How do you say dysfunctional in spanish

Following the first application of the patch, serum hormone levels increase gradually over the first 48 to 72 hours, reach a plateau, and then remain constant during the remainder of the day period.

Compared with COCs plasma hormone levels remain constant and the peak levels are lower because first-pass hepatic metabolism and gastrointestinal enzyme degradation are avoided. Serum hormone levels increase immediately after ring insertion and then decrease slowly over the cycle. Reversible contraceptive methods include: Combined hormonal contraceptives CHCs , progestin-only contraceptives, and intrauterine contraceptives IUCs.

Emergency hormonal contraceptives ECs are: Levonorgestrel of 1. Permanent contraceptive methods that are approved by the FDA are: Sterilization surgery for women, a sterilization implant for women, and sterilization surgery for men [ 20 ]. The hormonal composition of hormonal contraceptives is based on progestins alone or on a combination of progestogens and estrogens [ 10 , 20 , 21 , 22 , 23 , 24 ]. Several different progestins are used in combined oral contraceptives COCs.

These progestins may also have estrogenic, antiestrogenic, androgenic, antiandrogenic, or antimineralocorticoid activity [ 10 ]. Most progestins are nortestosterone derivatives. Progestins may be classified according to their chemical structure as an estrane norethindrone, norethindrone acetate, ethynodiol diacetate or as a gonane LNG, desogestrel, norgestimate.

In general, gonane progestins appear to be more potent than the estrane derivatives smaller doses can be used , but other differences between the estrane and gonane compounds are difficult to characterize [ 10 ].

Table 2 shows the classification of progestogens used in hormonal contraception according to their androgenic potency. Among the contraceptive progestins available in the United States, norgestrel and levonorgestrel are the most androgenic; norethindrone and norethindrone acetate are less androgenic; and desogestrel, etonogestrel, norgestimate, dienogest, and drospirenone are the least androgenic [ 2 ].

Newer progestins norgestimate and desogestrel have little or no androgenic activity, whereas other progestins cyproterone acetate, drospirenone, and dienogest have antiandrogenic activity [ 10 ].

Many variables affect the potency of COCs including dosage, bioavailability, protein binding, receptor binding affinity, and interindividual variability , making it difficult to extrapolate the results of isolated experiments to provide clinically relevant information in humans.

There is no clear clinical or epidemiological evidence that compares the relative potencies of currently available COCs [ 10 ]. Systemic progestins may be associated with a loss of sexual desire due to the suppression of ovarian function and endogenous estrogen production [ 6 ].

Furthermore, based on the findings by Grebe et al. However, contraceptive pills with progestogens with antiandrogenic effect do not affect sexual desire, according to some reports [ 28 , 29 ].

In recent studies, drospirenone and dienogest have reported a positive effect on sexual response as well as attraction, desire, satisfaction, and coital frequency [ 28 , 30 ], perhaps due to the ability to reduce the activity of 5-alpha reductase [ 31 ]. Classification of progestogens used in contraception according to their androgenic potency.

With regard to estrogens as hormonal components of hormonal contraceptive methods, three types of estrogens are used in COCs as it can be seen in Figure 2 : Ethinylestradiol EE , estradiol valerate E2V , and 17 beta-estradiol E2. E2V is rapidly metabolized to E2 [ 10 ].

Due to its biochemical structure, estradiol has less impact on the synthesis of hepatic proteins than ethinyl estradiol, which is likely to result in a better metabolic and vascular profile [ 3 ]. In Table 1 , we can see a summary of the different categories of hormonal contraceptives mentioned with their respective mechanism of action of hormonal contraceptives.

The mechanism of action of hormonal contraceptives depends on their hormonal composition and the route of administration. Combined hormonal contraceptives CHCs encompass oral contraceptives pill , patch, and the vaginal ring. Their mechanism of action is similar. With regard to combined oral contraceptives COCs , they have multiple mechanisms of action due to both their estrogenic and progestational components: The suppression of pituitary gonadotropin secretion inhibiting ovulation , the increase of cervical mucus viscosity impairing sperm transport , the suppression of the luteinizing hormone LH , and the impairment of ovulation [ 10 ].

