Sexual dysfunction in the elderly: age or disease?

Antidepressant-associated sexual dysfunction in outpatients

BACKGROUND

Antidepressant treatment is related to various sexual dysfunctions. This may cause discontinuation of the medication. This study aims to evaluate the level of sexual dysfunction of antidepressant users and the possible factors linked.

METHODS

Demographic variables and sexual dysfunction level of 452 people in total (291 males and 161 females) were assessed by demographic data form and Psychotropic-related Sexual Dysfunction Questionnaire (PreSEXDQ).

RESULTS

Sexual dysfunction was highly prevalent among both females (88.7%) and males (84.5%). Among females, significant differences were observed based on antidepressant type, with those using bupropion experiencing lower levels of sexual dysfunction compared to those on SSRIs, SNRIs, or vortioxetine. In contrast, no significant differences were found for males.

CONCLUSIONS

This highlights the importance of considering gender and medication type when addressing and managing psychotropic-related sexual dysfunction. Furthermore, additional studies are needed to determine whether a causal relationship exists between psychiatric medication-related sexual dysfunction and treatment discontinuation.

Assessment of Sexual Function in Relation to Microbiological Findings in Patients with Chronic Bacterial Prostatitis

Background/Objectives: Patients with chronic bacterial prostatitis (CBP) often present symptoms of sexual dysfunction. We aimed to evaluate the impact of the infection location and etiology on sexual dysfunction in patients with CBP. Methods: Male patients with CBP diagnosed by microbiological tests underwent a complete clinical assessment and were administered questionnaires for prostatitis (NIH-CPSI), voiding (IPSS), and sexual function (IIEF-15, PEDT). Results: Out of 614 patients, erectile dysfunction (ED) was present in 49.8%, and premature ejaculation (PE) in 40.7%. At least one sexual disorder was present in 86.3% when other disorders of ejaculation, orgasm, and sexual desire were considered. Patients with Gram-negative infections in expressed prostatic secretion (EPS) or voided urine after prostatic massage (VB3) had higher odds of moderate to severe erectile dysfunction compared to patients with infection by atypical pathogens (OR 3.31, CI 1.43-7.63, p = 0.0039). Rates of orgasmic dysfunction were also higher in Gram-negative and Gram-positive with respect to atypicals (OR 3.2, CI 1.36-7.90, p = 0.006 and OR 3.78, CI 1.64-8.71, p = 0.001). Hemospermia was more frequent in patients with semen infection by Gram-positive than in patients with infection by atypical pathogens (OR 2.2984, CI 1.3239-3.9901, p = 0.002). Prostatic calcifications at transrectal ultrasound were less frequent in patients with semen infection by Gram-negative compared to Gram-positive (OR 0.471, CI 0.3029-0.7322, p = 0.000). The addition of an "S" (sexual) domain to the UPOINT classification achieves a more significant correlation between the number of positive domains in each patient and the NIH-CPSI score. Conclusions: Infections by Gram-negative are associated with more sexual morbidity in patients with CBP. The use of a questionnaire investigating all the main domains of sexual dysfunction could be very useful for the phenotyping of patients with chronic prostatitis.

Experience of Racial Discrimination was Associated with Psychological Distress and Worsening Sex Life Among Adult Americans During COVID-19

The recent escalation of racism in the U.S. during the COVID-19 pandemic points to the importance of examining the association between experienced racism and sexual health. Based on data from a nationally representative survey conducted in the U.S. in October 2020 (n = 1,915), Chi-square tests and multivariable logistic regressions were estimated to examine the association between experience of racism and changes in sex life during the pandemic. We further performed a causal mediation analysis using the bootstrap technique to assess the mediating role of psychological distress in the observed association between the experience of racism and changes in sex life. Among the respondents, the proportions reporting better, worse, or no change in sex life were, respectively, 15%, 21%, and 64%. Experiencing racial discrimination during COVID-19 was significantly associated with worsening sex life (adjusted odd ratio [AOR] = 1.53; 95% confidence interval [CI] = 1.04, 2.25). Respondents with experienced racism were also more likely to report psychological distress (AOR = 1.68; 95% CI = 1.09, 2.59). About one-third (32.66%) of the observed association between experienced racism and worsening sex life was mediated through psychological distress. Addressing racism and its association with psychological distress has the potential to improve sexual health and reduce related racial and ethnic disparities.

Magnitude and factors associated with benign prostatic hyperplasia among adult male patients visiting Wolaita Sodo University comprehensive specialized hospital southern Ethiopia

Worldwide, in Africa and Ethiopia prevalence of Benign Prostatic Hyperplasia among patients with lower urinary tract symptoms was 26.2%, 44.2%, and 33.4% respectively. However, there is limited evidence regarding Benign Prostatic Hyperplasia in southern Ethiopia and it was not well explored. Therefore, this study aimed to assess the magnitude and associated factors of Benign Prostatic Hyperplasia among adult male patients visiting Wolaita Sodo University Comprehensive Specialized Hospital, southern Ethiopia 2022. A hospital-based cross-sectional study was conducted from July to September 2022. A systematic random sample technique was employed to select 376 participants. Data were gathered using a structured questionnaire and entered, cleaned, coded, and analyzed using SPSS Version 25.0. To describe the study respondents, descriptive statistics were used. Bivariate and multivariate analyses were conducted and an adjusted odd ratio with 95% Confidence Interval (CI) was utilized to quantify the degree of association, and statistical significance was declared at p-value < 0.05. A total of 376 male patients admitted to the surgical department of the Urology ward were included in this study and the magnitude of Prostatic Hyperplasia was 21.3%; 95% CI: 17.3, 25.8. The vegetable consumption, fruit consumption, physical activity, sleeping time and sexual dysfunction [(AOR = 7.57, 95% CI: (2.78, 20.60)], [(AOR = 21.06,95% CI: (7.06,27.53)], [(AOR = 0.57,95% CI: (0.19, 0.67)], [(AOR = 3.23, 95% CI: (1.18,8.79)] and [(AOR = 17.05, 95% CI: (4.82,60.28)] were factors associated with Benign Prostatic Hyperplasia respectively. The benign prostatic hyperplasia is a prevalent disease among men in this study. Sexual dysfunction, consumption of vegetables, consumption of fruits, practice of physical activity and sleeping time were factors associated with BPH. Hence, screening programs for higher-risk people to ensure the early presentation of benign prostatic hyperplasia and practicing eating balanced diets are vital areas to reduce the prevalence.

Sexual dysfunction among people with mental illness in Africa: A systematic review and meta-analysis study

BACKGROUND

Sexual dysfunction is the most frequent health problem among psychiatric patients. This could be the result of both the nature of the illness itself and the side effects of prescribed psychotropic medications. It also significantly affects an individual's general well-being, interpersonal relationships, self-esteem, and treatment outcomes. Therefore, the current systematic review and meta-analysis was conducted to determine the combined prevalence of sexual dysfunction and its correlated factors among people with mental illness.

METHODS

We retrieved eligible primary studies using various search databases like PubMed, EMBASE, Science Direct, African Journal Online, Google Scholar, and Psychiatry Online. The report of this systematic review was reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We used standardized data extraction checklists and STATA version 14 for data extraction and analysis, respectively. The I-squared statistics test was used to check statistical heterogeneity within the included articles. Publication bias was assessed using a funnel plot and the Egger test. To estimate the overall prevalence and correlated factors of sexual dysfunction, a random effects model meta-analysis was employed.

