Earticle

Diabetes mellitus is associated with the impairment of sexual function including desire and orgasmic dysfunction. Sexual dysfunction in the diabetes mellitus is due to a selective defect of the nitric oxide synthase (NOS) within paraventricular nucleus (PVN). c-Fos is an immediate ear-ly gene and c-Fos expression represents neuronal activity in response to various stimuli. In the present study, we investigated the effects of treadmill exercise on sexual behaviors and the expressions of NOS and c-Fos in the PVN were evaluated using streptozotocin (STZ)-induced diabetic rats. Diabetes mellitus was induced by intraperitoneal injection of STZ. The rats in the treadmill exercise groups were made to run on a treadmill for 30 min once a day during 4 weeks. Male sexual behaviors were evaluated by recording the number of mounting, intromission, and ejaculation frequency. The present results revealed that treadmill exer-cise ameliorated sexual dysfunction in the STZ-induced diabetic rats. Treadmill exercise restored the contents of NOS and c-Fos in the PVN. The improving effect of treadmill exercise on sexual function can be considered as the neuronal activating effect of exercise through in-creasing expressions of NO and c-Fos.

The purpose of this study was to identify the prevalence and related factors of female sexual dysfunction(FSD). Five hundred fourteen women aged more than 20 years and who lived in five major cities in Korea completed an organized questionnaire during study visits. Age, marital period, education, menstruation, marital status, type of contraception, perceived health state, presence of disease, sexual distress, sexual attitude, marital adjustment, and crisis had direct influence on FSD. In addition, sexual distress, sexual attitude, marital adjustment, and crisis were found to be significant risk factors of FSD. Sexual function was higher in women with good subjective health status, positive sexual attitude, and good marital adjustment and those without sexual distress, depression, crisis, and stressful life event. This study results indicate that FSD may be influenced by both health-related and psychosocial factors. While the causal relationship between sexual dysfunction and quality of life concomitants remains to be further investigated, the strong associations between the variables observed in this study suggest that sexual dysfunction is a largely uninvestigated yet significant public health problem. Future studies that develop comprehensive nursing interventions reflecting various predictors of FSD and effective educational programs considering features of Korean society are needed to decrease and prevent sexual dysfunction in Korean women.

This study was conducted to identify prevalence of sexual dysfunction and to determine factors influencing sexual dysfunction in middle aged women. The participants were 285 middle aged women. Data were collected through self-report questionnaires which were constructed to include general characteristics, FSFI (Female Sexual Function Index), sexual knowledge, sexual satisfaction. The mean score FSFI, sexual knowledge, sexual satisfaction were 14.82±5.74, 11.25±2.67, 45.84±8.60, respectively. The score for sexual dysfunction showed significant difference age(F=3.52, p=.031) and health status(F=3.66, p=.013). Sexual dysfunction had significant positive correlation to sexual satisfaction(r=.46, p<001). Age and sexual satisfaction were significant predictor and accounted for 22% of the variance in sexual dysfunction middle aged women. Future sexual dysfunction management program for middle aged women should be considered their emotional, psychological, socio-environmental factors.

Purpose: This study aimed to define and clarify the concept of sexual dysfunction in women diagnosed with breast cancer. Methods: This study used the concept analysis process of Walker and Avant, and 20 studies were selected. Results: Sexual dysfunction in women diagnosed with breast cancer was defined as experiencing 1) loss of femininity, 2) negative changes in sexual response, and 3) negative feelings about relationship with partners. The identified antecedents were 1) breast cancer treatment-induced changes in body structure and function, 2) disease-related pain, 3) depression, 4) lack of medical services provided to help address sexual matters and difficulties, and 5) lack of understanding and support from partners. The consequences of this were 1) deterioration of relationship with partner, 2) seeking alternatives to overcome sexual dysfunction, 3) deterioration in quality of life, 4) depression, and 5) decrease in frequency of sexual activity. Conclusion: The definition and attributes of sexual dysfunction in women diagnosed with breast cancer identified in this study can be applied to the development of tools and programs to measure sexual dysfunction in women diagnosed with breast cancer to enhance understanding of sexual dysfunction in women diagnosed with breast cancer.

