Clinical Practice Guidelines for Management of Sexual Dysfunction

A comparison of the effect of aromatherapy with Jasmine (Jasminum) and clary sage (Salvia officinalis) on sexual dysfunction in women of reproductive age: A randomized controlled clinical trial

BACKGROUND

Sexual dysfunction affects various aspects of life. Aromatherapy is easier and less risky than other methods of taking herbal medicines. Against this backdrop, this study aims to compare the effect of aromatherapy with Jasminum and Salvia officinalis on sexual dysfunction in women of reproductive age.

MATERIALS AND METHODS

This triple-blind randomized clinical trial was conducted on 168 women aged 15 to 45 who were referred to Rafsanjan Comprehensive Health Services Center no. 1 from February 2022 to June 2022, using a systematic sampling method. Individuals with an FSFI (Female Sexual Function Index) score of less than 28 were randomly assigned to 4 aromatherapy groups of Jasminum and Salvia officinalis as well as sweet almond (placebo) and control. The aromatherapy groups used the relevant aroma twice a day for 6 weeks, yet the control group received no intervention. After the completion of the intervention, the FSFI questionnaire was filled in once again by all participants. Besides, data analysis was conducted using the SPSS software, Chi-squared test, Fisher's test, ANOVA, Kruskal-Wallis test, Wilcoxon test, and a paired samples t-test. In addition, a P value less than 0.05 was considered statistically significant.

RESULTS

The median (IQR) score of sexual function before the intervention in Jasminum, Salvia officinalis, sweet almond, and control groups was 25.50 (21.27-82.25), 25.80 (20.27-57.50), 25.00 (23.27-10.10), and 25.90 (23.26-92.42), respectively. After the intervention, the score was 28.30 (25.30-60.45), 28.45 (25.31-90.12), 29.00 (27.30-10.80), and 25.35 (23.26-27.32) in the abovementioned groups, respectively. The comparison of the median score of sexual function in the four groups after the intervention showed a statistically significant difference between Jasminum, Salvia officinalis, and sweet almond groups with the control group (P < 0.001). Additionally, the effect of Salvia officinalis was higher than that of Jasminum in the domains of mental arousal, lubrication, and sexual pain (P < 0.0125).

CONCLUSIONS

Both aromas, i.e., Jasminum and Salvia officinalis, were effective in improving sexual dysfunction in women of reproductive age. The effect of Salvia officinalis was better than that of Jasminum in the domains of mental arousal, lubrication, and sexual pain. More studies are recommended to be conducted in this field.

Association of Sexual Health and Mental Health in Erectile Dysfunction: Expert Opinion From the Indian Context

Erectile dysfunction (ED) is a common condition in men, driven by a complex interplay of organic, relational, and psychological factors, necessitating an integrated treatment approach. Psychological factors, such as anxiety, depression, and stress, are significant contributors to erectile problems. Erectile dysfunction can have severe psychological consequences, including feelings of emasculation, humiliation, reduced self-confidence, isolation, loneliness, and a decline in overall well-being. A national advisory board comprising 12 experts from India, including 9 urologists and 3 psychiatrists, convened to discuss a multidisciplinary approach to the treatment of ED. Using a modified Delphi method and literature review, the 34 panels developed evidence-based insights. Experts highlighted the importance of thorough assessments of sexual dysfunction in patients. Given the frequent comorbidity of mental health issues with ED, physicians should proactively explore patients' sexual and mental health. Creating a secure and welcoming environment is crucial for these assessments. Physicians should gather detailed information on psychological symptoms, stressors, relationship dynamics, cognitive style, and distractions. Experts highlighted the importance of thorough diagnostic assessments and recommended a multidisciplinary approach integrating pharmacological interventions (e.g., phosphodiesterase-5 inhibitors) with psychometric therapy, tailored to the age, existing comorbidities, and underlying causes of ED. A balanced, interdisciplinary approach incorporating psychosexual therapy, lifestyle modifications, and advanced therapies is crucial for the holistic management of ED. Key consensus recommendations also emphasized fostering open communication between patients and healthcare providers, routine mental health screenings in patients with ED, and early referrals to specialists when necessary. Clinicians should actively involve mental health professionals in the management of ED and prioritize individualized treatment strategies tailored to each patient's needs. This multifactorial condition requires coordinated efforts to address both organic and psychogenic causes, restore patients' quality of life, and promote open communication. By proactively engaging with patients, addressing their concerns, and facilitating referrals as needed, clinicians can significantly improve outcomes for patients with ED.