RESULTS

In this meta-analysis, a total of 15 primary studies with 2849 psychiatric patients were included. The overall pooled prevalence of sexual dysfunction among psychiatric patients in Africa was 58.42% (95% CI: 49.55, 67.28). Having older age (OR = 1.92, 95% CI: 1.28, 2.87), longer duration of illness (OR = 2.60, 95% CI: 1.14, 5.93), history of relapse (OR = 3.51, 95% CI: 1.47, 8.43), poor quality of life (OR = 3.89, 95% CI: 2.15, 7.05), and antipsychotic medications (OR = 2.99, 95% CI: 1.84, 4.86) were significantly associated with sexual dysfunction.

CONCLUSION

This meta-analysis revealed that approximately two-thirds of psychiatric patients in Africa are affected by sexual dysfunction. Therefore, the findings of this study recommend that when evaluating psychiatric patients, health professionals should focus more on sexual dysfunction. It is also essential to promote awareness and incorporate sexual health assessment and intervention into mental health services to reduce the overall burden of the problem.

From couplepause to doublepause: the impact of midlife physical, psychological, and social changes on the sexual life of aging couples

INTRODUCTION

Midlife men and women are facing frequent sexual problems that affect not only individuals' sexual health but also the sexual health of aging couples.

OBJECTIVES

To review the main sexual life challenges faced by midlife couples, to present the concepts of couplepause and doublepause as 2 new paradigms to address the sexual health needs of aging couples, and to discuss key aspects in couple-focused care.

METHODS

An online meeting attended by 5 European experts in sexual health was carried out in June 2023 to discuss the topic. The conversation centered on their clinical experience and expert opinion. Additionally, the indexed literature was reviewed to endorse and complement the expert opinions obtained in the aforementioned meeting.

RESULTS

Midlife men and women face physical, psychological, and sociocultural changes that affect their sexual activity. These changes may be experienced differently between genders. Both members of a couple may experience age-related changes concurrently or in an unsynchronized manner affecting their sexual health. Communication, sharing expectations, defining sexual dynamics, and couple goals are determinant for the sexual health of a midlife couple. Couplepause and doublepause are 2 new complementary paradigms that effectively address the sexual health needs of aging couples as a unit, considering physical, psychological, cultural, social, and dyadic-related factors. Couple-centered strategies should promote open communication about couple intimacy issues, understanding the diverse expectations according to gender and orientation, communication styles, and goals. The following are identified as crucial aspects to promote couple-focused care: education and training of health care professionals, the provision of information to aging couples, physician involvement in addressing sexual problems, the need for collaboration across medical specialties, and the development of effective tools and strategies.

CONCLUSIONS

The sexual problems of aging couples should be managed following couple-centered strategies that effectively address their sexual health needs as a couple.

The Prevalence and Risk Factors of Sexual Dysfunction in the Elderly in Southern China

Objective

This study aims to evaluate the epidemiological features of sexual dysfunction in people aged more than 65 years in parts of China, and to investigate the independent significant risk factors.

Methods

According to the population distribution of five communities in Xiamen and Chongqing, we have randomly enrolled 2403 people more than 65 years-of-age. We collected data information through a questionnaire survey. Then demonstrated the current condition of sexual dysfunction in the samples by statistical analysis, and multivariable logistic regression was used to disclose the risk factors of sexual dysfunction in the older adults.

Results

According to this study, about 10.48% of the elderly had sexual dysfunctions of different degrees and duration. The proportion of men was about twice that of women (14.5% of males and 7.3% of females). During the course of the disease, 3.19% (43/1344) of women and 3.31% (35/1059) of men had more than 15 years duration of sexual dysfunction. In severity, 5.7% (77/1344) of women and 7.0% (74/1059) of men had very severe sexual dysfunction. There were statistically significant differences in BMI, smoking, drinking history, hypertension, depression incidence or median (p<0.05). Alcohol consumption history [OR = 1.711, 95% CI: 1.124-2.604, p = 0.012] and depression [OR = 2.107, 95% CI: 1.109-4.356, p =0.044] were independent risk factors for sexual dysfunction.

Conclusion

The prevalence of sexual dysfunction was low among elderly in the southern part of China. But the course of the disease is long and the degree of the disease is very severe. Elderly with a history of drinking and depression are more prone to sexual dysfunction.

[Sexuality among the elderly: understanding the weight of stereotypes]

Sexuality is an integral part of health and accompanies human beings throughout their lives. It contributes to well-being and improves quality of life. The social representations conveyed by Western society modulate sexuality and can play a decisive role in the expression of seniors' sexuality.

Daily Vaginal Dilator Use During Radiation for Women With Squamous Cell Carcinoma of the Anus: Vaginal Wall Dosimetry and Patient-Reported Sexual Function

PURPOSE

At our institution, we treat patients with a daily vaginal dilator (VD) during chemoradiation (CRT) for squamous cell carcinoma of the anus (SCCA). We evaluated compliance with daily VD use, radiation dose to the vaginal wall (VW), and anterior vaginal wall (AVW), and patient-reported long-term sexual function.

METHODS AND MATERIALS

We included women with SCCA who received definitive, intensity-modulated radiation therapy-based CRT. Women who were alive without evidence of disease received a patient-reported outcome survey, which included the Female Sexual Function Index (FSFI). We identified factors associated with FSFI, such as radiation dose to the VW and AVW using linear regression models and used Youden index analysis to estimate a dose cutoff to predict sexual dysfunction.

RESULTS

Three hundred thirty-nine consecutively treated women were included in the analysis; 285 (84.1%) were treated with a daily VD. Of 184 women alive without disease, 90 patients (49%) completed the FSFI, and 51 (56.7%) were sexually active with valid FSFI scores. All received therapy with a daily VD. Forty-one women (80%) had sexual dysfunction. Univariate analysis showed higher dose to 50% (D50%) of the AVW correlated with worse FSFI (β -.262; P = .043), worse desire FSFI subscore (β -.056; P = .003), and worse pain FSFI subscore (β -.084; P = .009). Younger age correlated with worse pain FSFI subscale (β .067; P = .026). Age (β .070; P = .013) and AVW D50% (β -.087; P = .009) were significant on multivariable analysis. AVW D50% >48 Gy predicted increased risk of sexual dysfunction.

CONCLUSIONS

Daily VD use is safe and well tolerated during CRT for SCCA. Using a VD during treatment to displace the AVW may reduce the risk for sexual dysfunction. Limiting the AVW D50% <48 Gy may further reduce the risk but additional data are needed to validate this constraint.

Construction and validation of a scale of sexual self-concept for the elderly Chilean population

BACKGROUND

Sexual self-concept has a central role in the life of the elderly population. Indeed, their sexual self-concept has significant and positive relationships with their satisfaction with life, pleasure, and willingness to interact with others. However, social-cultural prejudice means that the elderly are considered asexual individuals, harming their sexual self-concept. This prejudice is prominent in Chile, where the elderly do not have access to clear information about their sexuality. However, research on the Chilean elderly population is still in its infancy and requires more attention. Hence, this research aims to construct and validate a scale of sexual self-concept for the elderly Chilean population to cover this identified gap in the literature.

METHODS

Sixty items were integrated into the first version of the scale. Ten external judges were asked to assess the content validity. Twenty-eight items were maintained. Subsequently, an instrumental and cross-sectional design was implemented with a non-probabilistic sampling (N = 188). Items were refined with corrected homogeneity indices and conditional estimates of Cronbach's alpha and Omega coefficient.

RESULTS

A final scale of nine items equally distributed in three dimensions was obtained: Sexual self-efficacy (ω = 0.867), Sexual assertiveness (ω = 0.764), and Sexual self-esteem (ω = 0.803). The confirmatory factor analysis reflects that the theoretical model has an adequate fit (CFI = .989; TLI = .984; RMSEA = .086).

