodrigues de Mendonca - 2014.pdf: 3841382 bytes, checksum: 079c00331419687a5cc6570935d83e03 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-02-05T14:11:04Z (GMT). No. of bitstreams: 2 Dissertação - Carolina Rodrigues de Mendonca - 2014.pdf: 3841382 bytes, checksum: 079c00331419687a5cc6570935d83e03 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-01-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Infertility, besides being a medical condition that deserves medical attention and treatment, is a disturbing development, with implications on various aspects of life of infertile couples and individuals (personal, relational, social and sexual). The impact of infertility on women's sexuality is not entirely clear. Studies that have investigated the topic reported contradictory results and methodological limitation. Objectives: • Review important aspects of female sexual function, including, in Brazil the prevalence, diagnosis and treatment. • Establish the risk of female sexual dysfunction in infertile couples. • Determine the prevalence of sexual dysfunction among infertile and fertile women and among women undergoing the techniques of low and high complexity. • Compare the dysfunctions in fertile and infertile women and in women subjected to low and high technical complexity. Methods: A literature review article, constructed from research on PubMed/Medline and SciELO databases between 1985 and 2012 was drafted. Then an original article where a study of the case-control was developed with 278 infertile participants met at the Laboratory of Huma n Reproduction, Hospital das Clínicas and fertile patients recruited at the Clinic of Gynecology in the same hospital, from March 2012 to September 2013. The case group consisted of 92 women with sexual dysfunction and a control group of 186 women without sexual dysfunction. The questionnaire Female Sexual Function Index (FSFI) Portuguese version, which assesses the domains desire, arousal, lubrication, orgasm, satisfaction and pain, was used. Data were collected through interviews after signing the WIC. Two controls per case were randomly selected. The odds ratio (OR) was calculated for chance of female sexual dysfunction in infertile couples (p ≤ 0.05). Results: In the literature, it is observed that female sexual dysfunction have a multifactorial etiology, prevalence ranged from 35.9 % to 49.0 % and is rarely studied in the Brazilian population. Infertile and fertile women have the same chance for sexual dysfunction (OR = 1.45, 95% CI 0.86 to 2.44, p = 0.20). The prevalence of sexual dysfunction in infertile women was 36.31 %, and the fertile women was 28.18 %. In women undergoing low technical complexity prevalence was 38.88 %, 34.37 % and high complexity. Desire and arousal were significantly lower in infertile women. No significant differences were observed in relation to sexual dysfunction in women subjected to the techniques of low and high complexity. Conclusions: The risk of infertile women experiencing sexual dysfunction is the same fertile women. There was no statistical difference regarding the prevalence in infertile women compared to fertile, and women undergoing fertilization of low complexity when compared to high complexity. The desire and arousal domains were the most affected in infertile women. No differences were observed in the areas in relation to the techniques of low and high complexity. / Introdução: A infertilidade, além de ser uma condição clínica que merece atenção médica e tratamento, é um acontecimento perturbador, com implicações em diversas dimensões da vida dos casais e indivíduos inférteis (pessoal, relacional, social e sexual). O impacto da infertilidade na sexualidade da mulher não está inteiramente claro. Os estudos que investigaram o tema apresentam resultados contraditórios e limitações metodológicas. Objetivos: • Revisar aspectos importantes sobre a função sexual feminina, incluindo, prevalência no Brasil, diagnóstico e tratamento. • Estabelecer o risco de disfunções sexuais femininas em casais inférteis. • Determinar a prevalência de disfunção sexual entre mulheres inférteis e férteis e entre mulheres submetidas às técnicas de baixa e alta complexidade. • Comparar as disfunções em mulheres férteis e inférteis e em mulheres submetidas às técnicas baixa e alta complexidade. Métodos: Foi redigido um artigo de revisão da literatura, construído a partir de pesquisa nas bases de dados PubMed/Medline e SciELO entre 1985 e 2012. Em seguida um artigo original onde um estudo do tipo caso-controle foi desenvolvido com 278 participantes inférteis atendidas no Laboratório de Reprodução Humana do Hospital das Clínicas e pacientes férteis recrutadas no Ambulatório de Ginecologia do mesmo hospital, no período de março de 2012 a setembro de 2013. O grupo caso foi composto por 92 mulheres com disfunção sexual e o grupo controle por 186 mulheres sem disfunção sexual. Foi utilizado o questionário Female Sexual Function Index (FSFI) versão em português, que avalia os domínios desejo, excitação, lubrificação, orgasmo, satisfação e dor. Os dados foram colhidos por entrevista após assinatura do TCLE. Dois controles por caso foram selecionados aleatoriamente. Foi calculado o odds ratio (OR) para chance de disfunção sexual feminina em casais inférteis (p ≤0,05). Resultados: Na revisão da literatura, observa-se que as disfunções sexuais femininas apresentam etiologia multifatorial, a prevalência pode variar de 35,9% a 49,0% e é pouco estudada na população brasileira. Mulheres inférteis e férteis apresentam a mesma chance para disfunção sexual (OR= 1,45; IC 95% 0,86–2,44; p= 0,20). A prevalência de disfunção sexual em mulheres inférteis foi de 36,31%, e nas mulheres férteis foi de 28,18%. Em mulheres submetidas à técnica de baixa complexidade a prevalência foi de 38,88%, e alta complexidade 34,37%. Desejo e excitação foram significativamente inferiores em mulheres inférteis. Não foram observadas diferenças significativas em relação às disfunções sexuais em mulheres submetidas às técnicas de baixa e alta complexidade. Conclusões: O risco de mulheres inférteis apresentarem disfunção sexual é o mesmo de mulheres férteis. Não houve diferença estatística em relação à prevalência em mulheres inférteis quando comparadas às férteis, e em mulheres submetidas à fertilização de baixa complexidade quando comparadas a alta complexidade. Os domínios desejo e excitação foram os mais comprometidos em mulheres inférteis. Não foram observadas diferenças nos domínios em relação às técnicas de baixa e alta complexidade.