Sexual dysfunction is rising one of major diseases on modern society and it decreases the quality of life. Sildenafil, phosphodiesterase (PDE) inhibitor is a major medication for sexual dysfunction such as erectile dysfunction, uncomfortable sensation, or libido decrease. However, an antidepressant, trazodone which is serotonin-reuptake inhibitor is using for sexual dysfunction as the “unlabeled use” in Korea even the efficacy and safety of trazodone were not approved yet. Therefore, we tried to evaluate and compare the efficacy and safety of both trazodone and sildenafil for sexual dysfunction. This study was performed retrospectively based on the medical records of each 30 patients with one of drugs in Department of Urology, Chungbuk National University Hospital, from July 1st, 2006 to April 30th, 2007. All the prescribed doses were appropriate as trazodone 25 mg twice a day, sildenafil 50 or 100 mg daily. And efficacy were each at 14 patients (46.7%) per trazodone and 6 patients (20%) per sildenafil, respectively. Adverse drug reactions were showed at 5 patients (16.7%) in trazodone and 2 patients (6.7%) in sildenafil, respectively. In conclusion, the “unlabeled use” of trazodone for sexual dysfunction treatment is necessary for some selected patients by doctor's decision in Korea even though PDE inhibitors are still first choice. However, both medications are still recommended to monitor adverse drug reaction during the use.

Background: Polycystic ovary syndrome (PCOS) is a combination of chronic anovulation, obesity, and hyperandrogenism and can affect sexual function in women of reproductive age. It is also associated with endometrial cancer. Our aim was to evaluate the frequency and predisposing factors of sexual dysfunction in PCOS patients. Materials and Methods: In this cross-sectional study, 16 married women with a definite diagnosis of PCOS were recruited. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain using the female sexual function index (FSFI) questionnaire. Patients were also assessed for mental health using the depression, anxiety and stress (DASS-21) questionnaire. Presence of hirsutism was assessed using the Ferriman-Gallwey (FG) scoring system. Demographic data were obtained from patients during in-person interview. Results: Sexual dysfunction was present in 62.5% of patients with the domains of arousal and lubrication particularly affected (93.8% and 87.5%, respectively). Patients with symptoms of depression and anxiety were significantly more likely to suffer sexual dysfunction than those without these symptoms (p=0.04 and p=0.03 respectively). Patients with stress symptoms reported higher orgasm dysfunction than those without (p=0.02). No significant difference in any of the FSFI score domains was observed between patients with and without hirsutism. Conclusions: PCOS patients markedly suffer from sexual dysfunction and therefore it seems appropriate to be screened for intervention. Poor mental health conditions that may be the result of infertility or other complications of PCOS should also be considered as curable causes of sexual dysfunction in these patients.

Objective Gynecologic cancer survivors frequently experience sexual dysfunction and anxiety, which can adversely affect their quality of life. Despite its clinical importance, female sexual dysfunction (FSD) remains underrecognized and undertreated. This study aimed to assess the prevalence of FSD and anxiety, as well as their associated factors, among Thai gynecologic cancer survivors. Methods This prospective, cross-sectional study was conducted at a university hospital between July 2024 and May 2025. Eligible women aged ≥18 years who had completed treatment for gynecologic cancer at least 6 months prior were recruited. Sexual function was evaluated using the validated female sexual function index (FSFI), with a cutoff ≤26.55 indicating FSD. Anxiety was assessed using the generalized anxiety disorder seven-item scale. Associations with FSD were analyzed using the chi-square test and logistic regression analysis. Results Of the 202 eligible women, 160 (79.0%) participated in the study. Most participants were postmenopausal (84.38%) and had an early stage disease (78.12%). The prevalence of FSD was 84.38%, with the lowest FSFI domain scores observed for arousal, lubrication, orgasm, and pain. Anxiety was predominantly mild (77.78%), with only one participant reporting severe symptoms. Multivariable analysis identified age ≥50 years (adjusted odds ratio [OR], 9.84; P<0.001) and alcohol consumption (adjusted OR, 0.25; P=0.033) as independent factors associated with FSD. Conclusion FSD is highly prevalent among Thai gynecologic cancer survivors; however, anxiety is generally mild. Routine assessment of sexual health and multidisciplinary management should be considered a part of survivorship care to improve overall well-being.

