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Papers by Birgitta Hulter

Journal of Neurology, Neurosurgery, and Psychiatry, Aug 29, 2012

Background Huntington's disease results in a wide variety of physical, mental, and social dis... more Background Huntington's disease results in a wide variety of physical, mental, and social disabling impairments that will affect sexuality. Up to 85% men and up to 75% women experience high levels of sexual problems (Schmidt and Bonelli, 2007). Most prevalent is low sexual desire, but also increased sexual interest and paraphilia are found. Specific brain lesions might be associated with these changes, but also psychosocial factors with a steadily worsening disease might be causative. Depression and anxiety, common symptoms in early stages of HD, are often associated with sexual symptoms. Change in sexual interest and behaviour, sexual dysfunction, and socio-psychiatric consequences of HD cause suffering also for spouses and children. Aims Sexological rehabilitation is aiming at promoting well-being both in patient and the partner. Methods/techniques Bio-psycho-social approaches have been useful in sexological support and rehabilitation in people with chronic neurological impairments. Sexual rehabilitation follows the basics of the PLISSIT model (Annon, 1976). Acceptance and Commitment Therapy is a treatment option. Results/outcome There might be a need of comprehensive management and treatment of sexual complications in HD. Special training and experience in sexology is mandatory for professional counselling and support. Conclusions HD brings suffering in connection to sexuality. Sexual problems often reduce life satisfaction in patients and partners. The whole family situation can be affected. Professional attention should be given to the sexual symptoms in HD. Clinical sexology knowledge and skills should be developed. Sexological rehabilitation requires a broad focus on bodily changes, identity questions, as well as relationship challenges and adjustments.

Sexuality and Disability, Mar 1, 1996

Changes in sexual functions are very common among women with advanced multiple sclerosis but occu... more Changes in sexual functions are very common among women with advanced multiple sclerosis but occur also in early and mild cases. Decreased sexual desire as well as decreased or absent lubrication are almost as common as diminished orgasmic capacity, changes in orgasmic quality or anorgasmia. Changes in sexual functions correlate both to neurological symptoms from the sacral segments, such as sensory dysfunction in the genital area or weakness of the pelvic muscles, and to bladder and bowel dysfunction. However, disability in itself and a number of psychological and social factors may explain the problems but also gives clues to the treatment.

Archives of Sexual Behavior, Apr 1, 1994

The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual func... more The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual functions was investigated. Sexual functions and sexual appreciation were assessed in a comprehensive interview of 48 women with well-defined hypothalamo-pituitary disorders. Data about sex life were correlated to blood hormone levels and diagnosis. In most of the women (64.8%), the first clinical symptom indicating a hypothalamo-pituitary dysfunction began in the age group 16 to 35. In 43 patients (89.6%), the initial symptom was menstrual irregularities. Altogether 45 (93.8%) of the women declared that they had or had had significant sexual problems. Two of the three women who did not report sexual problems had never had bTtercourse. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasm were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Normal menstrual pattern, young age, and intrasellar tumor growth correlated better with normal sexual desire and sexual functions than did normal prolactin levels and normal testosterone levels. However, at the time of interview, only 7 women had hyperprolactinemia. Serum testosterone values colrelated significantly only with masturbation.

Journal of Neurology, Neurosurgery, and Psychiatry, Jul 1, 1995

Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eig... more Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eight (59-6%) of the women reported decreased sexual desire. Seventeen (36.2%) reported decreased lubrication. Five (10-6%) others did not know if they lubricated or not. Eighteen women (38.3%) reported diminished orgasmic capacity and six (12.8%) others had never had an orgasm. Sensory dysfunction in the genital area was experienced by 61-7% of the women and 76-6% had weakness of the pelvic muscles. Sixty six per cent had bowel problems and 89-4% had bladder dysfunction. The changes in sexual function correlated both with neurological symptoms from the sacral segments, such as weakness of the pelvic floor and bladder and bowel dysfunction, and to other symptoms such as ataxia and vertigo as well as with age and the occurrence of amenorrhoea. A significant correlation was found between expanded disability status scale (EDSS) score and cohabitation. Problems with sexual function were reported significantly more often by women with lower EDSS scores. Most women (83%) found the interview a positive experience.