CONCLUSIONS

The data analyses confirmed that the scale has adequate psychometric properties. This scale can be used for multidimensional measurements of sexual self-concept in the elderly in Chile. Further research can confirm its psychometric properties in different settings within the Spanish language population.

Age-related differences in the severity of sexual dysfunction symptoms and psychological distress in individuals with multiple sclerosis

BACKGROUND

Sexual dysfunction (SD) is a common symptom for many with multiple sclerosis (MS). However, SD research in general appears to often overlook young adults within their samples, which can be a major issue for better understanding and treatment for the MS population. Few studies have compared age-related differences in distress in response to physical disability. Research has also found that many people diagnosed with MS do not discuss any SD struggles with their providers. The present study hopes to see whether age-related differences exist in the reporting of the levels of primary, secondary, and tertiary SD, as defined by subscale scores of the Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), and amount of distress, as defined by the 12-Item Short Form Health Survey (SF-12)'s Mental Component Summary (MCS-12). Additionally, we hope to determine if there are any age-related or sex-related differences in help-seeking behaviors for SD.

METHODS

Study participants were recruited from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. Participants completed the MSISQ-19, SF-12, and Patient Determined Disease Steps (PDDS), provided demographic information, and responded if they received medical or psychological treatment for SD. Study participants were 5815 respondents (Mage = 51 years, SD = 9.63, 75 % female, 30 % having attained a high school diploma, 35 % scoring "advanced disability" on the PDDS). Young adult (19-39 years), middle adult (40-64 years), and mature adult (65-older) were compared on SD.

RESULTS

Linear mixed effects modeling revealed that the MSISQ-19 subscale scores were significantly predicted by secondary SD (t = 2.48, p < .13). Young adult participants had the lowest primary SD (M = 13.87, 95 % CI [13.13, 14.61]) when compared to mature adult (M = 14.12, 95 % CI [13.27, 14.97]) and middle adult participants (M = 14.44, 95 % CI [14.21, 14.66]), though none were statistically significant. Mature adults had the lowest secondary SD (M = 16.50, 95 % CI [15.65, 17.35]), a statistically significant difference from the middle adults (M = 18.20, 95 % CI [17.97, 18.42]) and young adults (M = 18.91, 95 % CI [18.17, 19.65]). Mature adults had the lowest tertiary symptoms (M = 10.12, 95 % CI [9.27, 10.96]), followed by young adults (M = 12.23, 95 % CI [11.48, 12.97]), and middle adults (M = 11.65, 95 % CI [11.43, 11.88]), though none were statistically significant. Hierarchical multiple regressions found that age had the most significant impact on SD. When SF-12 MCS-12 was added, linear mixed effects did not reveal any statistically significant results between the age groups and SD levels. In contrast, hierarchical multiple regressions found that SF-12 MCS-12 scores had the most significant impact on SD. There were significant age-related and sex-related differences in help-seeking behaviors in those who sought psychological counseling as opposed to medical treatment for SD.

CONCLUSION

Our study has highlighted the importance of clinicians assessing for SD and psychological distress within their patients and to consider potential differences in symptom presentations of age groups to better address their unique needs.

Health-Care Resource Utilization and Treatment Patterns in Men with Erectile Dysfunction and Benign Prostatic Hyperplasia-Associated Lower Urinary Tract Symptoms in the United States: A Retrospective Database Study

Objective

To compare health-care resource utilization (HCRU) outcomes in patients with erectile dysfunction (ED) and benign prostatic hyperplasia-associated lower urinary tract symptoms (BPH-LUTS) treated with tadalafil or non-phosphodiesterase-5 inhibitor (PDE5i), adherence to and persistence with tadalafil by dose in the United States (US).

Methods

This was a noninterventional, real-world evidence study of men (aged ≥45 years) with ED and BPH-LUTS treated with tadalafil or non-PDE5i. The IQVIA US PharMetrics Plus claims database was used. Outcomes included all-cause and disease-specific HCRU over a 12-month follow-up. Persistence with and adherence to tadalafil were evaluated stratified by dose (10 or 20 mg as needed; 2.5 or 5 mg as once daily [OD]).

Results

The final sample comprised 11,351 tadalafil and 48,722 non-PDE5i patients. For all-cause and disease-specific HCRU, including prescription fills, physician office visits, emergency room visits, laboratory tests, radiology examinations, outpatient surgical services, ancillary services, hospitalizations, mean number of utilizations, and proportions of patients with one or more utilizations, were lower for tadalafil compared with non-PDE5i patients. For all-cause HCRU, proportions of patients with one or more emergency room visits (18.6% vs 21.7%, p<0.0001) and outpatient surgical visits (63.0% vs 68.8%, p<0.0001) were significantly lower for tadalafil compared with non-PDE5i patients. For disease-specific HCRU, the proportion with one or more disease-specific physician office visits (55.1% vs 91.4%), laboratory tests (34.8% vs 58.2%), outpatient surgery (24.3% vs 38.9%), or outpatient ancillary services (18.0% vs 29.8%) were significantly lower for tadalafil compared with non-PDE5i patients (all comparisons, p<0.0001). Mean persistence days (179.8 vs 61.2), proportion persistence (35.8% vs 6.5%), and mean adherence (0.5 vs 0.2) were higher for tadalafil OD doses than as-needed tadalafil doses.

Conclusion

Patients on tadalafil demonstrated less HCRU and higher persistence and adherence (OD versus as-needed tadalafil) than non-PDE5i patients, which demonstrates its benefit in the management of ED and BPH-LUTS in the US.

Hypo- or hyperfunction? Differential relationships between compulsive sexual behavior disorder facets and sexual health

BACKGROUND

Previous studies linking compulsive sexual behavior disorder (CSBD) and sexual health have shown mixed results, which could be due to the fact that different CSBD facets may have differential relationships with sexual functioning.

AIM

As CSBD is a multidimensional disorder, we wanted to investigate whether distinct CSBD domains are differentially related to sexual health.

METHODS

Two online studies were conducted-the first on a convenience sample (812 Polish participants; mean [SD] age, 22.07 [5.91] years) and a replication study on a representative sample of Polish adults (n = 1526; 43.02 [14.37]). Hierarchical regression was employed with sexual functioning as a predicted variable and CSBD symptoms as predictors.

OUTCOMES

The Compulsive Sexual Behavior Disorder Scale was used to assess CSBD symptoms, and the Arizona Sexual Experience Scale was used to measure sexual dysfunction.

RESULTS

In study 1, CSBD salience (β = -.20, P < .001) predicted hyperfunction (ie, stronger sex drive, easier sexual arousal, easier vaginal lubrication/penile erection, easier ability to reach an orgasm, and more satisfying orgasms). Yet, CSBD negative consequences (β = .15, P = .001) and dissatisfaction (β = .22, P < .001) predicted hypofunction (ie, weaker sex drive, more difficulties in sexual arousal, greater difficulties in vaginal lubrication/penile erection, less ability to reach an orgasm, and less satisfying orgasms). Similar results were found in study 2: salience (β = -.26, P < .001) and relapse (β = -.11, P = .004) predicted hyperfunction, while negative consequences (β = .12, P < .001) and dissatisfaction (β = .12, P < .001) predicted hypofunction.

CLINICAL IMPLICATIONS

Our results stress the importance of assessing the severity of each group of symptoms in patients with CSBD to better understand possible difficulties in their sexual functioning.

STRENGTHS AND LIMITATIONS

Our studies are the first to evaluate the effects of each CSBD domain on sexual health. We also replicated results obtained from a convenience sample on a representative sample. The cross-sectional design of the current studies does not allow causal relations to be tested, so future longitudinal research should be carried out. We also gathered data from a general population-thus, it is important to replicate these results on patients diagnosed with CSBD.