Introdução: Embora a contracepção seja bastante prevalente no Brasil (77%), apenas dois métodos predominam: o contraceptivo hormonal oral e a esterilização cirúrgica (LT). No entanto a LT não é inócua e pode trazer diversas conseqüências para a vida dessas mulheres que se submetem a ela. Dentre estas pode estar a deterioração da função sexual o que seria contraditório visto que a LT objetiva uma vida sexual melhor, menos atemorizada pelo medo da gravidez. O presente estudo teve como objetivo avaliar a função sexual de mulheres submetidas à LT. Métodos: Estudo transversal de 235 casos, representativos de 1826, com dados obtidos através de inquérito da função sexual entre as mulheres laqueadas pelo SUS em Ribeirão Preto(SP) entre 2000 e 2004, utilizando-se o Female Sexual Function Index (FSFI) adaptado para o contexto brasileiro. Resultados: As entrevistadas tinham em média 35,9 anos e foram esterilizadas em média aos 33,3 anos; 89,8% estavam em união marital, 57,9% declararam-se brancas e 66,8%, católicas, tinham em média 6,1 anos de estudo e 76,6% pertenciam às classes C e D; 93,4% referiram ter um bom relacionamento conjugal e 59,5% declararam que o relacionamento não mudou após o procedimento. A média de filhos vivos foi 3,2, resultaram aborto 8,8% das gestações, 71,2% resultaram partos vaginais e 28,8%, cesáreas; 52,3% usaram pílula 6 meses antes da cirurgia; 98,7% responderam estar satisfeita com a cirurgia e 6,8% referiram dor pélvica. Em geral, 32,5% das mulheres apresentaram escores de índice com risco para disfunção sexual medido pelo FSFI. Foi observada associação entre a variável disfunção sexual e categoria de escolaridade, renda per capita, dor pélvica, número de gravidezes, número de partos vaginais e de cesáreas. Observou-se correlação negativa entre o escore de função sexual e o número de filhos vivos e correlação positiva entre o escore e renda familiar, renda per capita e os valores de classificação econômica. Conclusão: A partir dos dados obtidos, pôde-se observar que dentre as mulheres laqueadas do estudo a presença de disfunção sexual estava associada à dor pélvica e maior número de cesarianas, assim como a situações ligadas à vulnerabilidade social (baixa renda e escolaridade e maior número de filhos). / Introduction: Although contraception is high prevalent in Brazil (77%), only two methods prevail: the hormonal pills and the surgical sterilization. However female sterilization is not innocuous and it can bring several consequences for those women\'s life. Among these consequences it can be to deterioration of the sexual function what is contradictory sees that the use of contraceptional methods aims at a better sexual life, less frightened by the fear of pregnancy. The present study had as objective evaluates the women\'s sexual function submitted to LT. Methods: prevalence study of 235 cases, representative of 1826, with data obtained through inquiry of the sexual function among the women sterilized by the public health system in Ribeirão Preto(SP) between 2000 and 2004. There has been used the Sexual Female Function Index (FSFI) adapted for the Brazilian context. Results: The interviewees were 35,9 years old on average and they were sterilized on average to the 33,3 years; 89,8% were in marital union, 57,9% pronounced white and 66,8%, catholic, they had on average of 6,1 years of study and 76,6% belonged to the classes C and D; 93,4% referred to have a good matrimonial relationship and 59,5% declared that the relationship didn\'t change after the procedure. The alive children\'s average was 3,2, 8,8% of the gestations resulted abortion, 71,2% resulted vaginal childbirths and 28,8%, cesarean; 52,3% used pill 6 months before the surgery; 98,7% answered to be satisfied with the surgery and 6,8% referred pelvic pain. In general, 32,5% of the women presented index scores with risk for sexual dysfunction measured by FSFI. Association was observed between the variable sexual dysfunction and education category, per capita income, pelvic pain, number of pregnancies, number of vaginal childbirths and of Cesarean. Negative correlation was observed between the score of sexual function and the number of alive children and positive correlation among the score and surrender family, per capita income and the values of economical classification. Conclusion: Starting from the obtained data, it could be observed that among the sterilized women the presence of sexual dysfunction was associated to the pelvic pain and larger number of cesarean operations, as well as linked situations to the social vulnerability (low income and education and larger number of children).