The purpose of this investigation was to study sexual function in women with neurological disorde... more The purpose of this investigation was to study sexual function in women with neurological disorders at fairly distinct and separate locations. The dissertation comprises descriptive, retrospective, quantitative studies on sexual functioning in women with hypothalamo-pituitary disorders (HPD) (n:48), multiple sclerosis (MS)(n:47), and insulin-dependent diabetes mellitus (IDDM) (n:42). The results werecompared with those in an age-matched control group (C) (n:42), and as reported by representative Swedish women (n:742) in the Swedish sex survey SiS). The studies were based on comprehensive interviews, neurological examinations, incl. Vibration Perception Thresholds (IDDM), concentrations of prolactin and testosterone in serum (HPD), and a checklist on life satisfaction (IDDM, C, and SiS).Sexual dysfunction was prevalent in almost all women with HPD and MS, and in 40% of the IDDM group. The problem of insufficient vaginal lubrication was more common in those with neurological disorders...

Archives of Sexual Behavior, 1994

The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual func... more The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual functions was investigated. Sexual functions and sexual appreciation were assessed in a comprehensive interview of 48 women with well-defined hypothalamo-pituitary disorders. Data about sex life were correlated to blood hormone levels and diagnosis. In most of the women (64.8%), the first clinical symptom indicating a hypothalamo-pituitary dysfunction began in the age group 16 to 35. In 43 patients (89.6%), the initial symptom was menstrual irregularities. Altogether 45 (93.8%) of the women declared that they had or had had significant sexual problems. Two of the three women who did not report sexual problems had never had bTtercourse. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasm were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Normal menstrual pattern, young age, and intrasellar tumor growth correlated better with normal sexual desire and sexual functions than did normal prolactin levels and normal testosterone levels. However, at the time of interview, only 7 women had hyperprolactinemia. Serum testosterone values colrelated significantly only with masturbation.

Experimental and Clinical Endocrinology & Diabetes, 1991

Four different studies of sexual problems and sexual dysfunction in patients with hypothalamo-pit... more Four different studies of sexual problems and sexual dysfunction in patients with hypothalamo-pituitary disorders have been undertaken and data about the sex life of the patients have been correlated with diagnosis, tumour extension and pathology, endocrine insufficiency and pituitary hormone hypersecretion. In the first study 48 out of 53 (76.2%) adult males with pituitary tumours reported decreased or absent sexual desire. The corresponding figure in the second study was 29 out of 37 (78.4%) among adult males with pituitary tumours and hyperprolactinaemia. Twenty (31.7%) and 18 (48.6%) patients, respectively, reported decreased sexual desire as the first symptom of their tumour. A highly significant correlation between a decrease in serum testosterone and a decrease in sexual desire was found. Some males with normal serum testosterone but hyperprolactinaemia also reported decreased sexual desire. In the third study, 109 females (aged 20-60) with morphologically verified hypothalamo-pituitary disorders, 68 (62.4%) had noticed a decrease in sexual desire. This problem was registered for 53 (84.1%) out of the 63 women in this group who had hyperprolactinaemia but only in 15 (32.6%) out of the 46 women with normal serum prolactin (p less than 0.001). In the last study 48 women with well-defined hypothalamo-pituitary disorders underwent a comprehensive interview about sexual function and sexual appreciation. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasms were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Preservation of normal menstrual pattern, age, and intrasellar tumour growth was correlated to normal sexual desire and function.(ABSTRACT TRUNCATED AT 250 WORDS)