Purpose Few studies have addressed gonadal and sexual dysfunctions in childhood cancer survivors. We evaluated the prevalence rates and risk factors for gonadal failure among adolescent/ young adult childhood cancer survivors and their sexual function. Materials and Methods Subjects were childhood cancer survivors aged 15-29 years who had completed therapy more than 2 years ago. Demographic and medical characteristics were obtained from the patients’ medical records. In addition, hormonal evaluation and semen analysis were performed and sexual function was evaluated via questionnaire. Results The study included 105 survivors (57 males, 48 females), of which 61 were adults (age > 19 years) and 44 were adolescents. In both males and females, the proportion of survivors with low sex hormone levels did not differ among age groups or follow-up period. Thirteen female subjects (27.1%) needed sex hormone replacement, while five males subjects (8.8%) were suspected of having hypogonadism, but none were receiving sex hormone replacement. Of 27 semen samples, 14 showed azospermia or oligospermia. The proportion of normospermia was lower in the high cyclophosphamide equivalent dose (CED) group (CED ? 8,000 mg/m2) than the low CED group (27.3% vs. 62.5%, p=0.047). Among adults, none were married and only 10 men (35.7%) and eight women (34.3%) were in a romantic relationship. Though a significant proportion (12.0% of males and 5.3% of females) of adolescent survivors had experienced sexual activity, 13.6% had not experienced sex education. Conclusion The childhood cancer survivors in this study showed a high prevalence of gonadal/sexual dysfunction; accordingly, proper strategies are needed to manage these complications.

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.

Purpose: To determine the relationship between uterine leiomyoma and female sexual dysfunction (FSD) among premenopausaland postmenopausal women. Materials and Methods: The study population consisted of consecutive women who underwent gynecologic screening tests, includingtransvaginal ultrasound, and completed the questionnaires on FSD. A total of 841 women were included from January2010 to December 2011. FSD was defined as Female Sexual Function Index (FSFI) ≤26.55. The relationship between uterine leiomyomaand FSD were compared according to menopausal status. Results: In premenopausal group (n=564), there were no differences in the frequency of FSD (55.0% vs. 58.8%, p=0.387) and totalFSFI score. However, in postmenopausal group (n=277), women with uterine leiomyoma had a lower frequency of FSD thanthose without uterine leiomyoma (71.3% vs. 86.4%, p=0.003). This relationship between uterine leiomyoma and lower frequencyof FSD in postmenopausal women remained significant after adjusting for confounding variables. Conclusion: The relationship between uterine leiomyoma and FSD is different depending on the menopausal status.

Objective To evaluate whether smoking is a risk factor for female sexual dysfunction (FSD) and to determine the relationship between the cumulative smoking dose and FSD in premenopausal women. Methods The study population consisted of sexually active premenopausal women. The frequency of FSD and female sexual function index (FSFI) total score were evaluated according to the smoking status (never/former and current smokers). Evaluation of sexual function was done using FSFI questionnaire, and women with FSFI score of ≤26.55 were considered to have FSD. In current smokers, sexual function was also evaluated according to the cumulative smoking dose and nicotine dependency. Results A total of 900 women were included, and the frequency of current smokers and the frequency of FSD were 62 (6.9%) and 496 (55.1%), respectively. In current smokers, the frequency of FSD was significantly higher and the median total FSFI score was significantly lower than in never/former smokers, and this difference of FSD remained significant after adjustment for confounding variables. Among current smokers, the cumulative smoking dose (pack-years) and the total FSFI score showed negative correlation, in which increased cumulative smoking dose was associated with lower total FSFI score (r=-0.278, P<0.05). In terms of nicotine dependency, the total FSFI score of moderately to heavily nicotine dependent smokers was significantly lower than that of lightly dependent smokers. Conclusion In premenopausal women, current smoking was an independent risk factor for FSD. And cumulative smoking dose and nicotine dependency were associated with higher risk of FSD.

The aim of the present study was to retrospectively identify sexual dysfunction changes in the patients under mirtazapine-augmented serotonin reuptake inhibito (SSRI) treatment. The study comprised medical records of 20 outpatients, under mirtazapine-augmented SSRI treatment for their major depressive disorder, who had been selected among the patients that had developed sexual dysfunction to previous treatment as monotherapy, with SSRI for at least six weeks. These drugs were maintained and mirtazapine were added (15-45 mg/day). There was a significant difference in scores between baseline and week 4 or week 8 on the both Hamilton Depression Rating and Arizona Sexual Experience Scale. According to Clinical Global Impression-Improvement, 68.4% of the patients were responders. The use of low-dose mirtazapine as an add-on treatment to SSRIs appears to be an effective and well-tolerated augmenttaion for sexual dysfunction caused by SSRIs.