<p>The aim of this thesis was to examine different approaches to support the self-care of persons with Type 2 diabetes, with special reference to practical, social, and sexual aspects of women's self-management. The methods to elucidate this comprised: evaluating a new model for diabetes patient education; designing a model to analyse the role of social networks in women's diabetes; conducting individual and focus group interviews for deeper understanding of the social and sexual aspects of diabetes; and collecting questionnaire data as a complement to the above.</p><p>The experience-based educational program led by pharmacists was found to improve participants' subjective control over diabetes and to provide important emotional support and encouragement to continue self-care. Metabolic control as measured by HbA_1c temporarily improved. The social network model elucidated potential mechanism leading to conflict of disease and social demands in women's diabetes. Qualitative analysis of the focus group interviews pointed to the role of guilt, shame, and social taboo in connection with the women's diabetes and sexuality.</p><p>Borderland is the metaphor I have chosen to describe the space between the traditional health care system and the everyday self-care of people with chronic disease. Using Borderland as a framework, a future model for diabetes management, anchored in our own and other's findings, is outlined and the concept of "Disease Manager Role" is introduced. The vision of a self-care support center in Borderland addresses such issues as accessibility, continuity, equitable provider-user relations, shared care plans, and strengthening social support.</p>

The aim of this thesis was to examine different approaches to support the self-care of persons with Type 2 diabetes, with special reference to practical, social, and sexual aspects of women's self-management. The methods to elucidate this comprised: evaluating a new model for diabetes patient education; designing a model to analyse the role of social networks in women's diabetes; conducting individual and focus group interviews for deeper understanding of the social and sexual aspects of diabetes; and collecting questionnaire data as a complement to the above. The experience-based educational program led by pharmacists was found to improve participants' subjective control over diabetes and to provide important emotional support and encouragement to continue self-care. Metabolic control as measured by HbA1c temporarily improved. The social network model elucidated potential mechanism leading to conflict of disease and social demands in women's diabetes. Qualitative analysis of the focus group interviews pointed to the role of guilt, shame, and social taboo in connection with the women's diabetes and sexuality. Borderland is the metaphor I have chosen to describe the space between the traditional health care system and the everyday self-care of people with chronic disease. Using Borderland as a framework, a future model for diabetes management, anchored in our own and other's findings, is outlined and the concept of "Disease Manager Role" is introduced. The vision of a self-care support center in Borderland addresses such issues as accessibility, continuity, equitable provider-user relations, shared care plans, and strengthening social support.