CONCLUSION

Our research points out the differential impact of CSBD domains on sexual health: salience and relapse are related to sexual hyperfunction, while negative consequences and dissatisfaction to hypofunction.

The efficacy of PDE5 inhibitors in diabetic patients

BACKGROUND

Phosphodiesterase 5 inhibitors (PDE5i), since their introduction in the late 1990s, have proven their efficacy in treating several conditions, predominantly pulmonary hypertension and erectile dysfunction where they remain the first-line therapeutic option. However, in the recent years, growing evidence from both animal and human studies has emerged to suggest the additional benefits of PDE5i in cardiovascular and metabolic disorders. This is of specific interest to the diabetes population where prevalent cardiovascular disease and metabolic dysregulation significantly contribute to the increased morbidity and mortality.

OBJECTIVES

To examine the available data on the non-standard, pleiotropic effects of PDE5i in patients with diabetes mellitus.

MATERIALS AND METHODS

The review of the published background research, preclinical studies and clinical trials.

RESULTS

In human studies, PDE5 inhibition appeared to be associated with reduced cardiovascular mortality and overall improved clinical outcomes in those with established cardiovascular disease. PDE5i were also consistently found to reduce albuminuria in subjects with diabetic nephropathy. Furthermore, animal data suggest a plausible effect of this group of medication on sensory function and neuropathic symptoms in diabetic neuropathy as well as improved wound healing. A decrease in insulin resistance and augmentation of beta cell function seen in preclinical studies has not been consistently demonstrated in human trials.

DISCUSSION AND CONCLUSION

In animal models, PDE5 inhibition appears to decrease oxidative stress and reduce some of the micro- and macrovascular complications associated with diabetes. However, data from human trials are limited and largely inconsistent, highlighting the need for adequately powered, randomised-controlled trials in diabetic cohorts in order to fully assess the benefits of PDE5i in this group of patients.

Religiosity, Sex Frequency, and Sexual Satisfaction in Britain: Evidence from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal)

Previous studies on the relationship between religiosity and sexual behavior have yielded mixed results, partly due to variations by gender and marital status. Furthermore, less is known about this relationship in relatively secularized societies, as in the case of Britain. In this study, we used data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) to explore the link between religiosity (11% of men and 16% of women stated that religion and religious beliefs were very important to them) and sex frequency and satisfaction among men and women in different types of relationships. Women and men who saw religion as more important in their lives reported having less sex on average, though this was mainly driven by the significantly lower sex frequency among non-cohabiting religious individuals compared to their less religious peers. At the same time, religiosity was linked with overall higher levels of sex life satisfaction. This relationship appeared to be largely mediated by attitudes on the appropriate context for sexual intercourse. These findings highlight the importance of sociocultural norms in shaping sexual behavior and sexual satisfaction.

Sexuality in Older Adults in A Primary Care Unit of Thailand during the COVID-19 Pandemic: A Cross-sectional Survey

OBJECTIVES

To investigate sexuality in older Thai adults during the coronavirus disease (COVID-19) pandemic and the associated factors.

METHODS

This cross-sectional survey was conducted on older adults visiting a primary care unit (PCU) in Thailand. A hundred and ninety older adults were enrolled by convenience sampling. Multiple logistic regression analysis with a backward stepwise algorithm was used to analyze factors associated with sexual desire and activity in older Thai adults.

RESULTS

The median age of participants was 67.99 (60.01-88.57) years, and 63.2% were women. Overall, 37.4% of participants had sexual desires, and 54.2% were sexually active during the COVID-19 pandemic; however, more than half reported a decrease in sexual activity, fearing COVID-19 transmission as the most common reason. Men had more sexual desire and activity than women (adjusted OR [95% CI] = 13.92 [4.76, 40.73] and 6.63 [2.59, 16.94], respectively).

CONCLUSIONS

Older Thai adults in the PCU displayed decreased sexual desire and activity during the COVID-19 pandemic. Sexual health is a lifestyle aspect that required investigation and care during the pandemic.

CLINICAL IMPLICATIONS

Older Thai adults should be educated in that sexual activities can be broader than sexual intercourse, and sexual health should be cared for during an eventual new pandemic disease.

[The place of support care]

Supportive care, in the context of breast cancer in the elderly, is part of standard oncogeriatric care. Nevertheless, the multidisciplinary reinforcement of the different transversal teams can support the global approach, that is essential to the quality of care and the life course. Evaluation is the basis of this management. As a result of this evaluation, the approach to sexual health is a novelty that is often insufficiently considered with elderly patients suffering from breast malignancy.

The association between Parkinson's disease and Sexual dysfunction: Clinical correlation and therapeutic implications

Sexual function which comprises of desire, arousal, orgasm and satisfaction and pain, involves coordinated physiologic responses from multiple different pathways. Sexual dysfunction (SD) occurs when these domains of the sexual response cycle are affected. SD is a common but under-recognized non-motor feature in Parkinson's disease (PD), a common age-related neurodegenerative disorder. SD significantly affects the quality of life of PD patients and their partners. Advanced age, gender, hormone deficiency, neuropsychiatric and medical comorbidities contribute to SD in PD. Possible potential pathological mechanisms include vasculogenic, endocrinologic, neurogenic and psychogenic factors. Various therapeutic interventions, both pharmacological and non-pharmacological modalities have been suggested to improve SD in PD. However, erectile dysfunction (ED) is the only SD with evidence-based treatment available. Non-pharmacological therapies are also offering promising evidence in the improvement of SD. A multidisciplinary approach in the assessment, investigation, and treatment is needed to address the real life complex issues (gender and comorbidities, neurobiological, vasoactive, hormonal as well as psychosocial aspects). Future clinical studies with validated and standardized methods in assessing SD as well as experimental models will be necessary for better insight into the pathophysiology. This would facilitate appropriate therapy and improve sexual rehabilitation in PD patients.

Drug-Induced Sexual Dysfunction: An Analysis of Reports to a National Pharmacovigilance Database

INTRODUCTION

Sexual dysfunction (SD) is a problem that can affect any phase of the sexual response cycle (such as sexual desire, arousal and orgasm) and individuals of any age. SD can be caused by physical reasons, such as medical conditions, alcoholism or drug abuse; psychological factors, such as stress and anxiety; and different medicines, such as selective serotonin reuptake inhibitors (SSRIs), and their associated adverse effects.

AIM

The aim of this study was to characterise drugs suspected to have caused SD adverse drug reactions (ADRs) in patients, by conducting a descriptive study based on pharmacovigilance reports.

METHODS

Reports submitted to the Netherlands Pharmacovigilance Centre Lareb from January 2003 to December 2019 were used to investigate drug-induced sexual disorders. Selected reports had at least one ADR reported in the Medical Dictionary for Regulatory Activities (MedDRA^®) System Organ Class (SOC) 'Reproductive system and breast disorders' and the SOC 'Psychiatric disorders' relating to sexual disorders and corrected for drug utilisation (expenditure) for the Dutch population.

RESULTS

A total of 2815 SD ADRs were reported in the observed period. Data were divided according to three variables: pharmacotherapeutic group, the drug itself, and sex. A total of 722 different SD/pharmacotherapeutic group pairs were observed. The pharmacotherapeutic groups with the highest frequency of SD reports were SSRIs (n = 488, 17.58%), other antidepressants (n = 172, 6.20%) and HMG-CoA reductase inhibitors (n = 149, 5.37%). Distinguishing ADRs by sex, men suffered more from erectile dysfunction, decreased libido and ejaculation disorders, while among women, libido disorders, dyspareunia and SD were the most common ADRs.