A narrative review on sexual wellbeing and dysfunctions: Research in the past 15 years

Background

Psychosexual health is an important aspect of mental and physical wellbeing. Though Indian culture has a rich history of sexuality, over the years, our population has been reticent in talking about the same. With the advent of technology and new legislations protecting the rights of LGBTQIA population, awareness is also on the rise.

Methods

This review focuses on research published by Indian authors over the past 15 years, with search of databases like PubMed, Scopus, Google Scholar, and Litmaps to include original articles and case reports.

Results

Most studies focus on male sexual dysfunctions. Some emerging research showed promise in female sexual dysfunctions, the elderly, and the LGBTQIA population. The majority of research in sexual health continues to concentrate on dysfunctions, primarily prevalence, associations, or risk factors. Several studies investigated various medical/psychiatric comorbidities associated with sexual dysfunctions. A few studies have explored management strategies as well.

Conclusion

This review highlights the need for a more holistic approach to management to sexual health issues. It further underscores the importance of grassroots-level initiatives working on improving the training of all medical practitioners and postgraduate students, increasing the availability of services for sexual disorders, promoting sexual health research in areas with gaps, and raising awareness in the general population.

Psychological and sociodemographic factors associated with hypoactive sexual desire in Ecuadorian women

Introduction

Human sexuality is a multifaceted process, and sexual desire plays a central role in the triphasic model of the sexual response cycle, as proposed by Helen Singer Kaplan.

Methods

In this cross-sectional correlational study, we examined the relationship between various sociodemographic factors, such as age and motherhood, and sexual variables, including erotophobia, erotophilia, homophobia, and unconventional sex, with hypoactive sexual desire in women from Quito, Ecuador. The study sample comprised 421 women between the ages of 18 and 50, who were administered the Revised Sexual Opinion Survey and the Inhibited Sexual Desire Scale to assess their sexual attitudes and levels of desire.

Results

The findings revealed that age (F = 7.13, p < 0.001) and motherhood (F = 13.72, p < 0.001) had a significant impact on inhibited sexual desire. Furthermore, significant correlations were observed between inhibited sexual desire and age (r = 0.16, p < 0.001), motherhood (r = 0.18, p < 0.001), erotophobia (r = 0.19, p < 0.001), erotophilia (r = -0.21, p < 0.001), and homophobia (r = -0.18, p < 0.001).

Discussion

These results suggest that women who are older, mothers, or have higher levels of erotophobia are more likely to experience hypoactive sexual desire. In contrast, higher levels of erotophilia and homophobia were inversely related to hypoactive sexual desire. This contributes to a deeper understanding of how different personal and sexual attitudes influence sexual desire in Ecuadorian women.

Sexual health and emotional wellbeing of patients with haematological malignancies: general review

Sexual health is an important aspect of a person's life. Many patients and haematologists believe that intimacy and sexuality issues are substantial during cancer treatment. The haematological cancer disease, diagnosis, shock of the announcement, treatment, and follow-up appointments, can all have negative effects on the quality of life of patients, their partners, other family members, and friends. Addressing the intimate aspects of patients' lives not only enhances their wellbeing but also contributes to the quality of their survivorship. Progress has been made in the management of sexual life-related complications; however, novel strategies in coordination with a multidisciplinary team need to be implemented. New and comprehensive approaches must be developed on a multidisciplinary scale. In this Series paper, we discuss the factors affecting the sexual life of patients with haematological malignancies, different methods to assess sexual function, as well as management approaches of sexual wellbeing among patients with haematological cancers.

