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Chen M, Zhang Z, Zhou R, Li B, Jiang J, Shi B. The relationship between oxidative balance score and erectile dysfunction in the U.S. male adult population. Sci Rep 2024; 14:10746. [PMID: 38730004 PMCID: PMC11087471 DOI: 10.1038/s41598-024-61287-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
Oxidative stress strongly influences the pathophysiology of erectile dysfunction (ED). In this study, we used the oxidative balance score (OBS), a composite index, to measure the effects of oxidative stress triggered by diet and lifestyle factors. Here, we conducted a cross-sectional study to determine the statistical relationship between OBS and ED among adult males in the U.S. The data from 3318 participants in the National Health and Nutrition Examination Survey (NHANES) 2001-2004 were analyzed. Weighted logistic regression was used to correct for confounding factors and acquire nationwide representative estimates. Generalized additive modeling was used to explore the nonlinear relationship. We also supplemented subgroup and sensitivity analysis to examine the robustness of the main results. Multivariate logistic regression indicated a consistent negative linear association between OBS and ED across all participants [OR (95% CI) = 0.96 (0.94, 0.98)]. After categorizing OBS into tertiles, participants in the highest tertile had 43% lower odds of having ED than those in the lowest tertile [OR (95% CI) = 0.57 (0.37, 0.87)]. The generalized additive model also visualized the linear trend of this association. Furthermore, this linear relationship remained relatively consistent, regardless of whether subgroup or sensitivity analyses were performed. Our findings suggest that adopting a lifestyle and diet pattern that promotes favorable OBS may effectively protect against the development of ED, regardless of the underlying causes.
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Affiliation(s)
- Mutong Chen
- Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
- Shantou University Medical College, Shantou, China.
| | - Zhongfu Zhang
- Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Rui Zhou
- Clinical Psychology/Psychosomatic Medicine Department, Shenzhen People's Hospital, Shenzhen, China
| | - Baizhi Li
- Shantou University Medical College, Shantou, China
| | - Jiahao Jiang
- Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Bentao Shi
- Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
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Lazar A, Gewirtz-Meydan A, Rosenbaum TY. War-Time Stress and Sexual Well-Being in Israel. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:1-14. [PMID: 38596811 PMCID: PMC10903651 DOI: 10.1080/19317611.2024.2317169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 04/11/2024]
Abstract
Objective This study explored the relationship between war-related stressors and sexual well-being among a civilian population during the 2023 Israel-Hamas War, emphasizing a comprehensive assessment of sexual satisfaction, function, and distress. We aimed to investigate how direct exposure, media exposure, and acute stress symptoms during the war contribute to various dimensions of sexual well-being using a quasi-longitudinal online survey method. Methods An online survey with a convenience sample of 1033 Israeli adults, utilizing measures of direct and media exposure to war stress, acute stress symptoms, and various aspects of sexual well-being, both pre-war and present was distributed. Data analysis involved Pearson correlations and hierarchical regression. Results There were significant associations between stress-related variables and sexual well-being, highlighting the differential contribution of direct exposure, media exposure, and acute stress symptoms. Direct exposure to stress was uniquely associated with sexual dysfunction, while media exposure and acute stress symptoms contributed significantly to predicting various aspects of sexual well-being. Conclusions Recognizing the multifaceted impact of stress during wartime on sexual well-being is crucial for developing comprehensive mental health interventions that address individual and societal factors. This study contributes valuable insights into the relationships between stress-related variables and sexual well-being during wartime, emphasizing the need for holistic approaches in addressing the intimate challenges individuals face during times of conflict.
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Affiliation(s)
- Aryeh Lazar
- Department of Psychology, Faculty of Humanities and Social Sciences, Ariel University, Ariel, Israel
| | - Ateret Gewirtz-Meydan
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Kolaja CA, Roenfeldt K, Armenta RF, Schuyler AC, Orman JA, Stander VA, LeardMann CA. Sexual Health Problems among Service Men: The Influence of Posttraumatic Stress Disorder. JOURNAL OF SEX RESEARCH 2022; 59:413-425. [PMID: 33428452 DOI: 10.1080/00224499.2020.1855622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Military operational stressors, such as combat exposure, may increase the risk of sexual health problems. This study examined factors associated with sexual health problems, and tested the mediating effect of probable posttraumatic stress disorder (PTSD) on the association between stressors (i.e., combat deployment and sexual assault) and sexual health problems among U.S. service men. Using multivariable logistic regression (n = 16,603) and Cox proportional hazards models (n = 15,330), we estimated the risk of self-reported sexual health difficulties and sexual dysfunction medical encounters, respectively. Mediation analyses examined the effect of probable PTSD as an intermediate factor between high combat deployment and sexual assault on sexual health problems. Approximately 9% endorsed sexual health difficulties and 8% had a sexual dysfunction. Risk factors for these sexual health problems included older age, lower education level, enlisted rank, disabling injury, certain medical conditions, and higher body mass index. Probable PTSD significantly mediated the associations between high combat with sexual health problems and sexual assault with sexual dysfunction. Additionally, high combat was directly associated with sexual health difficulties. These findings indicate a relationship between these stressors and sexual health problems which suggests that treatment options should be expanded, especially to include psychogenic sexual dysfunctions.
