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Hypopituitarism means a partial or complete inability to produce pituitary hormones, including those regulating gonadal function. The condition therefore le to hormone deficiencies that may affect sexuality in various ways. Another important finding was that women felt that their sexual functioning and wellbeing tended to go unnoticed, while men Women want sex Cleary that healthcare professionals focused mainly on erectile function rather than problems with sexual wellbeing.

Cultural and gender norms were apparent in these healthcare interactions, and proactive efforts to improve awareness is required in order to improve the quality of care provided to these patients. Healthcare professionals need time, space and support for reflection so that they may enhance their knowledge about the complexity of sexuality and discuss the of research into hormone replacement in men and women.

They also need support to develop critical awareness of how gendered norms about sexuality may negatively affect the care provided to persons with hypopituitarism. Hypopituitarism is a condition caused by various diseases in the hypothalamic region of the brain. Hypopituitarism may be partial or complete and le to loss of gonadotropins, which regulate gonadal function in both men and women. This in turn in reduction or complete loss of androgens and estrogens and, consequently, infertility. The pituitary gland is a master gland situated at the base of the brain that regulates growth, metabolism and fertility through seven endocrine systems.

The gland produces and secretes growth hormone, prolactin and hormones that regulate the function of the gon, the thyroid gland and the adrenal cortex. In women, physical reactions related to sexual arousal and orgasm depend on the effects of estrogen, while libido is primarily regulated by testosterone [ 1 ]. Miller et al. In hypopituitarism, the loss of pituitary function is most commonly due to benign tumors [ 4 ]. Hypopituitarism in women of child-bearing age in loss of gonadal function, estrogen deficiency and amenorrhea, and the lack of androgens in reduced libido, sexual receptivity and pleasure.

s of testosterone deficiency in men may include reduced libido, erectile problems and loss of body hair.

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Other symptoms, in both men and women, include impaired wellbeing, lack of energy, motivation and initiative, mental fatigue and emotional reactivity, social isolation, anxiety, sexual problems, decreased physical activity, poor body image, loss of self-confidence, depression, and poor concentration and memory [ 45 ]. This group of patients also has an increased risk of cardiovascular disease and osteoporosis [ 467 ].

Findings suggest that women with hypopituitarism may be at greater risk of abdominal obesity, osteopenia and poor quality of life than men if severe androgen deficiency goes untreated [ 8 ]. In the case of complete hypopituitarism, hormone replacement therapy includes daily administration of hydrocortisone, thyroxine, growth hormone and gonadal steroids. Androgen deficiency necessitates testosterone replacement in men, while a combination of estrogen and progesterone is usually used in pre-menopausal women to mimic the normal menstrual cycle.

Gonadotropin treatment induces ovulation and fertility in women with hypopituitarism [ 9 ].

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Once a woman has reached the estimated mean age of menopause, estrogen replacement is usually discontinued [ 4 ]. Research on the hormonal treatment of women shows that it is complicated [ 10 ]. Androgen replacement may have androgenizing effects on the skin and axillary and pubic hair but may increase alertness, stamina, initiative and libido [ 811 ]. Chronic disorders of this kind and their treatment commonly affect sexuality in one or all of three ways: directly, indirectly or iatrogenically [ 12 ].

Iatrogenic effects are the unintended side effects of medication and these may be temporary or permanent. Disturbances in sexual functioning are usually referred to as sexual dysfunction while impaired sexual wellbeing is referred by terms such as sexual problems or concerns [ 12 ]. Research has shown that the deficiency of hormones found in hypopituitarism in both sexual dysfunction and other sexual problems [ 4 ].

Healthcare research and practice have both been criticized for focusing narrowly on sexual functioning while overlooking sexual wellbeing in this group [ 121314 ]. Sexuality is a complex, multifaceted phenomenon.

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However, a predominantly medicalized understanding of sexuality has long prevailed within the healthcare sciences and sexology [ 16 ]. This medical perspective has been criticized for ignoring sexual wellbeing [ 17 ] and leading to a medicalization of sexuality. Verschuren et al. Their framework includes biological, psychological, relational and socio-cultural factors and it makes an important distinction between sexual functioning and sexual wellbeing.