Evaluation of community pharmacy technicians' knowledge, attitudes, and practices about erectile dysfunction and its predictors in Gondar Town: A cross-sectional descriptive study

Background

Erection Dysfunction, which primarily affects males older than 40 years, is the inability to regularly produce or retain a penile erection that is strong enough to satisfy sexual activity.

Objective

To evaluate knowledge, attitudes, and practices related to erectile dysfunction and its predictors among community pharmacy technicians in Gondar, Ethiopia.

Method

We conducted a cross-sectional descriptive study on pharmacy technicians in Gondar from June 1, 2022, to August 30, 2022. The study included 165 respondents and utilized a standardized questionnaire with 42 questions to assess their knowledge (18 items), attitudes (5 items), practices (15 items), and demographic characteristics (4 items) regarding erectile dysfunction. We performed both univariate and multivariate analyses on the collected data.

Results

Multivariate logistic regression analysis showed that greater educational attainment was independently correlated with increased knowledge of erectile dysfunction. For postgraduate pharmacy education, the adjusted odds ratio (AOR) was 0.031 (95 % CI: 0.006-0.170, p < 0.001).Regarding work experience, the adjusted odds ratios (AORs) were as follows: 6.223E-010 (95 % CI: 9.713E-011-3.987E-009, p < 0.001) for 1-5 years, 7.940E-010 (95 % CI: 1.381E-010-4.566E-009, p < 0.001) for 5-10 years, and 6.134E-010 (95 % CI: 1.333E-010-2.824E-009, p < 0.001) for over 10 years.Additionally, respondents with 5-10 years of work experience had an AOR of 8.129 (95 % CI: 1.476-44.786, p = 0.016), and the gender of the participants had an AOR of 3.399 (95 % CI: 1.239-9.325, p = 0.017), both of which were associated with erectile dysfunction behaviors.The aggregate ratings indicated that the participants had moderate knowledge, attitudes, and practices regarding erectile dysfunction. The Pearson Correlation Test revealed a significant positive relationship between knowledge of erectile dysfunction and attitude (r = 0.589 and p < 0.001) and practice (r = 0.524 and p < 0.001). Additionally, attitudes and practices showed a significant positive correlation (r = 0.321, p < 0.001).

Conclusion

The study findings showed that pharmacy technicians have a moderate level of understanding, attitudes, and practices regarding erectile dysfunction. The scores for general erectile dysfunction knowledge, attitude, and practice showed a significant positive association (p < 0.001).

Analysis of the quality of information provided by "Dr. YouTube™" on premature ejaculation

Background

YouTube™ is an important online resource to access health-related online information by the public worldwide. However, the quality of information available on it has not been adequately characterized.

Aim

To assess the quality and reliability of information available on the treatment of premature ejaculation (PME) on YouTube™ in the Hindi and English language videos.

Materials and Methods

A total of 151 (Hindi: 109, English: 42) YouTube videos were selected for assessment. The quality was evaluated using structured tools: Patient Education Materials Assessment Tool (PEMAT); and a 5-point modified DISCERN questionnaire (Range: 1-serious shortcomings; 5-minimal shortcomings). PEMAT assesses the understandability and actionability of video as separate percentages.

Results

Three most common treatments suggested for PME were Kegel exercise (22.5%), start-stop technique (21.9%), and antidepressant medications (20.5%). Antidepressant medications, stop-squeeze techniques, and psychotherapy were more frequently suggested in English videos, whereas ayurvedic or herbal medicines were more frequently suggested in Hindi videos. About two-thirds of videos presented information in an easy-to-understand and actionable manner (PEMAT scores ≥70%). Only 6% of videos had a DISCERN score of ≥4, indicating good overall quality of information presented in them.