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Affiliation(s)
- Claire A Kolaja
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
| | - Kimberly Roenfeldt
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
| | - Richard F Armenta
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
- Department of Kinesiology, College of Education, Health, and Human Services, California State University
| | - Ashley C Schuyler
- College of Public Health and Human Sciences, Oregon State University, San Marcos
| | - Jean A Orman
- Department of Epidemiology & Biostatistics, University of Texas Health at San Antonio, Texas
| | | | - Cynthia A LeardMann
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
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K Blais R, K Zalta A, S Livingston W. Interpersonal Trauma and Sexual Function and Satisfaction: The Mediating Role of Negative Affect Among Survivors of Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5517-NP5537. [PMID: 32990170 DOI: 10.1177/0886260520957693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Healthy sexual function among women service members/veterans (SM/Vs) is associated with higher quality of life, lower incidence and severity of mental health diagnoses, higher relationship satisfaction, and less frequent suicidal ideation. Although trauma exposure has been established as a predictor of poor sexual function and satisfaction in women SM/Vs, no study to date has examined whether specific trauma types, such as military sexual trauma (MST), increase risk for sexual issues. Moreover, the possible mechanisms of this association have not been explored. The current study examined whether posttraumatic stress disorder (PTSD) and depression symptom clusters mediated the association of trauma type and sexual function and satisfaction in 426 trauma-exposed women SM/Vs. Two hundred seventy participants (63.4%) identified MST as their index trauma. Path analyses demonstrated that MST was related to poorer sexual function and lower satisfaction relative to the other traumas (χ2[28, N = 426] = 43.3, p = 0.03, CFI = 1.00, TLI = 0.99, and RMSEA = 0.04), and this association was mediated by higher non-somatic depressive symptoms and PTSD symptom clusters of anhedonia and negative alterations in cognition and mood (NACM). Causality cannot be inferred due to the cross-sectional nature of the data. However, our findings suggest that interventions aimed at decreasing sexual issues among female SM/Vs with MST should target depressogenic symptoms, whether the origin is depression or PTSD. Longitudinal research exploring the etiological processes that contribute to sexual dysfunction among those with MST is needed.
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Kratzer L, Heinz P, Schennach R, Knefel M, Schiepek G, Biedermann SV, Büttner M. Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis. Psychol Med 2022; 52:90-101. [PMID: 32517829 DOI: 10.1017/s0033291720001750] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse. METHODS Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization. RESULTS A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms. CONCLUSIONS Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.
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Affiliation(s)
- Leonhard Kratzer
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Peter Heinz
- Department of Psychotraumatology, Clinic St. Irmingard, Prien am Chiemsee, Germany
| | - Rebecca Schennach
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Knefel
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Günter Schiepek
- Institute for Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
- Department of Psychiatry and Psychotherapy, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
- Department of Psychology, Ludwig-Maximilians-University, Munich, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melanie Büttner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universität München, Munich, Germany
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Blais RK. The Association of Exposure to Military Sexual Trauma and Romantic Relationship Satisfaction Among Partnered Men Service Members/Veterans: The Influence of Compulsive Sexual Behavior. FAMILY PROCESS 2021; 60:1295-1306. [PMID: 33400283 DOI: 10.1111/famp.12623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Civilian literature shows a strong, consistent association between exposure to sexual violence and poor romantic relationship satisfaction. The impact of sexual violence that occurred during military service, or military sexual trauma (MST), on romantic relationship satisfaction among partnered men service members/veterans (SM/Vs) is understudied. However, a recent study conducted in women observed that MST that involved an assault was associated with poorer relationship satisfaction through higher sexual dysfunction and lower sexual satisfaction. The current study extended the literature by examining sexual function as a mediator of the association of exposure to MST and romantic relationship satisfaction among partnered men SM/Vs (N = 499). Participants completed self-report measures of MST exposure, romantic relationship satisfaction, erectile dysfunction, and compulsive sexual behavior, as well as a demographic inventory. The average score on relationship satisfaction was in the distressed range. Sixty-four participants (12.83%) reported MST exposure. MST exposure was related to lower relationship satisfaction through higher compulsive sexual behavior. The model explained 16% of the variance in relationship satisfaction. The indirect effect of erectile dysfunction was nonsignificant. Current findings are consistent with research in women SM/Vs: the association of MST and romantic relationship satisfaction appears to be indirect, through the effects of sexual function. Couples' therapy may be most effective if it addresses sexual health concerns among men MST survivors, particularly engagement in compulsive sexual behaviors. Due to low endorsement of MST that involved assault, the impact of MST severity could not be examined.