The patch is a 20 cm 2 square matrix system that delivers mg of norelgestromin the primary active metabolite of norgestimate and 35 mg of ethinylestradiol EE daily to the systemic circulation. Following the first application of the patch, serum hormone levels increase gradually over the first 48—72 h, reach a plateau, and then remain constant during the remainder of the day period.

Compared with COC, plasma hormone levels remain constant, and the peak levels are lower because first-pass hepatic metabolism and gastrointestinal enzyme degradation are avoided. Curiously, although peak levels are lower, the area under the curve, which represents overall EE exposure, is larger. One patch is applied weekly for three consecutive weeks, followed by a one patch-free week. The patch can be placed on one of four sites: The buttocks, upper outer arm, lower abdomen, or upper torso, excluding the breast [ 10 ].

The ring releases 15 mg of EE and mg of the progestin etonogestrel ENG the active metabolite of desogestrel per day, which is absorbed through the vaginal epithelium. Serum hormone levels increase immediately after ring insertion and then decrease slowly over the cycle [ 10 ].

The vaginal route is an ideal method of drug administration, and the advantages of this method are well established. By avoiding gastrointestinal absorption and the hepatic first-pass effect, the vaginal administration of contraceptives enables the use of lower hormonal doses and the achievement of steady drug concentrations [ 34 ].

There is another group of hormonal contraceptives only composed of progesterone. This group can include the progestin-only pill, depot medroxyprogesterone acetate DMPA , and the etonogestrel implant. The main mechanism of action is the alteration of the cervical mucus more viscid, less copious and the inhibition of sperm penetration. POPs containing desogestrel may inhibit ovulation more consistently [ 21 ]. DMPA is administered intramuscularly at three-month intervals every 12—13 weeks and is thus considered a long-acting reversible contraceptive LARC by some and a short-acting reversible contraceptive SARC by others.

DMPA works primarily by inhibiting the secretion of pituitary gonadotropins, thereby suppressing ovulation. Women enter a hypoestrogenic state, and their progesterone is low due to anovulation. DMPA also increases the viscosity of cervical mucus minor mechanism of action and induces endometrial atrophy [ 21 ].

The single-rod implant contains 68 mg of the progestin etonogestrel ENG and provides contraception for three years. The ENG implant works primarily by inhibiting ovulation and consistently does so until the beginning of the third year of use.

Ovarian activity, including estradiol synthesis, is still present. The ENG implant causes a thickening of the cervical mucus and changes in the endometrial lining [ 21 ]. The last group is formed by intrauterine contraceptives IUCs. The chief mechanism of action of all IUCs is the prevention of fertilization; they may also have post-fertilization effects, including the potential inhibition of implantation. The LNG-IUS produce a weak foreign body reaction and endometrial changes that include endometrial decidualization and glandular atrophy.

The primary mechanism of action is via changes in the amount and the viscosity of cervical mucus, which acts as a barrier to sperm penetration. Ovulation is likely inhibited in some women, but it is preserved in most study subjects. Endometrial estrogen and progesterone receptors are suppressed, which results in changes in bleeding patterns and may contribute to its contraceptive effect [ 22 ]. In contrast to animal species in which linear relationships exist between hormonal status and sexual behavior, sexuality in the human population is remarkably complex and is not determined so simply by the level of sexual steroids [ 29 ].

Hormonal contraceptives HCs are responsible for a decrease of circulating androgen levels [ 1 , 2 , 29 , 35 ], as well as a decrease of the baseline serum levels of estradiol [ 6 , 29 , 35 ] and progesterone [ 35 ] and the inhibition of oxytocin functioning [ 35 ]. However, the concentrations of the follicle-stimulating and luteinizing hormones are similar in freely cycling women and in women using HCs [ 35 ]. Decreased circulating androgen levels with oral combined hormonal contraceptive CHC use, and its negative effects on sexual life, occur by two mechanisms, as follows: 1 An oral CHC increases sex hormone-binding globulin SHBG and decreases free testosterone, and 2 androgen production from the ovary is suppressed with an oral CHC.