Conclusion

People likely to encounter poor-quality information when seeking information for PME treatment on YouTube. A large number of videos suggested ineffective or unproven treatment strategies for PME. Healthcare professionals need to be mindful of this while counselling patients, and guide them regarding useful and reliable sources of health information available online.

Prospective, randomized, placebo-controlled, two-arm study to evaluate the efficacy of coadministration of garlic as a hydrogen sulfide donor and tadalafil in patients with erectile dysfunction not responding to tadalafil alone - A pilot study

OBJECTIVE

The objective is to evaluate the efficacy of coadministration of garlic (as a hydrogen sulfide [H2S] donor) and tadalafil for patients with ED using a placebo-controlled, prospective, randomized, two-arm pilot study in patients responding poorly to tadalafil alone.

MATERIALS AND METHODS

The patients with complaints of ED (with normal penile Doppler) who failed to maintain sustained improvement in erectile function with tadalafil were recruited after excluding those with comorbidities. The study sample was randomized into two groups. Group A received garlic 5 g twice a day orally and Group B received a placebo twice daily orally for 4 weeks. Both groups continued tadalafil 5 mg in the night for 4 weeks. Their erectile function was assessed at the beginning and at the end of 4 weeks using the International Index of Erectile Function (IIEF-EF), erectile function domain and compared. A value of P ≤ 0.05 was considered statistically significant.

RESULTS

Nineteen patients in Group A (mean age 37.5 ± 10.6 years) and 16 patients in Group B (mean age 39.6 ± 9.6 years) participated in the pilot study conducted from May 2022 to August 2022. The participants treated with garlic (as an H2S donor) as a coadministrant had statistically significant improvement in IIEF-EF score (P ≤ 0.0001) at the end of 4 weeks compared to placebo.

CONCLUSIONS

Garlic (as an H2S donor) as adjunctive therapy was beneficial in our study participants responding poorly to tadalafil alone.

Impact of Cognitive Behavior Therapy on Sexual Dysfunction of Women in Reproductive Age: A Systematic Review

Background

A large number of women suffer from sexual dysfunction. Cognitive behavior therapy (CBT) is a psycho-educational therapy the main purpose of which is to help the individual alter their dysfunctional beliefs and behaviors. We investigated the impact of CBT on reproductive-aged women's sexual function.

Methods

The present study is a systematic review and meta-analysis in which a number of databases (Web of Science, PubMed, Scopus, Cochrane Library, and Embase) were searched from inception to November 2023. Clinical trials examining the impact of CBT on female sexual dysfunction were included. This study evaluated female sexual function and its components, including satisfaction, discomfort, lubrication, arousal, climax, desire, and assertiveness. We used Review Manager version 5.3 for performing the meta-analysis. P values less than 0.05 were considered statistically significant.

Results

Seven articles including a total of 448 women with sexual dysfunction were reviewed. The participants' mean age in the CBT groups was 33.43 ± 6.04 years and that of the control group was 33.24 ± 5.97, which were not significantly different. Our results indicated that CBT is efficient in improving the total score of women's sexual function (SMD = 1.34, 95% CI = (1.02, 1.65), I2 = 86%), sexual satisfaction, lubrication, desire, orgasm, and assertiveness compared with the control group. However, CBT had no positive effect on reducing sexual pain.

Conclusion

Based on the result of the current study, CBT can be suggested as an effective treatment method along with other treatments for women with sexual problems.