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Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
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Kolaja CA, Schuyler AC, Armenta RF, Orman JA, Stander VA, LeardMann CA. Sexual health difficulties among service women: the influence of posttraumatic stress disorder. J Affect Disord 2021; 292:678-686. [PMID: 34157663 DOI: 10.1016/j.jad.2021.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.
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Affiliation(s)
- Claire A Kolaja
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
| | - Ashley C Schuyler
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA
| | - Jean A Orman
- University of Texas Health at San Antonio, TX, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
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Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Garneau-Fournier J, McBain S, Turchik JA. Factors Associated with Sexual Satisfaction among Veterans Who Have Experienced Military Sexual Trauma. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:721-735. [PMID: 32847446 DOI: 10.1080/0092623x.2020.1808548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Veterans who have experienced military sexual trauma (MST) report lower sexual satisfaction than veterans without a history of MST. The current study examined the relationship between demographic, physical health, mental health, and trauma variables and sexual satisfaction among a national sample of U.S. veterans who endorsed MST. Results demonstrated that lower sexual satisfaction was associated with uncoupled relationship status, poor physical health, and symptoms of depression, post-traumatic stress disorder, and sexual dysfunction among male and female veterans. Several additional factors were related to lower sexual satisfaction among female veterans. Findings highlight the importance of gender-targeted assessment, prevention, and treatment of sexual satisfaction problems.
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Affiliation(s)
- Jade Garneau-Fournier
- Pacific Graduate School of Psychology at Palo Alto University, Palo Alto, CA, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Sacha McBain
- Pacific Graduate School of Psychology at Palo Alto University, Palo Alto, CA, USA
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jessica A Turchik
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA
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Dhillon HS, Yadav B, Bhat PS, Dhillon GK, Sasidharan S. Association of sociodemographic factors with various domains of alcohol-induced sexual dysfunction - An Indian perspective. Ind Psychiatry J 2020; 29:272-278. [PMID: 34158712 PMCID: PMC8188919 DOI: 10.4103/ipj.ipj_112_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/30/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual dysfunction is frequently seen in alcohol-use disorders. The available research on this topic has studied erectile dysfunction and premature ejaculation using nonvalidated scales. This study was undertaken to study the other major domains of sexual dysfunction, namely sexual desire, orgasmic dysfunction and satisfaction, and their association with sociodemographic factors. MATERIALS AND METHODS A cross-sectional descriptive study design was used and 78 male patients were recruited. The assessment was conducted using a specially designed intake pro forma, International Index of Erectile Function (IIEF-15) Scale, DSM-5 and International Classification of Disease, 10th revision, diagnostic criteria for research. A correlation between the amount of alcohol consumed and its effect on various domains of sexual dysfunction was also carried out using Pearson's correlation coefficient. RESULTS The sociodemographic profile was studied in association with the overall (total) IIEF-15 subscale using analysis of variance (ANOVA). Statistically significant differences were observed among age groups, education subgroups, marital disharmony, years of alcohol use, and lifetime alcohol use. Further, since the values of ANOVA were significant, Tukey's post hoc analysis was carried out which showed a statistically significant difference among the groups. Various domains of sexual dysfunction showed a strongly negative correlation for overall IIEF subscale followed by intercourse satisfaction, sexual desire, and orgasmic function with years of alcohol use and lifetime alcohol use. CONCLUSION Sexual dysfunction in alcohol dependence patients was significantly associated with a family history of paternal alcohol abuse, lower educational background, increasing age, and marital disharmony. This study also found a strongly negative correlation between various domains of sexual functioning and years of alcohol use/lifetime alcohol use.