Sexual dysfunction (SD) is a health problem which occurs during any phase of the sexual response cycle that keeps the individual or couple from experiencing satisfaction from the sexual activity. SD covers a wide variety of symptoms like in men, erectile dysfunction and premature or delayed ejaculation, in women, spasms of the vagina and pain with sexual intercourse, in both sexes, sexual desire and response. And pharmacopuncture, i.e. injection of subclinical doses of drugs, mostly herb medicine, in acupoints, has been adopted with successful results. This case report showed the effect of bee venom on SD. A 51-year-old male patient with SD, who had a past history of taking Western medication to treat his SD and who had previously undergone surgery on his lower back due to a herniated disc, received treatments using pharmacopuncture of sweet bee venom (SBV) at Gwanwon (CV4), Hoeeum (CV1), Sinsu (BL23), and Gihaesu (BL24) for 20 days. Objectively, the patient showed improvement on most items on the International Index for Erectile Dysfunction (IIEF) like 28 to 29 out of perfect score 30 for erectile function, 10 to 10 out of perfect score 10 for orgasmic function, 6 to 8 out of perfect score 10 for sexual desire, 10 to 13 out of perfect score 15 for satisfaction with intercourse, and 6 to 8 out of perfect score 10 for overall satisfaction; subjectively, his words, the tone of his voice and the look of confidence in his eyes all indicated improvement. Among the variety of effects of SBV pharmacopuncture, urogenital problems such as SD may be health problems that pharmacopuncture can treat effectively.

Purpose: The primary aim was to carry out a pilot study to compare the loss of sexual libido between a group of Lyme disease patients and a group of matched controls. The secondary aim was to evaluate whether loss of libido in Lyme disease patients is associated with urinary bladder detrusor dysfunction. Methods: A group of 16 serologically positive Lyme disease patients and 18 controls were queried directly about loss of libido. Results: The 2 groups were matched with respect to age, sex, body mass index, and mean arterial blood pressure. None of the 34 subjects was taking medication that might affect sexual libido or had undergone a previous operative procedure involving the genitourinary tract. Of the 16 Lyme disease patients, 8 (50%) had no loss of libido, and of the 18 controls, none had loss of libido (P<0.001). In the Lyme disease patient group, there was no statistically significant relationship between loss of libido and urinary bladder detrusor dysfunction (P=0.61). Conclusions: This pilot study suggested an association between Lyme disease and loss of libido. Moreover, this loss of libido did not seem to be associated with urinary bladder detrusor dysfunction. Given these results, we recommend further studies to confirm the association.

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.방 법 :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 복용 중인 항우울제에 bupropion SR을 추가하였고, 연구 시작 2주 후부터 2주 동안 SRI를 서서히 줄여서 끊은 다음, 이후 4주에 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. 결 과 :3명이 중도 탈락하였고, 11명(78.57%)이 연구를 완결하였으며, 연구 시작 시점(0주)과 연구 시작 후 2주 사이에는 유의미한 변화가 없었으나, 2주와 4주, 4주와 8주 사이에서 성기능 장애의 유의한 감소를 보였다. 하지만, 연구 기간 중 HAM-D 점수의 의미 있는 변화는 보이지 않았다.결 론 :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 tapped 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.

본 연구는 우리나라 여성의 성기능을 측정하기 위해서 Quirk 등16)이 개발한 SFQ-V1을 우리말로 번안하여 그 신뢰도와 타당도를 검증하였다. 먼저 문항분석 결과 원 척도의 31개 문항 중에 28개 문항이 선정되었고, 이를 SFQ-K로 명명하였다. SFQ-K에 대한 내적 일치도와 반분법 신뢰도 계수 모두 통계적으로 유의하여 신뢰도가 높은 척도임이 확인되었다. 문항간 상관계수와 수정된 문항-총합 상관계수도 유의하였다. 요인분석 결과 5개의 요인이 추출되었는데, 각각 ‘성적 반응’⋅‘성욕’⋅‘동통’⋅‘질 외 성행위’⋅‘만족감’으로 명명하였다. 다른 척도와 상관관계를 분석한 결과 BISF-W(요인 1, 2, 3)와 높은 양의 상관관계에 있었고, BDI와 약한 음의 상관관계가 있었으며, SWLS와는 약한 양의 상관관계가 있었다. 따라서 우리나라 여성을 대상으로 여성 성기능을 측정하기 위한 SFQ-K의 신뢰도와 타당도가 입증되었다.