CONCLUSION

Different reactions and disproportionality of reactions were detected between the sexes. Antidepressants, antihypertensives, oral contraceptives, α-blockers, and anti-androgens were the pharmacotherapeutic groups with the highest number of SD reports and corresponding high odds ratios.

Sexual and Emotional Health after Allogeneic Hematopoietic Cell Transplantation: A Comprehensive Review and Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

A person’s sexual and emotional life is greatly impacted after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This topic is not addressed very much by patients and caregivers. Physical, endocrine and genital chronic graft versus host disease (cGVHD)-related disorders are multiple and intertwined with psychological disorders. The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has issued recommendations for a better gynecological monitoring of female recipients after allo-HCT. A patient booklet was also offered to patients in the form of questions and answers to facilitate discussions between patients and caregivers and to improve the management of sexual and emotional life after transplant.

Management strategies of sexual dysfunctions in Parkinson's disease

Sexual dysfunctions (SD) are frequent and highly disabling nonmotor manifestations of Parkinson's disease (PD) but are also potentially treatable. Neurologists should actively discuss, recognize and treat sexual health issues as an integral part of the management of the disease. In this chapter, we provide recommendations for managing and treating both primary and secondary SD in PD. Many sexual problems can be, at least partially, improved by adjusting the treatment of motor, nonmotor symptoms and comorbidities. Although some treatments of primary SD are evidence-based, many therapeutic options have not been yet systematically studied in patients with PD. The development of new treatments and repurposing of existing remedies in patients with PD remain an unmet need.

Sexuality and neurodegenerative disease: An unmet challenge for patients, care-givers and treatment

BACKGROUND

Many factors affect sexuality in the elderly such as dementia which is a common cause of inappropriate sexual behaviors. These behavioral disturbances are distressing, disruptive and impair the care of the patient. Summery: The onset of dementia does not erase sexuality. Sexual expression can be an important aspect of wellbeing for older adults with dementia. This study gives a general overview about the relationship between sexuality and cognitive impairment. It starts with a general discussion of sexual aspects in the elderly. This is followed by research studies in this field including effects of dementia on sexual life, sexuality issues related to cognitive decline, inappropriate sexual behaviors in dementia patients and sexuality in healthcare institutions. We discuss also ethical aspects in relation with sexuality and dementia. Finally, we show different approaches to treat inappropriate sexual behaviors. Key messages: The discussion of sexuality in dementia raises many medical and ethical concerns. Inappropriate sexual behaviors are estimated to occur in about 7% to 25% of demented patients. The question is how to address such a delicate subject and discuss it in an easy way without making the patient feel humiliated or mistreated. This narrative review reveals sexual problems and difficult questions encountered in daily practice with patients suffering from cognitive impairment.

Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa

BACKGROUND

Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire.

AIM

The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios.

SETTING

This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district.

METHODS

This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group.

RESULTS

One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group.

CONCLUSION

Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.

Reliability of the Polish Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Assessment of Sexual Function before and after Pelvic Organ Prolapse Reconstructive Surgery-A Prospective Study

It is estimated that 31–44% of all patients with symptomatic POP and/or UI suffer from sexual dysfunction. We aimed to validate the PISQ-12 in pre-and postmenopausal women and to assess the sexual function before and after POP reconstructive surgery. One hundred and forty sexually active patients were hospitalized due to symptomatic POP and 50 healthy controls were enrolled into the study. The patients were asked to complete PISQ-12, the FSFI and Beck’s depression scale questionnaires twice. The Cronbach’s alpha (α) was used to estimate the internal consistency. The scores were compared using the Intraclass Correlation Coefficient (ICC). Improvement in the QoSL (quality of sexual life) was observed in each age group of women. Pre-menopausal patients’ QoSL was much better, both before and after surgery (29.62 and 34.64 points, respectively). The correlation between questionnaires before surgery was 0.63, and after was −0.76. The α value for the PISQ-12 was 0.83 before the procedure and 0.80 afterwards. In all the groups, the test–retest reliability was good—ICC = 0.72. Vaginal reconstructive surgeries improve the QoSL. The only demographic factor influencing the QoSL was the menopausal status. The Polish version of the PISQ-12 is a reliable and responsive instrument for assessing the sexual function in patients with diagnosed POP and/or UI.

Sexual Obligation and Perceived Stress: A National Longitudinal Study of Older Adults

Objectives: This study examines the relationship between sexual obligation and perceived stress among older adults in the United States.Methods: Using longitudinal data from three waves of the National Social Life, Health, and Aging Project (NSHAP), our sample included 1,477 partnered, sexually-active respondents aged 57 to 85 at the baseline survey. We estimated mixed-effects models to test how feelings of sexual obligation are related to changes in perceived stress score.Results: Sexual obligation was positively associated with perceived stress score. The positive relationship between sexual obligation and perceived stress score became stronger over the study period among older men, although it remained relatively stable among older women. Relationship quality only partially explains this relationship.Conclusions: Feeling more obligated to have sex had a significantly greater effect on older men's perceived level of stress over time than older women's. This association became marginally significant after relationship quality was controlled for, suggesting that relationship quality was a key explanatory factor for the gendered patterns in sexual obligation's linkage to stress. These results highlight the importance of understanding gendered sexuality among aging older adults within the context of their relationship.Clinical Implications: Older adults' feelings of sexual obligation can manifest in their daily stress experience. Clinicians seeking to lower older adults', in particular older men's, stress levels should address the context of their sexual life and if they feel obligated to have sex, along with the positive and negative aspects of their relationship, as these could elevate their stress levels over time.

Body Image and Hypoactive Sexual Desire Disorder Relationship in a Representative Sample of Iranian Women

Objective: Hypoactive Sexual Desire Disorder (HSDD) among women is a complicated one which is created by various factors playing roles. One of the potential concerns related to Body Image (BI) is lack of sexual appeal in women. Body Image is often described as what a person perceives of their body encompassing the biological, psychological and social factors. The present research pursues the goal to investigate the association between BI and HSDD among the reproductive age women in Iran. Materials and methods: The current study is a cross-sectional (descriptive -analytical) research done on 1000 reproductive age included woman (15-49 years), performed by systematic random sampling method. The data collection tool includes the socio-demographics and the sexual desire scale in addition to the revised sexual distress scale to measure HSDD completed as self-report by the samples. Univariate and multivariate regression tests have been used in order to analyze the data. Results: The mean ± SD age of the women participating in the study was 32.09 ± 7.33. Having adjusted the confounder variables' effect by logistic regression multivariate analysis; the odd ratio for HSDD has been analyzed. The findings suggested that the odd ratio for HSDD in those not satisfied or slightly feeling fulfilled with their BI has been OR: 4.2 (95% CI: 1.98-9.05) and OR: 3.9 (95% CI: 2.29-6.65), respectively, times more than the ones highly satisfied with their body image. Conclusion: The present study results indicate that being dissatisfied with BI is a determinant factor of HSDD that is more probable in the people with negative image of their body structure and feeling lack of bodily appeal. Thus it is imperative to pay attention to this factor when analyzing HSDD.

Prostatic Urethral Lift Versus Medical Therapy: Examining the Impact on Sexual Function in Men with Benign Prostatic Hyperplasia

BACKGROUND

Sexual dysfunction is a common side effect of medical therapy for benign prostatic hyperplasia (BPH), whereas prostatic urethral lift (PUL) offers safe and effective relief of lower urinary tract symptoms while preserving sexual function.

OBJECTIVE

To compare the long-term impact on sexual health of PUL or daily medical therapy of doxazosin or finasteride alone or in combination in BPH patients.