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Affiliation(s)
| | - Bhupendra Yadav
- Department of Psychiatry, 5 Air Force Hospital, Jorhat, Assam, India
| | - P S Bhat
- Brig Med, HQ 03 Corps, c/o 99 APO, Dimapur, Nagaland, India
| | | | - Shibu Sasidharan
- Department of Anaesthesiology and Critical Care, Level III Hospital, Goma, Congo
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12
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Elnazer HY, Baldwin DS. Structured review of the use of the Arizona sexual experiences scale in clinical settings. Hum Psychopharmacol 2020; 35:e2730. [PMID: 32236977 DOI: 10.1002/hup.2730] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Approximately 40% of women and 30% of men describe sexual dysfunction, although recognition in medical settings is suboptimal, due to problems in reporting and eliciting concerns relating to sexual function and satisfaction. Screening questionnaires may help to support this aspect of clinical practice. The Arizona sexual experiences scale (ASEX) includes items that quantify sex drive, arousal, vaginal lubrication or penile erection, ability to reach orgasm, and satisfaction from orgasm. METHOD We investigated the validity and other psychometric properties of the ASEX, and the findings from the populations in which it has been employed, by searching MEDLINE, EMBASE, and Google Scholar using the terms, Arizona sexual experiences scale, Arizona Sexual Experience Questionnaire, and ASEX. We eliminated duplications, letters, and papers not available in English, and grouped the remaining papers into the categories of psychometric, epidemiological, and outcome-based studies. RESULTS After elimination of letters and duplicates, papers not in English, and preclinical and irrelevant studies, 104 papers were analyzed. The ASEX has excellent internal consistency, scale reliability and strong test-retest reliability. Analyses of variance reveal significant differences in total ASEX scores between patients and controls and between females and males. ASEX appears to be useful in a range of clinical situations including patients with primary sexual dysfunction, specific psychiatric disorders, specific physical illnesses, and treatment emergent sexual dysfunction. DISCUSSION The ASEX appears to be a reliable instrument for identifying and quantifying sexual dysfunction across a range of populations in various clinical settings. Little is known about its utility in patients with anxiety disorders or relationships between ASEX scores and biological parameters.
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Affiliation(s)
- Hesham Y Elnazer
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry). Academic Department, University of Southampton, Southampton, UK
| | - David S Baldwin
- Faculty of Medicine, Clinical and Experimental Sciences (CNS and Psychiatry). Academic Department, University of Southampton, Southampton, UK
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Richardson JD, Ketcheson F, King L, Forchuk CA, Hunt R, St Cyr K, Nazarov A, Shnaider P, McIntyre-Smith A, Elhai JD. Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment. Mil Med 2020; 185:68-74. [PMID: 31268528 DOI: 10.1093/milmed/usz163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/07/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. MATERIALS AND METHODS Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction. RESULTS Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse. CONCLUSIONS Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.
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Affiliation(s)
- J Don Richardson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Felicia Ketcheson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Lisa King
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Callista A Forchuk
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada
| | - Renée Hunt
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Kate St Cyr
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St. Rm 500, Toronto, ON, M5T 3M7, Canada
| | - Anthony Nazarov
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Philippe Shnaider
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | | | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, 2801 Bancroft St, Toledo, OH, 43606
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Blais RK, Livingston WS, Fargo JD. Higher depression severity mediates the association of assault military sexual trauma and sexual function in partnered female service members/veterans. J Affect Disord 2020; 261:238-244. [PMID: 31655379 DOI: 10.1016/j.jad.2019.09.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/16/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Military sexual trauma (MST), and assault as opposed to harassment-only MST in particular, is associated with lower sexual function among female service members/veterans (SM/Vs). Recent research revealed that higher posttraumatic stress disorder (PTSD) symptom clusters of anhedonia and dysphoric arousal mediated the association of assault MST and sexual function. Such clusters represent the depressive symptoms of PTSD, and theories of sexual function suggest that depression worsens sexual function. The impact of depression on the association of MST and sexual function has yet to be tested. METHOD Using path analysis, the study examined whether depression severity mediated the association of MST and sexual function after accounting for demographics and mediators of PTSD-related anhedonia and dysphoric arousal. Female SM/Vs (N = 697) completed measures of MST (history, severity), depression, PTSD-related anhedonia and dysphoric arousal, sexual function, and a demographic inventory. RESULTS One hundred twenty-two (17.50%) indicated that they did not experience MST, 336 (48.21%) reported that they experienced harassment-only MST, and 239 (34.29%) reported assault MST. Fit indices evidenced strong model fit, χ2(12, N = 697)=18.85, p=.09, CFI=1.00, TLI=0.99, SRMR=0.02, and RMSEA=0.03. The indirect effect of depression severity was significant (p<.001). LIMITATIONS Use of cross-sectional data in a convenience sample of female SM/Vs. CONCLUSIONS Even after accounting for established covariates and mediators of assault MST and sexual function, depression accounted for a significant amount of variance in this association. Treatment of poor sexual function must address depressive symptoms. As medications for depression can exacerbate sexual issues, psychotherapy may be the most effective treatment strategy.