Journal of Neurology, Neurosurgery, and Psychiatry, Aug 29, 2012

Background Huntington's disease results in a wide variety of physical, mental, and social dis... more Background Huntington's disease results in a wide variety of physical, mental, and social disabling impairments that will affect sexuality. Up to 85% men and up to 75% women experience high levels of sexual problems (Schmidt and Bonelli, 2007). Most prevalent is low sexual desire, but also increased sexual interest and paraphilia are found. Specific brain lesions might be associated with these changes, but also psychosocial factors with a steadily worsening disease might be causative. Depression and anxiety, common symptoms in early stages of HD, are often associated with sexual symptoms. Change in sexual interest and behaviour, sexual dysfunction, and socio-psychiatric consequences of HD cause suffering also for spouses and children. Aims Sexological rehabilitation is aiming at promoting well-being both in patient and the partner. Methods/techniques Bio-psycho-social approaches have been useful in sexological support and rehabilitation in people with chronic neurological impairments. Sexual rehabilitation follows the basics of the PLISSIT model (Annon, 1976). Acceptance and Commitment Therapy is a treatment option. Results/outcome There might be a need of comprehensive management and treatment of sexual complications in HD. Special training and experience in sexology is mandatory for professional counselling and support. Conclusions HD brings suffering in connection to sexuality. Sexual problems often reduce life satisfaction in patients and partners. The whole family situation can be affected. Professional attention should be given to the sexual symptoms in HD. Clinical sexology knowledge and skills should be developed. Sexological rehabilitation requires a broad focus on bodily changes, identity questions, as well as relationship challenges and adjustments.

Sexuality and Disability, Mar 1, 1996

Changes in sexual functions are very common among women with advanced multiple sclerosis but occu... more Changes in sexual functions are very common among women with advanced multiple sclerosis but occur also in early and mild cases. Decreased sexual desire as well as decreased or absent lubrication are almost as common as diminished orgasmic capacity, changes in orgasmic quality or anorgasmia. Changes in sexual functions correlate both to neurological symptoms from the sacral segments, such as sensory dysfunction in the genital area or weakness of the pelvic muscles, and to bladder and bowel dysfunction. However, disability in itself and a number of psychological and social factors may explain the problems but also gives clues to the treatment.

Archives of Sexual Behavior, Apr 1, 1994

The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual func... more The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual functions was investigated. Sexual functions and sexual appreciation were assessed in a comprehensive interview of 48 women with well-defined hypothalamo-pituitary disorders. Data about sex life were correlated to blood hormone levels and diagnosis. In most of the women (64.8%), the first clinical symptom indicating a hypothalamo-pituitary dysfunction began in the age group 16 to 35. In 43 patients (89.6%), the initial symptom was menstrual irregularities. Altogether 45 (93.8%) of the women declared that they had or had had significant sexual problems. Two of the three women who did not report sexual problems had never had bTtercourse. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasm were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Normal menstrual pattern, young age, and intrasellar tumor growth correlated better with normal sexual desire and sexual functions than did normal prolactin levels and normal testosterone levels. However, at the time of interview, only 7 women had hyperprolactinemia. Serum testosterone values colrelated significantly only with masturbation.

Journal of Neurology, Neurosurgery, and Psychiatry, Jul 1, 1995

Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eig... more Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eight (59-6%) of the women reported decreased sexual desire. Seventeen (36.2%) reported decreased lubrication. Five (10-6%) others did not know if they lubricated or not. Eighteen women (38.3%) reported diminished orgasmic capacity and six (12.8%) others had never had an orgasm. Sensory dysfunction in the genital area was experienced by 61-7% of the women and 76-6% had weakness of the pelvic muscles. Sixty six per cent had bowel problems and 89-4% had bladder dysfunction. The changes in sexual function correlated both with neurological symptoms from the sacral segments, such as weakness of the pelvic floor and bladder and bowel dysfunction, and to other symptoms such as ataxia and vertigo as well as with age and the occurrence of amenorrhoea. A significant correlation was found between expanded disability status scale (EDSS) score and cohabitation. Problems with sexual function were reported significantly more often by women with lower EDSS scores. Most women (83%) found the interview a positive experience.