Theoretical part Currently accepted new conceptualization of women's sexual dysfunction is based on the model found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and International Classification of Diseases (ICD). These classifications are extended and combined interpersonal, contextual, personalpsychological and biological factors. Recent DSM- IV definitions have focused on absence of sexual fantasies and sexual desireprior to sexual activity and arousal, even though the frequencyof this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The structure of the new classification is based on the four categories of DSM-IV: disorders of desire, arousal, orgasm and pain. However these categories are newly assigned to the subjective dimension of satisfaction, stress and the presence of disorders during other sexual activities besides intercourse. The dimension lifetime vs. acquired, generalized vs. situational were added, as well as the etiology is taking into account. For clinical work it is important that these changes highlight the significance and importance of psychological, situational...

Title: Sexual Dysfunction and Pelvic Floor Dysfunction in Patients with Systemic Rheumatic Diseases Objectives: To assess sexual functions, quality of life and pelvic floor function in female patients with Systemic Sclerosis (SSc) and Idiopathic Inflammatory Myopathies (IIM) compared to age-/sex-matched healthy controls (HC). Methods: In total, 41 women with SSc (mean age: 50.9, disease duration: 5.8 years), who fulfilled the ACR/EULAR 2013 classification criteria for SSc, 41 healthy controls (mean age: 50.9) without rheumatic diseases, 22 women with IIM [mean age: 55.1, disease duration: 7.9 years, dermatomyositis (DM, 8)/ polymyositis (PM, 10)/ necrotizing myopathy (IMNM, 3)/ inclusion body myositis (IBM, 1)], who fulfilled the Bohan/Peter 1975 diagnostic criteria for DM/PM, and 22 healthy controls (mean age: 55.1 years) filled in 12 well-established and validated questionnaires assessing sexual function/quality of life, pelvic floor function, fatigue, physical activity and depression. Results: Compared to HC, patients with SSc and IIM had significantly higher prevalence and greater severity of sexual dysfunction (FSFI, BISF-W: in all subscales as well as total scores), dysfunction of pelvic floor (PISQ-12), and worse sexual quality of life (SQoL-F). Worse scores in SSc patients were associated...

Theoretical part Currently accepted new conceptualization of women's sexual dysfunction is based on the model found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and International Classification of Diseases (ICD). These classifications are extended and combined interpersonal, contextual, personalpsychological and biological factors. Recent DSM- IV definitions have focused on absence of sexual fantasies and sexual desireprior to sexual activity and arousal, even though the frequencyof this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The structure of the new classification is based on the four categories of DSM-IV: disorders of desire, arousal, orgasm and pain. However these categories are newly assigned to the subjective dimension of satisfaction, stress and the presence of disorders during other sexual activities besides intercourse. The dimension lifetime vs. acquired, generalized vs. situational were added, as well as the etiology is taking into account. For clinical work it is important that these changes highlight the significance and importance of psychological, situational...

Background Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. Aim To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. Methods Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. Outcomes Patients completed the Female Sexual Function Index, the Couple's Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. Results Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. Clinical Implications Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. Strengths and Limitations The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are strengths. The cross-sectional design precludes any causal conclusions and it is unknown whether the results generalize to male partners, partners within other relationship structures, and non-heterosexual couples. Conclusion Greater relational intimacy mitigates the adverse impact of impaired sexual functioning on sexual behavior and satisfaction in women. Witherow MP, Chandraiah S, Seals SR, et al. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. J Sex Med 2017;14:843–851.