Objectives : To develop a Sexual Function Questionnaire-Korean version(SFQ-K) for measuring the female sexual dysfunction and to verify both reliability and validity of the Korean version Methods : Data from 320 women residing in Daegu city and Gyungbuk states were collected. 230 women out of all subjects completed a psychometric assessment package which included the SFQ-K, Beck Depression Inventory(BDI) and Satisfaction with Life Scale(SWLS). Brief Index of Sexual Function for Women(BISF-W) was also administered to the other 90 women. Item analysis, split-half reliability, internal consistency reliability, content validity, construct validity and concurrent validity of the SFQ-K were evaluated. Results : 1) 3 items were removed from the English version of SFQ(consist in 31 items) as a results of item analysis, 28 items were selected in SFQ-K. 2) SFQ-K showed high internal consistency(Cronbach`s alpha=0.957). 3) SFQ-K demonstrated high split-half reliability(Spearman-Brown coefficients r= 0.7677-0.951). 4) The principal component analysis for SFQ-K produced the five identical factors explaining 71.429% of total variance. The five domains of female sexual function were sexual response, desire, pain, non-coital sexual activity, satisfaction 5) The total scores of SFQ-K showed a significant correlation with the sexual function factor scores of BISW-F(Person`s correlation coefficients r=0.853,p<0.01). 6) The total scores of SFQ-K showed a weak correlation with the total scores of BDI(Person`s correlation coefficients r=-0.260,p<0.01) and SWLS(Person`s correlation coefficients r=0.272,p<0.01). Conclusion : SFQ-K is thought to have a good reliability and validity that be used for Korean women subjects.

This study was conducted to explore prevalence of sexual dysfunction and to determine factors influencing sexual dysfunction in married women. Methods: The participants were 372 married women in age 20~59 years. Data were collected through self-report questionnaires which were constructed to include general characteristics items (sociodemographic, health-related, and gynecological characteristics) and the FSFI (Female Sexual Function Index). Results: The mean total FSFI score was 20.6 while the proportion of women with female sexual dysfunction based on FSFI overall scores of 25.0 or less was 57.5%. Sexual dysfunctions were detected as desire problems (48.9%), arousal problems (56.9%), lubrication problems (40.1%), orgasm problems (37.9%), satisfaction problems (39.5%), and pain problems (37.9%). The sexual function of married women was significantly different according to age, job, duration of marriage, education, religion, monthly income, chronic disease, menopausal status, frequencies of delivery and pregnancy. Significant predictors influencing sexual function in married women were post-menopausal state, frequencies of delivery, chronic disease, and peri-menopausal state, and these predictors account for 29% of the variance in sexual dysfunction. Conclusion: The results indicate a high prevalence of sexual dysfunction in married women which is comparable with results reported worldwide. Nurses need to be trained and prepared to address this issue.

1) 성기능장애 빈도는 정신분열병 환자군이 80%로 대조군 42%에 비해 유의하게 높았다(p<0.001). 성반응 주기에 따른 장애유형은 성적욕망장애 76%, 발기장애 75%, 발기유지장애 75%, 성적극치감의 질적감소 61%, 지루 50%, 사정시 정액량의 감소 44% 순서로 많았다. 성적극치감 횟수의 감소는 32%로 다른 장애유형에 비해 적었으며, 조루를 호소하는 경우도 15%나 되었다. 2) PRL 및 5-HT 측정치는 환자군에서 $28.5{\pm}20.6ng/ml$, $298.5{\pm}89.1ng/ml$으로서 대조군 $10{\pm}5.6ng/ml$, $169.2{\pm}37.8ng/ml$보다 유의하게 높았다(p<0.001). TST 측정치는 환자군이 $4.3{\pm}1.5ng/ml$, 대조군이 $4.5{\pm}1.2ng/ml$로 양군 모두 유의한 차이가 없었다. 3) 성기능장애를 증가시키는 변인은 결혼(미혼), 초발연령, 이병기간, 입원기간, 총약물투여기간 그리고 5-HT 측정치이었다. 특히 5-HT 비정상치군이 정상치군보다 성기능장애가 유의하게 높았다. 그러나 연령, 교육연한, 종교, 경제상태, PRL 및 TST 측정치, 항정신병약물용량, 약물역가, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K 점수와 성기능장애와는 무관하였다. 성기능장애는 정신분열병군에서 높았고, 성기능장애 유형별로는 성적욕망장애와 발기장애가 많았다. 미혼이거나, 초발연령이 높을수록, 질병에 이환된 기간이 길수록, 5-HT 농도가 높을수록 성기능장애가 증가하였다. 비록 혈중 5-HT 농도가 뇌 5-HT 활성을 어느정도 반영하는지는 알 수 없으나, 정신분열병 환자의 일차 병인인 과도한 5-HT 활성으로 인한 직접적인 성기능 억제효과 때문에 장애가 초래한다고 생각된다.