Cleary and Hegarty [ 13 ] further divide sexual wellbeing into sexual relationships and sexual self-conception.

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Both Verschuren et al. From a social constructivist point of view, sexuality is understood as a social, cultural and historical phenomenon. While human sexual physiology is universal, its triggers and the meanings ascribed to it vary according to time and place. People engage in the construction of sexuality in particular social, cultural and historical contexts and this process is related to power differentials, in which factors such as heteronormativity, gender order, social class, age and ability may all play a role [ 1819202122 ].

Social norms prescribe with whom, when and how people should engage with one another sexually [ 23242526 ]. The aim of the present study was to explore perspectives of patients with hypopituitarism on sexuality. Using a purposive sampling strategy, 42 patients with pituitary deficiency from a department of endocrinology at a university hospital in Sweden were asked if they would like to participate in the study.

Nineteen 12 men and 7 women agreed to participate. They were suffering from deficiency in growth hormone, thyroid hormone androgens or estrogens, or from reduced levels of all pituitary hormones.

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The mean age was 57 range, 37—77 years. Seventeen of them were living with a partner while two lived alone and had no partner. Sixteen had children, twelve were in employment, while seven were retired, four of them, recently. Data was collected using semi-structured interviews. The interviewees were encouraged to reflect upon how sexuality related to living with hypopituitarism.

The conversations were tape recorded and transcribed verbatim. All authors contributed to the study conception and de. All authors participated in the interpretation of analysis and commented on versions of the manuscript. All authors read and approved the final manuscript. A hermeneutic approach was selected [ 2829 ]. However, this horizon is constantly changing and expanding as new experiences are gained. Women want sex Cleary of the horizon takes place through a process referred to as the hermeneutic circle.

This describes the circular movement between: 1 the horizon of the interpreter and that of the subject who is to be understood; 2 the meaning of the parts and the whole of the phenomenon that is to be interpreted. Following Fleming et al. This was achieved through ongoing reflection in conversations between the co-authors [ 28 ]. The process of gaining understanding followed the four steps outlined by Fleming et al. Since Fleming et al. The authors took notes while listening and reading and then wrote a summary of basic meanings of the texts.

The next step in analysing the transcriptions involved looking at the whole, then the parts, and then the whole again [ 29 ]. The researchers continually considered how their pre-understandings were altered as they became increasingly aware of these themes, and they then rearranged and renamed them accordingly.

The final step involved identifying passages in the transcriptions that illustrated shared understandings between the researchers and participants. These analytical stages were not conducted in chronological sequence, but took place in a back-and-forth manner, as described in hermeneutics.

Guidelines provided by Whittemore et al. Firstly, notes were taken about the research process in order to document how understandings evolved during the process of analysis.

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Furthermore, efforts were made to remain true to what the participants meant by using verbatim quotations. Finally, we made every effort to ensure that the authors were aware that their understanding emerged through personal involvement in a reciprocal interpretive process [ 28 ]. Analysis was performed through in-depth comparison of the interviews and in numerous discussions and dialogue between the authors in order to achieve the most reasonable interpretation of the texts. Participants were informed about the purpose of the study. They were informed of their right to withdraw at any time without explanation, and that their decision about whether or not to participate would in no way influence the care they would receive.

The researcher informed them about the interview procedure and explained that interviews would be tape-recorded and transcribed. The researcher stressed to all participants that any identifying details would be excluded from the material to ensure anonymity and confidentiality. Both verbal and written consent were obtained from participants at the time of the interview. The main finding in this study was that hypopituitarism alters sexuality in unsettling ways. Interviewees explained that their condition and the treatments affected their sexuality in various ways.

They experienced fatigue, changes in sexual desire and a reduced drive to take initiative. On a more profound level, they also described how the condition affected the way in which they understood their relation to themselves and Women want sex Cleary. The loss of sexual desire had a generally debilitating effect on their lust for life and sometimes brought feelings of loss of self.

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Perspectives on Sexuality Among Patients with Hypopituitarism: Broadening the Medical Focus on Sexual Function to Include Sexual Wellbeing