Made available in DSpace on 2016-07-27T14:20:53Z (GMT). No. of bitstreams: 1 Tayssa Andrade Batista Novato Machado.pdf: 1002749 bytes, checksum: fcfda75cce20c8e392a6858cdf2c5c06 (MD5) Previous issue date: 2015-08-31 / The present study aimed at modifying difficult (awkward) actions related to sexual behavior, such as comments related to dissatisfaction with the partner and the use of artificial lubricants, through general and specific behavioral interventions. With respect to general behavioral interventions we applied several techniques, like instruct through information, provide feedback, prioritize tasks, and provide models and instructions as positive reinforcement, while with specific behaviors we included teaching discriminative training of bodily responses before and during sexual intercourse. In addition, as a case study, it aimed to evaluate the antecedents and consequences of sexual dysfunction reported by a participant female of 26 years with a stable partner. The functional evaluation included procedures through an interview and a questionnaire. Further, we also used behavioral logging activity (self-monitoring). To demonstrate that interventions (independent variable) had effect on the dependent variable we used the design of alternating-type treatments (ABC) succeed by follow-up. The results showed decrease in behaviors-problem and increase of skilled actions related to sexual behavior, such as reports of satisfaction with the partner and vaginal lubrication response. / O presente estudo objetivou a modificação de ações inábeis relacionadas ao comportamento sexual, bem como dos relatos de insatisfação com o parceiro e do uso de lubrificantes artificiais, por meio de intervenções comportamentais gerais (instruir por meio de informações, fornecer feedbacks, hierarquizar tarefas, fornecer modelos e instruções e instruir o uso do reforçamento positivo) e específicas (ensinar o treino discriminativo das respostas corporais antes do coito e ensinar o treino discriminativo das respostas corporais durante o coito). Ainda objetivou avaliar os antecedentes e consequentes da disfunção sexual relatada por uma participante do sexo feminino, de 26 anos e com parceiro fixo. A avaliação funcional incluiu procedimentos indiretos por meio de uma entrevista e de um questionário. Também utilizou-se de uma atividade de registro comportamental (auto-observação). Para demonstração de que as intervenções (variável independente) é que produziram efeito sobre a variável dependente, foi empregado o delineamento de tratamentos alternados do tipo (ABC) seguido por follow-up. Os resultados demonstraram diminuição dos comportamentosproblema e aumento de ações hábeis relacionadas ao comportamento sexual, de relatos de satisfação com o parceiro e da resposta de lubrificação vaginal.

Bakgrund: Det finns många olika tillstånd som kan leda till att en person får en tarmstomi, och detta kan påverka en persons syn på den egna kroppen. En persons kroppsuppfattning är starkt kopplad till sexualiteten som är en viktig del i människors liv. Stomioperationer kan även ge fysiska skador som medför problem i opererade människors sexualliv. Patienter med stomi finns i alla vårdinriktningar, och det är därför viktigt för alla sjuksköterskor att kunna bemöta dem. Syfte: Syftet var att belysa hur patienter med enterostomi upplever sin sexualitet. Metod: Metoden var en litteraturöversikt där 15 vetenskapliga artiklar granskades, varav fem var kvalitativa, nio kvantitativa och en använde mixad metod. Artiklarna söktes fram genom kombinationer av olika sökord i databaserna CINAHL Complete och Pubmed med ett tidsspann på år 2008-2017. Resultat: I resultatet kunde fyra huvudteman och sex underteman identifieras. De huvudteman som hittades var En förändrad kropp, Fysisk sexuell funktion, Ett förändrat sexliv och Stöd från omgivningen. Resultatet visade på att många patienter upplever problem med sin sexualitet relaterat till stomin, både fysiska problem och hinder som följd av patientens egna tankar om sin stomi. Ett ökat behov av stöd och information kunde också identifieras hos patienterna, både från en eventuell partner, men även från sjukvårdens sida. Diskussion: Resultatet diskuteras med utgångspunkt i Parse's teori om humanbecoming. I diskussionen tas upp teman kring hur stöd och information från vården saknas av patienterna. Även bristen på forskning kring kvinnors sexuella upplevelser med stomi i jämförelse med den forskning som finns kring män diskuteras. / Background: There are many reasons as to why a person receives a bowel ostomy, and this can affect the person’s view of their own body. A person's perception of the body is strongly linked to sexuality that is an important part of people's lives. Stoma surgery can also cause physical damage that causes problems in the sex life of the operated person. Patients with stoma will appear in all care settings, and it is therefore important for all nurses to be able to treat them. Aim: The aim was to illustrate how patients with an ostomy experience their sexuality Method: The method was a literature review where 15 scientific articles were reviewed, five of which were qualitative, nine quantitative and one used mixed method. The articles were identified through combinations of different keywords in the databases CINAHL Complete and Pubmed with a time span of the years 2008-2017. Results: In the results four main themes and six sub themes could be identified. The main themes were A Changed Body, Physical Sexual Function, A Changed Sex Life and Support from the Surroundings. The results showed that many patients experience problems with their sexuality related to their stoma, both physical problems and obstacles as a result of the patient's own thoughts about one's stoma. An increased need for support and information was also identified by the patients, both from an eventual partner and from the healthcare. Discussion: The result is discussed based on Parse's theory of humanbecoming. The discussion addresses topics about the lack of support and information for patients from the healthcare. The lack of research into women's sexual experiences with a stoma in comparison to the research that exists around men is also discussed.