Experience of adapted cognitive behaviour therapy to address sexuality problems after traumatic brain injury: A qualitative study

Although sexuality has been shown to be negatively impacted in up to half of individuals who sustain traumatic brain injury (TBI), few studies have sought to evaluate the efficacy of targeted interventions. Gaining insight into the participant experience of undergoing treatment for post-TBI sexuality changes is a crucial aspect of intervention evaluation. This study aimed to investigate participants with TBI experience of undergoing eight sessions of a novel CBT intervention designed to help both couples and singles improve sexual wellbeing after TBI. Eight participants (50% male) with moderate-severe TBI, and a mean age of 46.38-years (SD = 13.54), completed a qualitative interview. A six-phase reflexive thematic analysis approach was used. Despite variability in participant characteristics, the findings suggested that participants with TBI experience reflected that of a positive treatment journey characterized by high levels of enjoyment and satisfaction. Key themes identified included contextual factors that preceded treatment, factors that facilitated treatment engagement, outcomes derived from the treatment experience, and feedback provided on reflection. The results not only provide an enriched understanding of the client experience of the intervention but provide corroborating preliminary evidence of efficacy for this novel CBT intervention in addressing complex and persistent sexuality problems after TBI.

Treatment-emergent sexual dysfunctions due to antidepressants: A primer on assessment and management strategies

Antidepressants (ADs) are among the most commonly prescribed drugs worldwide. Persons with mental illness taking ADs commonly report sexual dysfunction (SD) related to treatment. A brief discussion on the neurobiology of sexual functioning and mechanism of treatment-emergent SD (TESD) was performed. The incidence of prevalence of TESD in various studies has been reviewed. TESD impacts patients as it frequently leads to nonadherence, while psychiatrists have challenges in proceeding forward with treatment in such patients. Assessment of patients with suspected TESD is described with a focus on practical tips for clinicians. Five strategies (watchful waiting, drug holiday, downward titration, switching, and add-on therapy) to manage TESD have been extensively discussed with evidence in the literature. Each strategy comes with its own bag of advantages and drawbacks, which have been pointed out for simplicity. A detailed discussion on individual pharmacological strategies is given, and options for non-pharmacological management that can be tried are enlisted. Common clinical case scenarios have been discussed to incorporate the implementation of this literature.

Knowledge, practices and barriers to access sexual health of women in the menopausal stages: a cross-sectional study with Brazilian gynecologists

BACKGROUND

Sexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women's health care in Brazil.

METHODS

With a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice.

RESULTS

The sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women's relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages.

CONCLUSIONS

Sexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.

Effect of vitamins on sexual function: A systematic review

Sexual dysfunction can adversely affect the quality of life, self-confidence, and interpersonal relationships. Some studies reported a relationship between vitamin supplementation and sexual health. This systematic review aimed to evaluate the effect of vitamins on female and male sexual function. All relevant English and Persian articles published in English databases (Medline, Scopus, Cochrane Library, Web of Sciences, Psycho-Info, and Proquest) and Farsi databases (SID and Magiran) until July 2020 were searched. The Cochrane Handbook for Systematic Reviews of Interventions was used for assessing the risks of bias. A total of 11 randomized controlled trials (RCTs) on 337 women, 472 men, and 35 couples were included. One study reported that vitamin D 300000 IU supplement administrated twice through intramuscular injection (at the beginning and after four weeks) had a significant effect on female sexual function (p<0.05), whereas another study showed that vitamin D 2000 IU supplement for six months did not have any significant effect on female sexual function (p>0.05). A study reported the significant effect of niacin (vitamin B3) 1500 mg daily for 12 weeks on erectile function (p=0.004). The results showed that vitamins A, C, and E had no significant effect on male and female sexual function. The conduction of trials with long-term interventions is recommended to reach a more definitive conclusion about the effect of vitamins on sexual function.

The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai): Reliability and validity in Thai patients with mental disorders

Background: Sexual dysfunction is common among patients with mental disorders but receives less clinical attention, especially in Thailand and other Asian countries. The Arizona Sexual Experiences Scale-the Thai Translation (ASEX-Thai), a self-rated, brief, questionnaire is a potential tool for screening for sexual dysfunction in this population. Our study aimed to assess the reliability and validity of ASEX-Thai in Thai patients with mental disorders.