This antiandrogenic effect may be magnified with an oral CHC containing an antiandrogenic progestin [ 2 ]. Thus, all CHCs are antiandrogenic, although some formulations, depending on the specific progestin, are more so than others. The patch and the vaginal ring are more antiandrogenic than the pill [ 1 ]. As expected, the baseline serum levels of estradiol and progesterone are significantly higher in freely cycling women than in women using an HC.

Nevertheless, the concentrations of the follicle-stimulating and luteinizing hormones are similar in both groups [ 35 ]. In respect of oxytocin, its functioning is likely to be altered by this variation in the peripheral estradiol and progesterone levels that were found to be altered in women using HCs, and, therefore, a potential mechanism could be related to the direct binding of progesterone to oxytocin receptors OXTRs , thereby inhibiting OXTR functioning. The association between hormones and sexuality is multidimensional, as several hormones are important in the regulation of sexual behavior [ 29 ].

Though some evidence shows that testosterone has a role in sexual function for women, these conclusions are derived primarily from studies involving postmenopausal women reporting sexual dysfunction [ 2 ]. It has been established that sexual desire, autoeroticism, and sexual fantasies in women depend on androgen levels [ 29 ]. However, the relevance of changes in androgen levels for an individual woman is unclear, and some women may be more sensitive to androgen level alteration than others [ 2 ].

The review by Casey et al. In other studies, decreased levels of estrogen and testosterone in older women have been associated with decreased libido, sensitivity, and erotic stimuli [ 29 ]. In addition, it has been found that patients using birth control pills may present with decreased libido. On the other hand, there are reports that suggest that progestogens with antiandrogenic effects in contraceptive pills do not affect sexual desire [ 29 ].

While there is conflicting evidence concerning a link between progestins and libido, there is some evidence to suggest that estrogens play an essential role in female sexuality. In this respect, prior research has found that declining sexual functioning in women is most closely related to declining estrogen levels [ 6 ]. Finally, with regard to oxytocin, Scheele et al. Multiple lines of evidence suggest that the hypothalamic peptide oxytocin OXT is a key factor modulating pair-bonding behaviors, which means a strong affinity that develops in humans and some species between a mating couple.

In humans, peripheral OXT concentrations are significantly higher in new lovers compared with singles. Likewise, OXT reduces jealousy ratings and neural responses in an imagery task of sexual partner infidelity. OXT also increases the arousal induced by infant photos in nulliparous women and promotes responsiveness to infant crying and laughter by reducing activation in anxiety-related neural circuits.

Moreover, OXT has been found to increase the intensity of orgasm and contentment after copulation. Nevertheless, OXT seems to not have an effect on vital signs. The results of the research by Scheele et al. This mechanism was disturbed in those women using an HC, indicating that the partner-specific modulatory effects of OXT are antagonized by gonadal steroids.

On the other hand, women prefer masculine faces and exhibit higher levels of intersexual competition related to attractiveness at peak fertility in the menstrual cycle; however, these cyclical shifts were found to be diminished in women using an HC. In conclusion, OXT interacts with the brain reward system to reinforce partner value representations in both sexes, a mechanism which may significantly contribute to stable pair-bonding in humans and appears to be altered in women using an HC.

To talk about the effects on sexual function, it is first convenient to define the concept of sexual dysfunction, as well as the types of female sexual dysfunction that are currently described.

In this section, the methods used and validated to quantify the degree of sexual dysfunction are also briefly discussed. In addition, an estimate of the prevalence of sexual dysfunction in the female population of childbearing age is shown. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence [ 37 ].

Therefore, optimal sexual function transcends the simple absence of dysfunction [ 18 ]. In this regard too, multiple studies have shown a strong positive association between sexual function and the health-related quality of life [ 18 ].