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Wilcox SL, Varpio L. Finding Comfort in the Discomfort of Difficult Conversations with Military Patients. Mil Med 2019; 184:e590-e593. [DOI: 10.1093/milmed/usz137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/04/2019] [Accepted: 05/24/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sherrie L Wilcox
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
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de Alarcón R, de la Iglesia JI, Casado NM, Montejo AL. Online Porn Addiction: What We Know and What We Don't-A Systematic Review. J Clin Med 2019; 8:E91. [PMID: 30650522 PMCID: PMC6352245 DOI: 10.3390/jcm8010091] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 01/09/2023] Open
Abstract
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the "triple A" influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.
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Affiliation(s)
- Rubén de Alarcón
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Javier I de la Iglesia
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Nerea M Casado
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Angel L Montejo
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
- University of Salamanca, EUEF, 37007 Salamanca, Spain.
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Dick B, Reddy A, T. Gabrielson A, Hellstrom WJ. Organic and Psychogenic Causes of Sexual Dysfunction in Young Men. ACTA ACUST UNITED AC 2018. [DOI: 10.29252/ijmr-040404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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Nnamani NS, Pugh MJ, Amuan ME, Eapen BC, Hudak SJ, Liss MA, Orman JA. Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration. Mil Med 2018; 184:e297-e301. [DOI: 10.1093/milmed/usy196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nina S Nnamani
- US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Mary Jo Pugh
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX
- South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
| | - Megan E Amuan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
- Department of Rehabilitation Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX
| | - Steven J Hudak
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Michael A Liss
- South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX
| | - Jean A Orman
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX
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Balzano FL, Hudak SJ. Military genitourinary injuries: past, present, and future. Transl Androl Urol 2018; 7:646-652. [PMID: 30211054 PMCID: PMC6127528 DOI: 10.21037/tau.2018.04.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Genitourinary (GU) injuries among military service members are as old as war itself. The frequency and clinical picture of GU injuries sustained in conflicts over the ages have evolved along with the constantly changing nature of combat. In this review, we discuss changing trends in the diagnosis and management of GU injuries over the past century and introduce areas of innovation which could impact the care of casualties who sustain GU trauma in the future.
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Bhalla A, Allen E, Renshaw K, Kenny J, Litz B. Emotional numbing symptoms partially mediate the association between exposure to potentially morally injurious experiences and sexual anxiety for male service members. J Trauma Dissociation 2018; 19:417-430. [PMID: 29601288 DOI: 10.1080/15299732.2018.1451976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Service members (SMs) returning from deployment are at risk of a range of sexual problems, some of which are thought to be related to psychological issues that may arise during deployment or combat. The current study sought to examine whether exposure to potentially morally injurious events (PMIEs) was associated with sexual anxiety (SA) above and beyond combat exposure and whether any such association was mediated by post-traumatic stress disorder (PTSD) symptom clusters. These questions were tested using data from self-report surveys collected from 221 partnered male Army (Active Duty, National Guard, or Reserve) SMs at three separate time points. Findings showed that exposure to PMIEs was significantly related to greater SA, with transgressions by self and perceived betrayal demonstrating unique associations when controlling for all factors of PMIEs. Moreover, total exposure to PMIEs was associated with SA above and beyond general combat exposure. PTSD symptoms partially mediated the association between exposure to PMIEs and SA, with emotional numbing accounting for significant unique indirect effects after controlling for other PTSD symptom clusters. The findings suggest that exposure to PMIEs is associated with SA, even when accounting for either combat exposure or PTSD symptoms, emphasizing the importance of this issue in understanding post-deployment problems in sexual intimacy.