Objective : There are four possible explanations for the sexual dysfunction of schizophrenics. The first is the possibility of a real structural aspect. The second possibility is that sexual function changes secondary to the illness. The third possibility is that there are medical and sociocultural barriers to sexual expression for chronic schizophrenics. The fourth possibility is that sexual dysfunction due to antipsychotic medication. However, we didn't know the precise cause of sexual dysfunction in schizophrenics. Therefore, the purpose of this study was to explore the mechanism of illness itself and antipsychotics on sexual dysfunction in male schizophrenics. Methods : The serum prolactin(PRL), testosterone(TST), and the plasma serotonin(5-HT) concentrations were measured by radioimmunoassay and high performance liquid chromatography method for 100 healthy male schizophrenics according to the DSM-IV. Concomitantly, the severity of psychotic symptoms using Clinical Global Impression(CGI), Brief Psychiatric Rating Scale(BPRS), Positive and Negative Syndrome Scale(PANSS), and the severity of side effects for antipsychotics using Extrapyramidal Side Effects Scale(EPSE), Anticholinergic Side Effects Scale(ACSE), the cognitive function using PANSS-Cognitive Function(PANSS-CF), Mini Mental State Exam-Korean(MMSE-K), and the sexual dysfunction using Sexual Functioning Questionnaire(SFQ), Questionnaire for Sexual Dysfunction in Men were assessed. The PRL, TST, and 5-HT levels of 50 healthy male controls who had no medical, neurological, and psychiatric illnesses were evaluated. The sexual function using SFQ(items FGa, FNa) were also assessed. Furthermore, the correlation with age, education, religion, economic status, age at onset, duration of illnesses, duration of admission, levels of PRL, TST, 5-HT, antipsychotic dosages, potency, benztropine, total duration of medication, EPSE, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K and sexual dysfunctions were identified in male schizophrenics. Results : 1) The frequencies of sexual dysfunctions for schizophrenics(80%) were significantly(p<0.001) higher than those for controls(42%). The sexual dysfunctions according to sexual response cycle were 'low sexual desire' 76%, 'impairment of achieving erection' 75%, 'impairment of maintaining erection' 75%, 'impairment of obtaining orgasm' 32%, 'impairment in the quality of orgasm' 61%, 'impairment in quantity of ejaculate' 44%, 'premature ejaculation' 15%, and 'delayed ejaculation' 50%. 2) The PRL, 5-HT levels of schizophrenics($28.5{\pm}20.6ng/ml$, $298.5{\pm}89.1ng/ml$) were significantly(p<0.001) higher than those of controls($10{\pm}5.6ng/ml$, $169.2{\pm}37.8ng/ml$), while the TST levels of schizophrenics($4.3{\pm}1.5ng/ml$) and controls($4.5{\pm}1.2ng/ml$) were not significantly different. The sexual dysfunctions of schizophrenics who had abnormal 5-HT levels($4.7{\pm}1.3$ scores) were significantly(p<0.05) higher than those of who had normal 5-HT levels($3.8{\pm}1.6$ scores) on item D7. 3) The sexual dysfunctions of unmarried schizophrenics were significantly(p<0.01 : p<0.05) higher than those of married schizophrenics($6.1{\pm}2.8$ scores, $4.7{\pm}1.3$ scores on item FGa : ${\beta}$=-0.211 on item FNa). The sexual dysfunctions were positively correlated with the rise of 5-HT levels(r=0.209, p<0.05 on item D4 and r=0.241, p<0.05 on item D7), the higher age at onset(r=0.275, p<0.01 on item FNa : r=-0.202, p<0.05 on item FDa), the longer duration of illnesses(r=0.237, p<0.05 on item D6), the longer duration of admission(r=0.234, p<0.05 on item D4 : r=0.328, p<0.05 on item D6), the longer total duration of medication(r=0.237, p<0.05 on item D6). However, age, education, religion, economic status, PRL, TST levels, antipsychotics dosage, potency, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K scores were not correlated