Having said that, it can be gathered that the female sexual function is complex and multifactorial, and it is influenced by many biological, psychological, and environmental factors [ 2 , 5 , 18 , 29 ].

The biopsychosocial approach recognizes that biological, psychological, interpersonal, and sociocultural factors can all affect female sexual function, and these factors interact with each other in a dynamic system over time. Psychological factors include mood symptoms, like depression or anxiety, or negative behaviors such as critical self-monitoring during sexual activity. When assessing alterations of sexual function possibly related to hormonal contraceptives, other factors that may also affect it should be taken into account.

Therefore, there are several factors that can affect female sexual function which should be explored by health providers for an adequate diagnostic and therapeutic approach to sexual dysfunction. However, there are studies that show in their results that sexual health is not a widely explored area for health providers in general. Mercer et al. Three of these models are briefly explained here. First, according to the Masters—Johnson model, sexual response progresses predictably and linearly from excitement to plateau, orgasm, and resolution.

The main focus of this model is on the physical response of the genitals. Secondly, Helen Singer Kaplan noted that many individuals had problems with sexual desire, denoting the importance of desire to sexual response. In the s, she modified the Masters—Johnson model to a three-phase model of desire, excitement, and orgasm. Thirdly, in , Rosemary Basson and colleagues proposed an alternative circular model of female sexual response.

This model has several distinguishing features. On the other hand, this model emphasizes that sexual stimuli often precede physical arousal and desire, and sexual arousal and desire often co-occur.

Finally, the Basson model acknowledges that both physical and emotional satisfaction are important outcomes of engaging in sexual activity. This physical and emotional satisfaction can lead to higher emotional intimacy, which, in turn, can lead to greater receptivity and seeking out of sexual stimuli—hence, the circular model [ 18 ].

There has been debate regarding which model best reflects the experiences of women. With the concept of sexual dysfunction now developed, we may now discuss the types of sexual dysfunction that are described.

In this scale, questions are graded on a Likert scale, and domains are weighted and summed to give a total score ranging from 2—36, with a cutoff of less than The FSFI has been validated in multiple languages, across age groups, and for multiple sexual disorders [ 18 , 41 ]. Why is it important to read up on sexual dysfunction? This section presents different results found in the literature about the effects of hormonal contraceptives HCs on female sexuality including results that advocate for positive or negative effects or the absence of sexual effects.

It also discusses the peculiarities of the different types of HCs on sexuality. Some studies have found no change in sexual function with some hormonal contraceptives HC [ 2 , 3 , 6 , 10 , 42 , 43 , 44 , 45 , 46 ]. A recent systematic review of 36 studies involving more than 13, women reported no significant changes in sexual desire with the use of oral combined hormonal contraception CHC [ 43 ].

Another study [ 47 ] also reported high satisfaction rates with both LNG-IUS and copper IUC but no difference in sexual function overall or within psychological domains. In another recent study, no association was found between any LARC method and sexual satisfaction scores [ 48 ]. On the other hand, Reed et al. Further analysis showed no association between vulvodynia and previous OC use HR 1. In a study by Iliadou et al. A systematic review of the literature found that sex drive is unaffected in most women taking OC, 3.

However, the effects of other forms of hormonal contraception on sex drive have not been studied as comprehensively as OC [ 1 ]. According to the studies reviewed, hormonal contraceptives have a series of non-contraceptive effects which can influence and improve different areas of female sexual function. Some of these non-contraceptive effects are: Relief of gynecologic pain [ 1 ]; improved appearance, self-confidence, and self-esteem [ 2 ]; decrease of anxiety and discomfort [ 2 ]; loss of fear of having an unwanted pregnancy [ 6 ]; more stable levels of hormones throughout the cycle [ 51 ]; and less bleeding with the consequent lower risk of anemia [ 51 ].

All these effects contribute to the well-being of women and, consequently, to a possible improvement in the female sexual function.

Similarly, hormonal contraceptives have described positive effects on some areas of female sexuality. The most frequently affected areas are: Sexual desire, orgasm number and intensity, satisfaction, and arousal.