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Affiliation(s)
- Arjun Bhalla
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - Elizabeth Allen
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - Keith Renshaw
- b Department of Psychology , George Mason University , Fairfax , VA , USA
| | - Jessica Kenny
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
| | - Brett Litz
- c Massachusetts Veterans Epidemiological Research and Information Center , Boston VA Healthcare System , Boston , MA , USA
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Blais RK, Monteith LL, Kugler J. Sexual dysfunction is associated with suicidal ideation in female service members and veterans. J Affect Disord 2018; 226:52-57. [PMID: 28961442 DOI: 10.1016/j.jad.2017.08.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/15/2017] [Accepted: 08/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Suicide is a leading cause of premature death among military service members/veterans (SM/Vs). The Interpersonal Theory of Suicide (Joiner, 2007) proposes that higher thwarted belonging, perceived burdensomeness, and acquired capability confer increased risk for suicide. However, no studies have examined the association of sexual dysfunction, a possible component of thwarted belonging and perceived burdensomeness, with suicidal ideation. The present study explored whether sexual dysfunction was associated with suicidal ideation when accounting for mental health, demographic, and military characteristics among female SM/Vs. METHOD Female SM/Vs (n = 710) completed an anonymous online survey assessing demographics, mental health, military characteristics, sexual dysfunction, and suicidal ideation. RESULTS One hundred fifty-nine participants (22.39%) reported suicidal ideation during the preceding two weeks. A multivariable ordinal regression adjusted for age, marital status, probable posttraumatic stress disorder (PTSD), probable depression, race/ethnicity, Army service, and deployment history. Lower sexual functioning (adjusted odds ratio [AOR] = 0.98, 95% confidence interval[CI] = 0.95-0.99), probable PTSD (AOR = 2.54, 95% CI = 1.61-4.01), and probable depression (AOR = 5.28, 95% CI = 3.34-8.34) were associated with suicidal ideation. Post-hoc analyses examined the association of suicidal ideation with specific components of sexual functioning: difficulties with sexual arousal (AOR = 0.87, 95% CI = 0.79-0.97) and sexual satisfaction (AOR = 0.85, 95% CI = 0.75-0.96) were associated with suicidal ideation. LIMITATIONS Data were cross-sectional and limited to self-report. DISCUSSION Sexual dysfunction is associated with suicidal ideation, accounting for established mental health, military, and demographic characteristics among female SM/Vs. Efforts to prevent suicidal ideation in female SM/Vs may be enhanced by screening for and treating sexual dysfunction, particularly sexual arousal and satisfaction.
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Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, United States.
| | - Lindsey L Monteith
- Denver Veterans Affairs Medical Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), United States; Department of Psychiatry, University of Colorado Anschutz Medical Campus, United States
| | - Jordan Kugler
- Department of Psychology, Utah State University, United States
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23
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Colson M, Cuzin B, Faix A, Grellet L, Huyghes E. Current epidemiology of erectile dysfunction, an update. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2018.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Complex Genital Trauma: Lessons Learned from Operation Iraqi Freedom and Operation Enduring Freedom. CURRENT TRAUMA REPORTS 2017. [DOI: 10.1007/s40719-017-0106-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
PURPOSE OF REVIEW Sexual dysfunction is a frequent issue in patients with affective disorders, affecting its quality of life and posing challenges to the approach of these patients. RECENT FINDINGS In recent years, human sexuality has attracted interest from the scientific community, and today we have a much deeper knowledge of the mechanisms involved in the sexual response. Paraphilias or sexual dysfunctions like low sexual desire, premature ejaculation, and erectile dysfunction, are frequent in affective disorders, and the frequency of each sexual problem varies according to the affective disorder. Comparing what is currently known about the sexual response with the main neurobiological findings of depressive, anxiety, obsessive-compulsive and posttraumatic stress disorders, it is possible to better understand specific sexual complaints of patients with these disorders. SUMMARY A better understanding of sexual function in affective disorders may help clinicians to choose treatments more suited to specific needs of these patients. Although the current state of science already allows us to have some understanding about sexual function in affective disorders, this critical area of research is still in its infancy, waiting for more investment.
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Cederbaum JA, Wilcox SL, Sullivan K, Lucas C, Schuyler A. The Influence of Social Support on Dyadic Functioning and Mental Health Among Military Personnel During Postdeployment Reintegration. Public Health Rep 2016; 132:85-92. [PMID: 28005474 PMCID: PMC5298500 DOI: 10.1177/0033354916679984] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Although many service members successfully cope with exposure to stress and traumatic experiences, others have symptoms of depression, posttraumatic stress disorder (PTSD), and anxiety; contextual factors may account for the variability in outcomes from these experiences. This work sought to understand mechanisms through which social support influences the mental health of service members and whether dyadic functioning mediates this relationship. METHODS We collected cross-sectional data as part of a larger study conducted in 2013; 321 military personnel who had at least 1 deployment were included in these analyses. Surveys were completed online; we collected data on demographic characteristics, social support, mental health measures (depression, PTSD, and anxiety), and dyadic functioning. We performed process modeling through mediation analysis. RESULTS The direct effects of social support on the mental health of military personnel were limited; however, across all types of support networks, greater social support was significantly associated with better dyadic functioning. Dyadic functioning mediated the relationships between social support and depression/PTSD only when social support came from nonmilitary friends or family; dyadic functioning mediated social support and anxiety only when support came from family. We found no indirect effects of support from military peers or military leaders. CONCLUSION Findings here highlight the need to continue to explore ways in which social support, particularly from family and nonmilitary-connected peers, can bolster healthy intimate partner relationships and, in turn, improve the well-being of military service members who are deployed.