The purpose of this investigation was to study sexual function in women with neurological disorde... more The purpose of this investigation was to study sexual function in women with neurological disorders at fairly distinct and separate locations. The dissertation comprises descriptive, retrospective, quantitative studies on sexual functioning in women with hypothalamo-pituitary disorders (HPD) (n:48), multiple sclerosis (MS)(n:47), and insulin-dependent diabetes mellitus (IDDM) (n:42). The results werecompared with those in an age-matched control group (C) (n:42), and as reported by representative Swedish women (n:742) in the Swedish sex survey SiS). The studies were based on comprehensive interviews, neurological examinations, incl. Vibration Perception Thresholds (IDDM), concentrations of prolactin and testosterone in serum (HPD), and a checklist on life satisfaction (IDDM, C, and SiS).Sexual dysfunction was prevalent in almost all women with HPD and MS, and in 40% of the IDDM group. The problem of insufficient vaginal lubrication was more common in those with neurological disorders...

Archives of Sexual Behavior, 1994

The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual func... more The extent to which hypothalamo-pituitary disorders in women affect sexual desire and sexual functions was investigated. Sexual functions and sexual appreciation were assessed in a comprehensive interview of 48 women with well-defined hypothalamo-pituitary disorders. Data about sex life were correlated to blood hormone levels and diagnosis. In most of the women (64.8%), the first clinical symptom indicating a hypothalamo-pituitary dysfunction began in the age group 16 to 35. In 43 patients (89.6%), the initial symptom was menstrual irregularities. Altogether 45 (93.8%) of the women declared that they had or had had significant sexual problems. Two of the three women who did not report sexual problems had never had bTtercourse. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasm were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Normal menstrual pattern, young age, and intrasellar tumor growth correlated better with normal sexual desire and sexual functions than did normal prolactin levels and normal testosterone levels. However, at the time of interview, only 7 women had hyperprolactinemia. Serum testosterone values colrelated significantly only with masturbation.

Experimental and Clinical Endocrinology & Diabetes, 1991

Four different studies of sexual problems and sexual dysfunction in patients with hypothalamo-pit... more Four different studies of sexual problems and sexual dysfunction in patients with hypothalamo-pituitary disorders have been undertaken and data about the sex life of the patients have been correlated with diagnosis, tumour extension and pathology, endocrine insufficiency and pituitary hormone hypersecretion. In the first study 48 out of 53 (76.2%) adult males with pituitary tumours reported decreased or absent sexual desire. The corresponding figure in the second study was 29 out of 37 (78.4%) among adult males with pituitary tumours and hyperprolactinaemia. Twenty (31.7%) and 18 (48.6%) patients, respectively, reported decreased sexual desire as the first symptom of their tumour. A highly significant correlation between a decrease in serum testosterone and a decrease in sexual desire was found. Some males with normal serum testosterone but hyperprolactinaemia also reported decreased sexual desire. In the third study, 109 females (aged 20-60) with morphologically verified hypothalamo-pituitary disorders, 68 (62.4%) had noticed a decrease in sexual desire. This problem was registered for 53 (84.1%) out of the 63 women in this group who had hyperprolactinaemia but only in 15 (32.6%) out of the 46 women with normal serum prolactin (p less than 0.001). In the last study 48 women with well-defined hypothalamo-pituitary disorders underwent a comprehensive interview about sexual function and sexual appreciation. Thirty-eight (79.2%) of the women had developed a lack of or a considerable decrease in sexual desire. Problems with lubrication or orgasms were reported by 31 (64.6%) and 33 (68.7%) of the women, respectively. Preservation of normal menstrual pattern, age, and intrasellar tumour growth was correlated to normal sexual desire and function.(ABSTRACT TRUNCATED AT 250 WORDS)