Characterizing FSD
Female Sexual Dysfunction (FSD) is age-related, progressive and
highly common affecting 30-50% of women. For post-menopausal
women, the occurrence rate of FSD may be as high as 63%. FSD is
currently thought to represent a spectrum of sexual disorders with
both psychogenic and organic causes that have been classified into
four major categories: desire, arousal, orgasmic and sexual pain
disorders. Based on the National Health and Social Life Survey of
1,749 women, 43% experienced sexual dysfunction (compared with 31%
of men). Female sexual dysfunction has clearly become an important
women's health issue that affects the quality of life of many
female patients.
Organic FSD - a Timely Issue
A number of factors contribute to the growing problem of female
sexual dysfunction; leading among them are the neurological
disorders, surgeries and childbirth techniques that destroy the
delicate nerve networks that connect female sexual organs to the
brain. For instance, most hysterectomies are performed without
attempts to prevent damage to nerves in the area. Organic Female
Sexual Dysfunction is now a timely and hot issue and a major focus
of research and therapeutic development. Currently, there are only
a small number of clinical diagnostic tests available for
assessing such organic dysfunction. Growing television, radio and
print media reports are bringing increasing physician, industry
and consumer attention to this subject.
GSA GenitoSensory Analyzer
Assessing Pelvic Floor Sensory Functions
In cooperation with leading neurologists and urologists in the
USA, Europe and Israel, medoc has
developed a system and methodology for quantitative assessment of
pelvic floor sensory functions. The GSA GenitoSensory Analyzer
system can be also applied as a valuable, new diagnostic tool for
assessment of neural dysfunction intra and peri-vaginally,
including clitoral sensation. The GSA GenitoSensory Analyzer
assists in determining whether FSD is caused by physiological or
psychological reasons, as well as assist in therapy selection and
monitoring progression and patients' recovery. The system can also
supply objective documentation as well as a basis to argue for
continued coverage with insurance carriers. As thermal and
autonomic fibers are small-fibers, thermal testing with the GSA
GenitoSensory Analyzer can be employed as a means of inferring
diagnostic information concerning autonomic response. Thermal
testing may provide a sensitive measure in autonomic disorders,
such as with neurogenic bladder, orthostasis and impotence (see
below).
Assessing Sensory Fibers
In the context of FSD, the assessment of the large myelinated
sensory fibers - those that convey the sensations of touch,
vibration position and light pressure – may be very important.
Their dysfunction could affect the sensory modalities most
important for female sexual function. The thresholds for vibration
detection represent the functioning of these large sensory fibers
and their central (CNS) connections. The thermal senses, warm and
cold, are served by small nerve fibers. The thresholds for cold
and warm detection represent the functioning of these small
sensory fibers, and their central connections.
Neurogenic Male Impotence
Neurogenic Male Impotence can be evaluated successfully with the
GSA GenitoSensory Analyzer as well, assisting in the differential
diagnosis of neurogenic vs. psychogenic impotence. Neurogenic
impotence is associated with failure of autonomic, small-caliber
nerve fibers, as can be assessed with the GSA. Several studies
(Robinson et al, 1987, Fowler et al, 1988) evaluated thermal
sensation of penile skin in diabetic impotent patients, finding a
high percentage of abnormality of thermal thresholds. The VSA-3000
Vibratory Sensory Analyzer provides a low cost computerized method
to assess large fiber function, providing a computerized and more
precise alternative to the Biothesiometer, which is commonly used
in the evaluation of neurogenic impotence (Goldstein et al, 1988).
Lefaucheur et al (2000) investigated penile small nerve fiber
damage after transurethral resection of the prostate by
measurement of penile thermal sensation. The authors concluded:
"This study highlights the occurrence of penile small nerve
fiber damage following TURP and supports the hypothesis of
neurogenic damage as the primary cause of post-operative erectile
dysfunction". In Yarnitsky et al's 1996 paper published in
the JOURNAL OF UROLOGY, the authors concluded: "Penile
thermal thresholds are repeatable and can be used as a valid
diagnostic tool to assess somatic small fiber function in patients
with lower urinary tract disorders". Xin et al (1996)
concluded: "Patients with primary premature ejaculation have
penile hypersensitivity, which provides further implications for
an organic basis of premature ejaculation."
Clinical and Research
Activity into Chronic Pelvic Pain
Chronic Pelvic Pain is an area of growing clinical and research
activity in which the TSA-II NeuroSensory Analyzer has been
playing an active role. The TSA and GSA GenitoSensory Analyzer
allows for intra and peri-vaginal assessment of both small caliber
A-delta and C-fiber function. Assessment of sensory deficits
through cold and warm threshold testing, as well as the evaluation
of positive sensory phenomena through cold and heat-pain threshold
and suprathreshold testing is available. medoc
systems also facilitate the investigation of Windup and Temporal
Summation and the role this may play in certain chronic pain
conditions. Utilizing the medoc system
in the study of chronic pelvic pain patients, Lee et al (2000)
concluded: "Patients with Chronic Pelvic Pain Syndrome (CPPS)
have an altered sensation of perineal pain affected by heat, which
may represent a C-fiber mediated effect". |
|
+ 55 11 3662-0762
+ 55 11 3825-7311