DESIGN, SETTING, AND PARTICIPANTS

This was a comparative analysis of sexual function outcomes from PUL studies (L.I.F.T. [n=107], Crossover [n=42], and MedLift [n=39]) and the Medical Therapy of Prostatic Symptoms (MTOPS) trial. The men included were sexually active with International Prostate Symptom Score ≥13, Qmax ≤12ml/s, and prostate volume 30-80 cm³. MTOPS subjects completed the Brief Male Sexual Function Inventory, while PUL subjects completed the International Index of Erectile Function and the Male Sexual Health Questionnaire for Ejaculatory Function.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Mean percentage changes from baseline in erectile, ejaculatory, and sexual satisfaction domains were compared at 12, 24, 36, and 48 mo.

RESULTS AND LIMITATIONS

PUL significantly improved erectile function through 24 mo, and ejaculatory function and sexual satisfaction across all time points. Medical therapy did not improve sexual function at any time point. Finasteride significantly decreased erectile function at 48 mo, and combined therapy significantly reduced ejaculatory function at 12 and 24 mo. Comparatively, PUL was superior to finasteride in preserving erectile function at 24 and 48 mo, and superior to doxazosin and combined therapy at 12 mo. PUL outperformed all three medical therapies at all time points in improving ejaculatory function and sexual satisfaction. Limitations include the use of distinct patient-reported questionnaires and narrowed data on comorbidities that influence male sexual function.

CONCLUSIONS

Indirect comparison reveals that PUL is superior to BPH medical therapy in preserving erectile and ejaculatory function and sexual satisfaction.

PATIENT SUMMARY

In our non-head-to-head study, only patients undergoing PUL for an enlarged prostate experienced improvements in sexual health. Conversely, patients on medical therapy experienced worsening of erectile and ejaculatory function.

Significant Increase of Sexual Dysfunction in Patients With Renal Failure Receiving Renal Replacement Therapy: A Systematic Review and Meta-Analysis

BACKGROUND

It has been shown that sexual dysfunction (SD) is highly prevalent among patients with chronic renal failure (CRF), and starting renal replacement therapy may even increase it. However, SD is an infrequently reported problem in these treated patients.

AIM

To investigate the prevalence of SD among patients with CRF undergoing renal replacement therapy, by a meta-analysis method.

METHODS

PubMed, Embase, and the Cochrane Library were systematically searched for all studies assessing sexual function in patients with CRF receiving renal replacement therapy from January 2000 to April 2020. Relative risk (RR) with 95% CIs was used for analysis to assess the risk of SD in patients with CRF receiving renal replacement therapy. The cross-sectional study quality methodology checklist was used for the cross-sectional study. The methodologic quality of the case-control and cohort studies was assessed with the Newcastle-Ottawa Scale. Data were pooled for the random-effect model. Sensitivity analyses were conducted to assess potential bias. The Begg and Egger tests were used for publication bias analysis.

OUTCOMES

The prevalence of SD among patients with CRF receiving renal replacement therapy was summarized using pooled RR and 95% CI.

RESULTS

This meta-analysis included 3,725 participants from 10 studies. Of these, 737 were patients with CRF receiving renal replacement therapy. The mean age of participants ranged from 32.75 to 56.1 years. Based on the random-effect model, synthesis of results demonstrated that the prevalence of SD was significantly increased among patients with CRF receiving renal replacement therapy in women (RR = 2.07, 95% CI: 1.47-2.91, P = .000; heterogeneity: I² = 78.7%, P = .000) and in men (RR = 2.95, 95% CI: 2.16-4.02, P = .000; heterogeneity: I² = 86.1%, P = .000). Estimates of the total effects were generally consistent in the sensitivity analysis. No evidence of publication bias was observed.

CLINICAL IMPLICATIONS

Patients with CRF receiving renal replacement therapy had a significantly increased risk of SD, which suggests that clinicians should evaluate sexual function, when managing patients with CRF receiving renal replacement therapy.

STRENGTHS AND LIMITATIONS

This is the first study to explore the prevalence of SD among patients with CRF undergoing renal replacement therapy based on all available epidemiologic studies. However, all included studies were an observational design, which may downgrade this evidence.

CONCLUSION

The prevalence of SD is significantly increased among patients with CRF receiving renal replacement therapy. More research studies are warranted to clarify the relationship. Luo L, Xiao C, Xiang Q, et al. Significant Increase of Sexual Dysfunction in Patients With Renal Failure Receiving Renal Replacement Therapy: A Systematic Review and Meta-Analysis. J Sex Med 2020;17:2382-2393.

Associations of Affect, Action Readiness, and Sexual Functioning

Introduction

Emotions are theorized to contain the components of affect and action readiness. Affect guides behavior by causing an approach or withdrawal orientation. Action readiness is the individual's degree of willingness to interact with the environment. Emotions contribute to changes in behavior and physiological responses.

Aim

The present study applied these notions to sexuality and examined the associations between affect, action readiness, and sexual functioning.

Methods

Participants were male patients with urologic condition (N = 70) with and without sexual problems.

Main Outcome Measure

Affect and action readiness were jointly assessed using the latent factor of affective polarity of the Positive and Negative Affect Schedule. Trait affective polarity was assessed questioning generally experienced feelings. State affective polarity was assessed after exposure to an erotic stimulus and questioning momentaneously experienced feelings. Sexual functioning was assessed using the International Index of Erectile Functioning questionnaire.

Results

A significant increase of approach-oriented action readiness was found after erotic stimulation, relative to trait levels. In addition, significant associations were found between state approach-oriented action readiness and various aspects of sexual functioning. Interventions based on principles of positive psychology might be developed to reinforce action readiness in men with erectile dysfunction. The strength of the current research concerns the introduction of action readiness as a potential psychological factor implied in sexual functioning. Limitations pertain to the use of the algorithm used to calculate state approach-oriented action readiness and the use of the current sample of patients with urological conditions, limiting generalizability of findings.

Conclusion

Action readiness was found to correlate positively with all aspects of sexual functioning. Further research into the role of action readiness in sexuality is recommended.

Henckens MJMJ, de Vries P, Janssen E, et al. Associations of Affect, Action Readiness, and Sexual Functioning. Sex Med 2020;8:691–698.

Effects of age on depressive symptomatology and response to antidepressant treatment in patients with major depressive disorder aged 18 to 65 years

BACKGROUND

There is evidence that symptomatology in patients with major depressive disorder (MDD) changes with age. However, studies comparing depressive symptomatology between different age groups during antidepressant therapy are rare. We compared demographic and clinical characteristics in depressed patients of different age groups at baseline and during treatment.

METHODS

889 MDD inpatients were divided into four age groups (18-29, 30-39, 40-49, 50-65 yrs.). Demographic and clinical characteristics including depressive symptomatology (assessed by the Inventory of Depressive Symptoms) were assessed at baseline and weekly during treatment.

RESULTS

At baseline, young patients (18-29 years) significantly more often reported cognitive symptoms like irritability, suicidality, negative self-concept and interpersonal sensitivity and more often suffered from drug abuse and comorbid personality disorders. Late middle aged patients (50-65 years) significantly more often suffered from neuro-vegetative symptoms such as reduced general interest, sexual interest and sleep disturbances and more often showed a recurrent MDD and comorbid physical disorders. During therapy, symptoms such as interpersonal sensitivity in young patients and low interest in sex in late middle aged patients persisted until the end of treatment while all other symptoms declined until day 56.

LIMITATIONS

The herein presented age differences in depressive symptomatology only hold true for the study medication and are not generalizable to other antidepressants agents.

