Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
J Sex Med. 2010 Jan;7(1 Pt 2):374-88. doi: 10.1111/j.1743-6109.2009.01621.x.
Direct and indirect effects of chronic disease on sexual health are frequent and complex, but guidelines for their optimal management are lacking. With improved surgical and medical treatment of the underlying disease, the numbers of men and women needing assessment and management of associated sexual dysfunction are increasing.
To provide recommendations/guidelines for the clinical management of sexual dysfunction within the context of chronic illness.
An international consultation in collaboration with the major sexual medicine associations assembled 186 multidisciplinary experts from 33 countries into 25 committees. Nine experts from four countries compiled the recommendations of sexual dysfunction in chronic illness and cancer with four focusing on neurological, renal, and psychiatric disease and lower urinary tract symptoms (LUTS). Searches were conducted using Medline, Embase, Lilacs, and Pubmed databases.
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.
Some conclusions concerning prevalence and pathophysiology of sexual dysfunction in the context of neurological disorders, end-stage renal failure, LUTS, and psychiatric disease were made. Optimal assessment of the multiple factors affecting sexuality when one or both partners are chronically ill is outlined. Evidence-based recommendations for management are presented. Comorbid depression is frequent and independently determines prevalence of sexual dysfunction in many conditions.
There is need for more research and scientific reporting on prevalence, pathophysiology, and optimal treatment of sexual dysfunction associated with chronic illness. Screening for and managing comorbid depression is strongly recommended.
慢性病对性健康的直接和间接影响较为常见且复杂，但缺乏针对其最佳管理的指南。随着基础疾病的外科和医学治疗得到改善，需要评估和管理相关性功能障碍的男性和女性人数正在增加。
为慢性病背景下性功能障碍的临床管理提供建议/指南。
一次国际咨询会与主要的性医学协会合作，召集了来自 33 个国家的 186 名多学科专家，组成了 25 个委员会。来自四个国家的 9 名专家编写了慢性疾病和癌症中性功能障碍的建议，其中 4 项侧重于神经、肾脏和精神疾病以及下尿路症状（LUTS）。使用 Medline、Embase、Lilacs 和 Pubmed 数据库进行了搜索。
专家意见基于对循证医学文献的分级、广泛的内部委员会讨论、公开陈述和辩论。
对神经系统疾病、终末期肾衰竭、LUTS 和精神疾病背景下性功能障碍的患病率和病理生理学得出了一些结论。概述了对一对或双方患有慢性病时影响性行为的多种因素进行最佳评估的方法。提出了基于证据的管理建议。合并抑郁在许多情况下较为常见，且独立决定了性功能障碍的患病率。
需要进一步研究和科学报告来了解与慢性疾病相关的性功能障碍的患病率、病理生理学和最佳治疗方法。强烈建议筛查和治疗合并的抑郁。