As mentioned, HCs may help to eliminate the fear of pregnancy, presumably providing a more relaxed and enjoyable sexual experience [ 1 ]. Similarly, it is reasonable to consider that an improved appearance would promote self-confidence and increase self-esteem, thereby having a positive effect on sexual function [ 2 ].

In a comparison between the vaginal ring, an oral CHC containing a third-generation progestin, subdermal contraception, and no hormonal contraception control group , the three groups using an HC had increased positive indicators of sexual function sexual interest and fantasies, orgasm number and intensity, and satisfaction and decreased negative indicators anxiety and discomfort.

The same results were obtained in a comparison between etonogestrel implant and no contraception [ 2 , 52 ]. LNG-IUS have also been positively associated with sexual desire, arousal, orgasm, and overall sexual function compared with no contraception [ 2 , 53 ].

Furthermore, it may be advantageous for women to have more stable levels of hormones throughout the cycle. Because of the monthly fluctuations in estrogens, progesterone and androgens are associated with a range of symptoms, both genital i. Consequently, it is important to keep in mind that hormonal contraceptives could have associated side effects that have an influence on female sexual function.

Some of these effects could be: Vaginal dryness [ 2 , 10 , 51 ], a decrease of lubrication [ 2 , 51 ], and pelvic floor symptoms such as dyspareunia [ 3 , 51 ], urinary incontinence, vestibulodynia, and interstitial cystitis [ 3 ]. COCs have been also associated with long- and short-term anatomical changes, such as atrophic vulvovaginitis and a decrease of thickness of the labia minora and vaginal introitus area [ 1 ].

Negative effects on some areas of female sexuality have been described with HCs, such as: Decreased sexual desire [ 2 , 6 , 10 , 54 ], frequency of intercourse [ 2 , 54 ], arousal [ 2 , 54 ], pleasure [ 2 , 54 ], orgasm [ 2 , 54 ], sexual thoughts [ 54 ], interest, and enjoyment [ 6 , 54 ].

In contrast to the above section, Elaut et al. Furthermore, longer durations of oral CHC use and younger ages at initiation have been associated with a higher relative risk of vestibulodynia [ 2 ], with the resulting negative impact on female sexual function.

Combined oral contraceptives are widely studied. Nevertheless, other hormonal contraception methods have fewer studies about their influence on sexual function. In this section, the results obtained from the studies reviewed for each type of hormonal contraceptive will be presented.

Table 1 shows a summary of this information. Concerning patch-related sexual effects, this could be considered the most innocuous CHC. Gracia et al. However, they concluded that for both products, these changes are not likely to be clinically significant [ 1 , 34 ]. Therefore, it would be advisable to expand the research in this regard.

With regard to ring-related sexual effects, there are mixed results. On the one hand, two studies showed a decrease in sexual function with vaginal ring compared with COCs [ 56 , 57 ], and one study showed similar results but compared with the patch [ 58 ].

However, an improvement in sexual function including sexual desire, fantasies, and satisfaction, accompanied by a reduction of sexual distress, has been described with the vaginal ring [ 1 , 2 , 10 , 34 ]. As suggested by the researchers, these data indicate that both oral and vaginal contraception seem to improve to some extent the sexual life of women and their partners, whereas the vaginal ring seems to exert a further beneficial effect on the psychological aspects of sexual functioning [ 59 ].

Vaginal contraception offers many benefits, including high efficacy, good tolerability, ease of use, once-a-month dosing, and a favorable pharmacokinetic profile, with the added benefits of positive effects on the vaginal microbiome and on sexual parameters [ 34 ].

Consequently, it could be a good hormonal contraceptive option. DMPA is a highly effective method of contraception. It has been used as a contraceptive agent since by millions of women worldwide, particularly in less developed regions [ 21 ]. In respect of DMPA-related sexual effects, there are mixed results.