CONCLUSION

There are substantial differences in the clinical presentation of depression between age groups. Whereas many of these differences disappear during treatment, some differences persisted until the end of treatment. These findings my help to more specifically tailor the treatment of depressed patients.

Sexual function through decades: association with androgens and cardiometabolic features

Aim: This study aimed to determine the change in sexual function among Turkish women through decades and to define the association between sexual dysfunction and androgens and cardiometabolic features.Materials and methods: A total of 206 postmenopausal women aged 50-69 years and 210 premenopausal women aged 30-49 years who applied to menopause and gynecology clinics at a university-affiliated education and research hospital were included in this prospective study. Groups were constructed according to decades (i.e., 30-39, 40-49, 50-59, and 60-69 years). Sexual function was assessed between the groups, using the Female Sexual Function Index (FSFI). Cardiometabolic features and androgen levels were also compared between the groups.Results: Sexual function determined at each decade by FSFI scores were 27.18, 23.11, 18.40, and 11.35, respectively (fourth, fifth, sixth, and seventh decade). Desire, arousal, and satisfaction domains tended to be lower in the 40s than in the 30s. As time passes after the 30s, the total FSFI score decreased until the late 60s. Serum total testosterone, androstenedione, and dehydroepiandrostenedione sulfate (DHEAS) levels decreased through the decades. There was no correlation between cardiometabolic features, androgens, and FSFI scores.Conclusion: According to our survey, sexual function decreases starting at the age of 30 and continues to drop until the late 60s among postmenopausal women. There was no association between sexual dysfunction and androgen levels in premenopausal women. The serum DHEAS level was associated with sexual dysfunction only among postmenopausal women. There was no association between sexual dysfunction and cardiometabolic features in either premenopausal or postmenopausal women.

Evaluating co-occurrence of depression and sexual dysfunction and related factors among Iranian rural women: A population-based study

Background and objectives

Sexual dysfunction and mood disorders have a high prevalence rate and their co-occurrence has been reported in previous studies. This study aimed to determine the prevalence of co-occurrence of sexual dysfunction and depression and related factors in women.

Materials and methods

This descriptive-analytical study was carried out on 826 married rural women aged 15-49 years in Sari, Iran in 2018, selected by random sampling. The participants filled the demographic and fertility questionnaires, as well as Beck's Depression Inventory and Female Sexual Function Index (FSFI).

Results

In this study, 18% of the participants experienced the co-occurrence of depression and sexual dysfunction. In addition, results of the multiple logistic regression showed that forced marriage (OR = 0.31, CI 95%: 0.15 to 0.64, P < 0.001), a one-level increase in the education of the spouse (OR = 0.76, CI 95%: 0.59 to 0.98, P < 0.041), lack of history of depression (OR = 0.36, CI 95%: 0.20 to 0.66, P < 0.001) and lack of vaginal infection (OR = 0.41, CI 95%: 0.27 to 0.62, P < 0.001) were considered as factors contributing to a decline in the co-occurrence of depression and sexual dysfunction. On the other hand, not having a private bedroom (OR = 1.63, CI 95%: 1.09 to 2.43, P < 0.017), no vehicle (OR = 1.52, CI 95%: 1.02 to 2.27, P < 0.038), a history of sychiatric diseases (OR = 2.09, CI 95%: 1.2.0 to 3.65, P < 0.009), lack of chronic diseases (OR = 2.11, CI 95%: 1.03 to 4.31, P = 0.039) and lack of use of antidepressants (OR = 2.03, CI 95%: 2.03 to 1.03, P < 0.039) increased the co-occurrence of depression and sexual dysfunction.

Conclusion

According to the results of the study, about one-fifth of the married rural women experienced the co-occurrence of depression and sexual dysfunction. If healthcare providers detect one of the disorders of depression or sexual dysfunction in a patient, it is suggested that the person be assessed in terms of the other disorder and the proper treatment be applied. Furthermore, the healthcare personnel must pay attention to factors related to the co-occurrence of these disorders in addition to providing a treatment program.

Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease

Background

Stenoses of internal pudendal arteries (IPAs) appear to be related to erectile dysfunction (ED). Nevertheless, the correlation between the severity of ED and stenosis of the IPAs is not well established.

Objectives

To evaluate angiographic findings of IPAs in patients with suspected coronary artery disease (CAD) and to assess the correlation between the severity of ED and IPA stenosis.

Materials and methods

Ninety-one patients who were scheduled for cardiac angiogram (CAG) because of suspected CAD participated. ED was assessed using the International Index of Erectile Function (IIEF) questionnaire. Erectile function (EF) domain scoring was used to assess the severity of ED: severe (EF score = 1–10); moderate (11–16); mild-moderate (17–21); mild (22–25); and no ED (26–30). Angiography was performed in bilateral common, internal iliac, and IPAs and the location and extent of stenoses were measured. We divided patients according to those with maximum stenosis of less than 50% (Group I) and those with more than 50% (Group II), regardless of direction.

Results

We diagnosed 88 patients (88/91, 96.70%) with ED. There was no correlation between increasing age and severity of ED (r = - 0.063, p = 0.555). There were 72 patients in Group I and 19 in Group II. In Group I, 62 patients were diagnosed with ED even though there was no stenosis. There was no significant correlation between the severity of ED and the extent of stenosis in IPAs (r = -0.118, p = 0.265).

Conclusions

There was no significant correlation between the severity of ED and the extent of stenosis of IPAs. We believe that this is because the progression of ED is induced by endothelial cell dysfunction, not by mechanical obstruction leading to blood flow reduction.

Sexual Health of Postmenopausal Women in North India

Background:

Sexual health is the most important aspect of person's well being, self-esteem and quality of life. Sexual pleasure leads to enhanced conjugal relationships and an overall healthy psychological state. There is paucity of data on sexual health of postmenopausal women.

Aims and Objectives:

To assess the prevalence and determinants of sexual health in postmenopausal women of North India.

Materials and Methods:

The study was conducted over a period of 18 months, from January 2016 to June 2017. Standard FSFI-6 questionnaire and various socio-demographic factors were used to analyse the sexual health of 110 menopausal women.

Results:

80.9% postmenopausal women reported sexual dysfunction (SD). We found more sexual dysfunction in postmenopausal women with increasing age and increasing duration of menopause. Satisfied past sexual experience, joint family structure, low socioeconomic and education status were found to be important determinants of sexual health of postmenopausal females. Parity, substance use and past medical and gynaecological history of participants and various partner's factors like medical disorders, substance use and sexual disorders showed no association with sexual health in postmenopausal females.

Conclusion:

Sexuality varies with cultural and social differences across the globe. The prevalence of female sexual dysfunction in our study is much higher because Indian women are suppressed, self conscious, inhibited and hesistant to talk about their sexual problems with health care professionals. Also revalidation of the FSFI tool for Indian population is required. Further studies are needed to evaluate the sexual health in postmenopausal women.

Chronic Disease Burden, Sexual Frequency, and Sexual Dysfunction in Partnered Older Adults

This research evaluates the relationship between chronic disease burden and partnered sexuality of older adults by using data from the National Social Life, Health, and Aging Project. Ordinary least squares and logistic regressions identify how chronic disease burden is associated with sexual frequency and sexual dysfunction for men (N = 893) and women (N = 641). Results indicate that an increasing chronic disease burden is negatively associated with men's sexual frequency, while a greater burden of chronic disease is related to a greater risk of lubrication problems for women and orgasm problems for men. The findings reveal gender differences in how disease is linked to older adults' sexual lives.

Are we neglecting sexual function assessment in suspected cauda equina syndrome?

OBJECTIVES

We assessed the documentation rates of signs and symptoms, including sexual function, in patients with suspected cauda equina syndrome and whether they can be improved by increasing local awareness.