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Affiliation(s)
- Julie A. Cederbaum
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Sherrie L. Wilcox
- School of Social Work, University of Southern California, Los Angeles, CA, USA
- Center for Innovation and Research on Military Veterans and Families, Los Angeles, CA, USA
| | - Kathrine Sullivan
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Carrie Lucas
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ashley Schuyler
- School of Social Work, University of Southern California, Los Angeles, CA, USA
- Center for Innovation and Research on Military Veterans and Families, Los Angeles, CA, USA
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Prevalence of use of erectile dysfunction medication by Dutch military personnel between 2003 and 2012. Int J Impot Res 2016; 29:54-56. [PMID: 27853169 DOI: 10.1038/ijir.2016.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/09/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
Use of ED medication can be seen as a marker for ED. ED is associated with increasing age, exposure to traumatic events and physical injuries in military veterans. The objective of this study was to assess the prevalence of use of ED medication in Dutch military personnel in the period 2003-2012 and to assess its association with age and psychotropic medication use. Data on dispensing of ED medication, age and co-medication with psychotropic medication of all Dutch military personnel between 2003 and 2012 were collected. The prevalence of ED medication use in each year was estimated, stratified for age and use of psychotropic medication. The number of ED medication users increased a hundredfold from 0.09 to 9.29 per 1000 per year between 2003 and 2012. ED medication was more often used by men over 40 than under 40 (prevalence in 2012: 2.4% vs 0.2%, OR (2003-2012, adjusted for calendar year) 15.6, 95% CI 13.5-17.9) and by men using psychotropic medication (prevalence in 2012: 3.8% vs 0.9%, OR (2003-2012, adjusted for calendar year) 3.13, 95% CI 2.66-3.67). This study shows a strong increase between 2003 and 2012 in a number of ED medication users in male Dutch military personnel. ED medication use increases with age and with psychotropic medication use.
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28
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Genitourinary injuries and extremity amputation in Operations Enduring Freedom and Iraqi Freedom. J Trauma Acute Care Surg 2016; 81:S95-S99. [DOI: 10.1097/ta.0000000000001122] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Park BY, Wilson G, Berger J, Christman M, Reina B, Bishop F, Klam WP, Doan AP. Is Internet Pornography Causing Sexual Dysfunctions? A Review with Clinical Reports. Behav Sci (Basel) 2016; 6:E17. [PMID: 27527226 PMCID: PMC5039517 DOI: 10.3390/bs6030017] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/29/2016] [Accepted: 08/02/2016] [Indexed: 01/07/2023] Open
Abstract
Traditional factors that once explained men's sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain's motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography's unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.
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Affiliation(s)
- Brian Y Park
- Flight Surgeon, Fleet Logistics Support Squadron 40, Norfolk, VA 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Gary Wilson
- The Reward Foundation, 5 Rose Street, Edinburgh EH2 2PR, Scotland, UK.
| | - Jonathan Berger
- Department of Urology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Matthew Christman
- Department of Urology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Bryn Reina
- Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Frank Bishop
- Department of Ophthalmology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Warren P Klam
- Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
| | - Andrew P Doan
- Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
- Department of Ophthalmology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92592, USA.