Despite decreased libido being a common complaint among DMPA users and the fact that progestins have been observed to decrease interest in sex [ 6 ], positive sexual effects are also described with this method [ 6 , 60 ]—some reviews even reveal that DMPA is unlikely to be associated with sexual function in women [ 1 , 2 , 6 ].

However, further research would be needed to support these claims. Etonogestrel implant-related sexual effects are described as negative effects. It has been associated with a lack of interest in sex, a decreased libido, and a reduced sex drive. In addition, a decreased libido has been observed as a significant cause for implant discontinuation [ 1 , 6 ].

Intrauterine contraceptives IUCs are long-acting reversible contraceptive LARC methods that are used by over million women worldwide. IUCs are highly effective methods of contraception that can be used by women of all ages. They have generally been associated with positive sexual effects. They have been reported to improve desire, sexual function, and arousal [ 1 , 2 , 60 ]. Moreover, they seem to improve the health-related quality of life through the improvement of dysmenorrhea and symptoms in patients with endometriosis and adenomyosis, among other things [ 22 ].

There has been no evidence to suggest that the copper IUD is associated with an altered libido [ 6 ]. As a non-hormonal contraceptive method, the effect of sterilization on sexual function extends beyond a simple hormonal effect into the psychological aspects of permanent pregnancy prevention, whether positive i. Female sexual function is complex and multifactorial and is influenced by many biological, psychological, and environmental factors [ 2 , 5 , 18 , 29 ].

Consequently, sexual dysfunction does not have to be associated with hormonal contraception. Visible droplets that he had caught within this distance were still contagious. The study was published in the American Medical Journal. If that were the case, perhaps the people on this lawn on the banks of the Rhine in Dusseldorf would be safe — if every other circle remained free.

But wait a minute — we are not dealing with streptococci bacteria here, but with viruses. Viruses are much smaller than bacteria, so they can float around for hours and spread better in the air.

This is why the researchers recommend that the distance between people should not be the only safety criterion but that other factors should be considered, too: How well a room is ventilated, whether people are wearing masks, and whether they are silent, speaking softly or singing and shouting. Numerous studies have also shown that coughing can propel veritable parcels of viruses up to 8 meters through the air.

Speaking or singing loudly also spread a lot of aerosols and droplets about the room. If, however, people only speak quietly, as in a library, and sit in the fresh air, safe distances can be smaller again. The duration of a stay in a contaminated room and how many people are in that room are also decisive factors when assessing the risk of infection.

The researchers have used those factors to develop a traffic light model. The clear result: In rooms with a high occupancy, you should generally stay only for a short time, make sure they are well aired, wear a mask and speak quietly.

Now, "close contact" is defined as being within 2 metres of an infected person for at least 15 minutes cumulatively within 24 hours.

Here, however, the traffic light of the UK-US research team would show green. Outside, people can be safe for long periods of time even without a mask, provided there are few people around, everything is well ventilated and no one talks much. But even so, will the distance between deck chairs being measured here be enough?

Visit the new DW website Take a look at the beta version of dw. Go to the new dw. More info OK. Wrong language? Change it here DW. COM has chosen English as your language setting. Partly as a consequence of dysfunctional institutions, the economy entered into decline from the mids, a downward slide that accelerated in the s. Because we are guided by a functionalist framework, we do not want to imply that anger, per se, is a " dysfunctional " or maladaptive emotion.

Additionally, as we saw above, a generally dysfunctional security sector riddled with poor leadership created circumstances in which order and discipline were undermined. Research should therefore also be aimed at investigating the genetic basis of hemispheric connectivity and its role in dysfunctional social cognition in schizophrenia. Besides, many features of the system, especially motherhood at a very early age, were seen to be cruel and socially dysfunctional.

In particular, it is hypothesized that oppositional behaviors without concurrent aggression primarily reflect dysfunctional parent-child relations. However, much to the chagrin of these fishermen, within a few years of operation, caused most of these units to become dysfunctional.

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Translations of dysfunctional in Chinese Traditional. See more. Need a translator? Translator tool. What is the pronunciation of dysfunctional?

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