PATIENTS AND METHODS

We reviewed all electronic records of patients referred with suspected CES who required urgent MRI to our regional service over a 2 month period. We recorded the documentation rates of clinical signs and symptoms. The results were presented locally to increase awareness. A further 2 month period was then re-audited. 120 patients in total were included across both time periods. Chi-squared was used to compare documentation rates between time periods.

RESULTS

25 of 120 patients had radiological cauda equina compression. Lower limb neurology, urinary function and saddle sensation were almost universally documented. After the intervention, there was a significant increase (p < 0.05) in the documentation of bowel function and post-void residual but not sexual function. Sexual function was poorly documented with rates of 3% and 11% throughout the two audited periods.

CONCLUSION

Certain clinical features of CES are well documented. Increasing awareness may improve documentation of certain symptoms/signs in patients with suspected cauda equina syndrome. Sexual function was poorly documented and increasing awareness alone is an inadequate intervention.

The willingness of Saudi men with type 2 diabetes to discuss erectile dysfunction with their physicians and the factors that influence this

OBJECTIVES

The study's objectives were to find out the proportion of Saudi men with type 2 diabetes who have been asked by their physicians about erectile dysfunction (ED) in the last year, to determine the willingness of Saudi men with type 2 diabetes to discuss ED, and to explore the factors that may be related to their willingness to discuss ED with their physicians.

METHODS

This study employed a cross-sectional survey design using a quantitative self-administered questionnaire among 309 Saudi men with type 2 diabetes. The study was conducted in hospital-based primary care clinics at King Khalid University Hospital, Riyadh, Saudi Arabia during the period from July to September 2015.

RESULTS

The mean age of the patients was 60.2 years with the mean duration of diabetes approximately 12.5 years. Few of the patients (9.7%) had been asked by their physicians about ED within the last year of attending the clinics although most patients (84.8%) were willing to discuss this issue. The presence of ED among the respondents was 89%. Two participants' characteristics were associated with a willingness to discuss ED with the physicians. These characteristics were age above 60 (OR = 0.25, 95% CI: 0.11-0.55), and having severe ED (OR = 0.26, 95% CI: 0.08-0.85). The respondents' main barriers to discussing ED with their physicians were embarrassing the doctor, ED is a personal issue, too old or too sick to address ED issues now, no effective treatment available, and the doctor is too young to discuss ED with.

CONCLUSIONS

Most patients who have type 2 diabetes are not asked about ED within the last year of attendance even though most are willing to discuss it with their physicians. Being older and suffering more severe ED will result in being less willing to discuss ED with their doctor. Further research is needed to explore the barriers which prevent physicians from discussing ED with their patients who have diabetes.

Rheumatoid Arthritis and Risk of Sexual Dysfunction: A Systematic Review and Metaanalysis

Objective.

It has been reported that there is an association between rheumatoid arthritis (RA) and increased susceptibility to sexual dysfunction (SD). This systematic review and metaanalysis aimed to investigate whether RA was a risk factor for SD.

Methods.

MEDLINE (PubMed), EMBASE, and the Cochrane Library were systematically searched for all studies assessing sexual function in patients with RA. The association between RA and risk of SD was summarized using relative risk (RR) with 95% CI.

Results.

Overall, 44,745 participants (mean age 43.2 yrs) were included from 7 studies (4 cross-sectional and 3 case-control studies). Of these, 6642 were patients with RA, with the mean disease duration from 5.7 years to 12.17 years. The methodological qualities of the included studies were judged as moderate to high. Synthesis of results demonstrated that RA was significantly associated with an increased risk of SD in females (RR 1.73, 95% CI 1.36–2.22, p < 0.001; heterogeneity: I2 60.3%, p = 0.028) as well as in males (RR 1.99, 95% CI 1.64–2.43, p < 0.001). The outcomes related to the Grading of Recommendations Assessment, Development, and Evaluation approach showed that the absolute effect of RA on SD was 10 more per 1000 (6–15 more); the overall quality of evidence was rated as low.

Conclusion.

Evidence from included studies indicates that patients with RA have a significantly increased risk of SD, which suggests that both patients and clinicians should be aware of the potential role of RA in the development of SD.

Prevalence and predictors of erectile dysfunction in adult male outpatient clinic attendees in Johor, Malaysia

INTRODUCTION

Erectile dysfunction (ED) is a serious global burden that affects men as well as their partners. This study aimed to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia.

METHODS

We conducted a cross-sectional study of Malaysian men aged ≥ 18 years attending two major outpatient clinics in Johor Bahru and Segamat in Johor, Malaysia, between 1 January 2016 and 31 March 2016. Subjects were chosen via simple random sampling and 400 patients were recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay versions of the 15-item International Index of Erectile Function, and the 21-item Depression Anxiety Stress Scale.

RESULTS

The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17.0%), mild to moderate (23.8%), moderate (11.3%) and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indian as compared to Malay ethnicity (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734) and stress (OR 4.259, 95% CI 1.793-10.114).

CONCLUSION

ED has significant prevalence and severity among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, singlehood and stress were significant predictors of ED.

The Predictive Value of Arteriogenic Erectile Dysfunction for Coronary Artery Disease in Men

BACKGROUND

Erectile dysfunction (ED) is assumed to be connected with vascular disease caused by endothelial dysfunction, and characterized by the incapability of the smooth muscle cells lining the arterioles to relax, therefore, inhibit vasodilatation.

AIM

To assess the predictive value of arteriogenic ED for coronary artery disease in men above the age of 40 years.

METHODS

75 Patients reporting arteriogenic ED and 25 men with normal erectile function were enrolled in the study. Both patients and controls were subjected to the following investigations: lipid profile, fasting blood sugar, body mass index (BMI), waist circumference, penile duplex study, stress electrocardiography (ECG) test, International Index of Erectile Function (IIEF) Type 5 (Arabic version), and cardiovascular (CV) 10-year risk assessment using Framingham and Prospective Cardiovascular Münster (PROCAM) scoring systems.

OUTCOMES

We compare between the study groups regarding the interpretation of exercise testing.

RESULTS

We observed significant increase in the mean value of age, systolic blood pressure, BMI, weight, height, and waist circumference in the cases; significant prevalence of obesity and overweight in the cases (P < .001); significant increase in the mean value of total cholesterol, triglycerides (TG), and low-density lipoprotein; and decrease in mean value of high-density lipoprotein in the cases (P < .001). Additionally, there was high incidence of positive stress ECG in the cases (25.3%) vs that in controls (12%), and significant difference between patients with positive stress ECG test and those with negative stress ECG test regarding their lipid profile, age, BMI, and waist circumference with higher values in positive stress ECG for total cholesterol, TG, and low-density lipoprotein, and lower value for high-density lipoprotein (P < .001). According to PROCAM and Framingham scoring systems 10-year risk assessment, there was a high significant difference between the cases and control groups with a higher score in cases than the control group with 30.7% of cases having ≥ 30% risk of developing coronary heart disease, and significant positive correlations between CV risk and BMI, and negative correlations with IIEF-5 cases (P < .001).

CLINICAL TRANSLATION

Ischemic heart disease events were higher in men with documented arteriogenic ED than those without ED.

CONCLUSIONS

All items of metabolic syndrome were investigated and analyzed and we evaluated our groups using both PROCAM and Framingham scoring system. An exercise ECG is suggested before starting treatment of vasculogenic ED at least in patients with CV risk factors. Azab SS, Hosni HED, El Far TA, et al. The Predictive Value of Arteriogenic Erectile Dysfunction for Coronary Artery Disease in Men. J Sex Med 2018;15:880-887.