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Breyer BN, Fang SC, Seal KH, Ranganathan G, Marx BP, Keane TM, Rosen RC. Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort. J Trauma Stress 2016; 29:229-36. [PMID: 27128485 PMCID: PMC4899252 DOI: 10.1002/jts.22097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 01/23/2023]
Abstract
We sought to determine whether posttraumatic stress disorder (PTSD) was associated with sexual health in returned warzone-deployed veterans from the recent Iraq and Afghanistan conflicts. We studied 1,581 males and females from the Veterans After-Discharge Longitudinal Registry, a gender-balanced U.S. Department of Veterans Affairs registry of health care-seeking veterans with and without PTSD. Approximately one quarter (25.1%) of males (n = 198) and 12.7% of females (n = 101) had a sexual dysfunction diagnosis and/or prescription treatment for sexual dysfunction. Both genders were more likely to have a sexual dysfunction diagnosis and/or prescription treatment if they had PTSD compared with those without PTSD (male: 27.3% vs. 21.1%, p = .054; female: 14.9% vs. 9.4%, p = .022). Among the 1,557 subjects analyzed here, males with PTSD had similar levels of sexual activity compared to those without PTSD (71.2% vs. 75.4%, p = .22), whereas females with PTSD were less likely to be sexually active compared to females without PTSD (58.7% vs. 72.1%, p < .001). Participants with PTSD were also less likely to report sex-life satisfaction (male: 27.6% vs. 46.0%, p < .001; female: 23.0% vs. 45.7%, p < .001) compared with those without PTSD. Although PTSD was not associated with sexual dysfunction after adjusting for confounding factors, it was significantly negatively associated with sex-life satisfaction in female veterans with a prevalence ratio of .71, 95% confidence interval [.57, .90].
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Affiliation(s)
- Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Shona C. Fang
- Division of Epidemiology, New England Research Institutes, Watertown, Massachusetts, USA
| | - Karen H. Seal
- Departments of Medicine and Psychiatry, University of California, San Francisco, Veterans Administration Medical Center, San Francisco, California, USA
| | - Gayatri Ranganathan
- Division of Epidemiology, New England Research Institutes, Watertown, Massachusetts, USA
| | - Brian P. Marx
- VA Boston Healthcare System, Boston, Massachusetts, USA
,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Terence M. Keane
- VA Boston Healthcare System, Boston, Massachusetts, USA
,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Raymond C. Rosen
- Division of Epidemiology, New England Research Institutes, Watertown, Massachusetts, USA
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Wilcox SL, Redmond S, Davis TL. Genital Image, Sexual Anxiety, and Erectile Dysfunction Among Young Male Military Personnel. J Sex Med 2015; 12:1389-97. [DOI: 10.1111/jsm.12880] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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32
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Yehuda R, Lehrner A, Rosenbaum TY. PTSD and Sexual Dysfunction in Men and Women. J Sex Med 2015; 12:1107-19. [DOI: 10.1111/jsm.12856] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Badour CL, Gros DF, Szafranski DD, Acierno R. Problems in sexual functioning among male OEF/OIF veterans seeking treatment for posttraumatic stress. Compr Psychiatry 2015; 58:74-81. [PMID: 25596624 PMCID: PMC4369440 DOI: 10.1016/j.comppsych.2014.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Few studies have examined sexual dysfunction among Operations Enduring/Iraqi Freedom (OEF/OIF) veterans with posttraumatic stress disorder (PTSD). The present study investigated predictors of erectile dysfunction [ED] and self-reported sexual problems among 150 male combat veterans seeking outpatient treatment for PTSD within the Veterans Affairs healthcare system. METHOD Participants completed clinical interviews and several questionnaires including measures of sexual arousal and sexual desire. A medical records review was also conducted to document evidence of an ED diagnosis or associated medication use. RESULTS An ED diagnosis was present for 12% of the sample, and 10% were taking associated medications. Sexual arousal problems were reported by sixty-two percent of partnered veterans. Sexual desire problems were endorsed by 63% of the total sample, and by 72% of partnered veterans. Age was the only significant predictor of ED diagnosis or medication use. Age, race, PTSD diagnosis (versus subclinical symptoms), depression, and social support predicted self-reported sexual arousal problems; while race, combat exposure, social support, and avoidance/numbing symptoms of PTSD predicted self-reported sexual desire problems. CONCLUSIONS Sexual problems are common among male OEF/OIF combat veterans seeking treatment for PTSD. Moreover, avoidance/numbing symptoms robustly predicted sexual desire problems. These findings highlight the importance of expanding assessment of sexual dysfunction and support the need for additional research in this area.
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Affiliation(s)
- Christal L. Badour
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA,Corresponding author. 67 President Street, MSC 861, 2nd Fl. IOP South Building, Charleston, SC 29425, Ph. (843) 792-2945, Fax (843) 792-3388,
| | - Daniel F. Gros
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Derek D. Szafranski
- National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Ron Acierno
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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Bentsen IL, Giraldi AG, Kristensen E, Andersen HS. Systematic Review of Sexual Dysfunction Among Veterans with Post‐Traumatic Stress Disorder. Sex Med Rev 2015; 3:78-87. [DOI: 10.1002/smrj.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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