Methods: We enrolled 202 patients from an outpatient psychiatric department at a tertiary hospital in Bangkok, Thailand. Demographic data, clinical data, and diagnosis of sexual dysfunction were assessed. ASEX-Thai was done, and we analyzed the test’s psychometric properties. 

Results: Most participants were diagnosed with major depressive disorder (48%). There was a positive correlation between the ASEX-Thai and sexual dysfunction diagnosis (r = 0.402, p < 0.001). The KMO coefficient was 0.77 and Barlett’s sphericity test was significant (χ  ² = 409.76, p<0.001). A score of ≥ 17 points of the ASEX-Thai was the most suitable for sexual dysfunction screening (sensitivity 77.23 %, and specificity 58.42 %). For reliability, the Cronbach’s alpha coefficient (0.831) showed good internal consistency.

Conclusions: The ASEX-Thai is a valid and reliable self-rated questionnaire for screening for sexual dysfunction among Thai patients with mental disorders. The test could help clinicians to evaluate this undetected condition and deliver proper interventions.

Reaching consensus: a scoping review on erectile disorder guidelines

Erectile disorder (ED) is the continuous or repeated inability to achieve an erection or maintain its firmness for an adequate amount of time during sexual intercourse. Given the importance of utilizing quality clinical practice guidelines (CPGs) for the diagnosis of ED, the research team conducted a scoping review of erectile disorder CPGs to address the questions based on the clinical guideline of the best quality. This scoping review was conducted in five steps: 1 - identification of the research question, 2 - identification of relevant studies, 3 - selection of studies, 4 - data extraction, 5 - summarizing and reporting the results. The initial search yielded 1,888 articles, CPGs and books but after primary and secondary screening by two appraisers, 9 CPGs were extracted. After that, the two appraisers examined the quality of these guidelines using the AGREE II tool. Eventually, 5 CPGs extracted. After reviewing 5 guidelines, 5 questions were answered. Overall, the CPGs had desirable overlap in response to the marked questions; nevertheless, there were some differences in details too. This review shows that the first and foremost principle in examining the affected individuals is taking a complete detailed history, followed by a physical examination and use of relevant questionnaires to complete the information necessary to diagnose the problem. The next step is to perform routine lab tests; hormonal profiles may also be checked, and if necessary, special tests should be performed based on an individual's conditions.

Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study

Background

Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician's or patient's reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables.

Methods

This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV).

Results

Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ2 = 7.86, P = 0.04), lower educational qualification (χ2 =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ2 = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ2 = 4.49, P = 0.03).

Conclusions

Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.

Evaluating a Novel Treatment Adapting a Cognitive Behaviour Therapy Approach for Sexuality Problems after Traumatic Brain Injury: A Single Case Design with Nonconcurrent Multiple Baselines

There has been little progress in development of evidence-based interventions to improve sexuality outcomes for individuals with traumatic brain injury (TBI). This study aimed to evaluate the preliminary efficacy of an individualised intervention using a cognitive behaviour therapy (CBT) framework to treat sexuality problems after TBI. A nonconcurrent multiple baseline single-case design with 8-week follow-up and randomisation to multiple baseline lengths (3, 4, or 6 weeks) was repeated across nine participants (five female) with complicated mild–severe TBI (mean age = 46.44 years (SD = 12.67), mean post-traumatic amnesia = 29.14 days (SD = 29.76), mean time post-injury = 6.56 years (median = 2.50 years, SD = 10.11)). Treatment comprised eight weekly, individual sessions, combining behavioural, cognitive, and educational strategies to address diverse sexuality problems. Clinical psychologists adopted a flexible, patient-centred, and goal-orientated approach whilst following a treatment guide and accommodating TBI-related impairments. Target behaviour was subjective ratings of satisfaction with sexuality, measured three times weekly. Secondary outcomes included measures of sexuality, mood, self-esteem, and participation. Goal attainment scaling (GAS) was used to measure personally meaningful goals. Preliminary support was shown for intervention effectiveness, with most cases demonstrating sustained improvements in subjective sexuality satisfaction and GAS goal attainment. Based on the current findings, larger clinical trials are warranted.

Perceived Barriers in the Assessment and Management of Female Sexual Dysfunction: a Survey Among Resident Trainees in Psychiatry

OBJECTIVE

The authors examined the perceived barriers in the assessment and management of female sexual dysfunction among resident trainees in psychiatry.

METHODS

An online survey was conducted among 148 resident trainees in psychiatry at a tertiary academic psychiatry center in India. It consisted of nine items with responses rated on a Likert scale. The anonymity of the responses was maintained.

RESULTS

A total of 73 residents (49.3%) responded to the survey. Spontaneous reporting of sexual functioning, which is patient-driven, and spontaneous inquiry, which is resident-driven, were lacking. Specific barriers identified in the majority were lack of time, privacy, linguistic challenges, limited knowledge, and sociocultural background of the patient. The gender of the resident was not perceived as a major barrier in a majority. Marital discord appeared as a common response for inquiries into sexual functioning, while the use of psychotropics, the presence of medical comorbidities, and the postmenopausal state did not attract a majority to inquire about the same. Furthermore, a response that there was a lack of intervention in those reporting sexual dysfunction was commonly noted. Only 5.5% of the participants reported having received adequate formal training in the management of female sexual dysfunction.

CONCLUSION

Female sexual dysfunction is common, adds to psychiatric morbidity, and affects the quality of life. It is important to impart training on female sexual dysfunction as a part of their residency program with cultural appropriateness. A future direction would be to evaluate the effectiveness of a formal training program for assessing and managing female sexual dysfunction.

Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked

Background

Sexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction.

Aim

This study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations.

Setting

The study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas.

Methods

One-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data.

Results

Twenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time.

Conclusion

Consultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.

The therapeutic potential of Crocus sativus Linn.: A comprehensive narrative review of clinical trials

Crocus sativus Linn. (Saffron) is valued worldwide for its potential use in the management of various degenerative disorders, including cardiovascular diseases (CVDs), diabetes, cancer, metabolic syndrome (MetS), neurodegenerative diseases, immune disorders, and sexual dysfunction. Previous reports, based on clinical trials, suggest that crocetin, crocin, picrocrocin, and safranal are the main bioactive components of saffron with antioxidant, anti-inflammatory, and anti-apoptotic effects. In this comprehensive narrative review, we studied the recent clinical trials, investigating the medicinal applications of saffron and/or its components. The present results can provide important insights into the potential of saffron in preventing and treating different disorders, with a special focus on the underlying cellular and molecular mechanisms. However, further high-quality studies are needed to firmly establish the clinical efficacy of saffron in treating some degenerative diseases.

History and mystery of Dhat syndrome: A critical look at the current understanding and future directions

Sexual health, an essential component of individual's health, is influenced by many complex issues including sexual behavior, attitudes, societal, and cultural factors on the one hand and while on the other hand, biological aspects, genetic predisposition, and associated mental and physical illnesses. Sexual health is a neglected area, even though it influences mortality, morbidity, and disability. Dhat syndrome (DS), the term coined by Dr. N. N. Wig, has been at the forefront of advancements in understanding and misunderstanding. The concept of DS is still evolving being treated as a culture-bound syndrome in the past to a syndrome of depression and treated as "a culturally determined idiom of distress." It is bound with myths, fallacies, prejudices, secrecy, exaggeration, and value-laden judgments. Although it has been reported from many countries, much of the literature has emanated from Asia, that too mainly from India. The research in India has ranged from the study of a few cases in the past to recent national multicentric studies concerning phenomenology and beliefs of patients. The epidemiological studies have ranged from being hospital-based to population-based studies in rural and urban settings. There are studies on the management of individual cases by resolving sexual myths, relaxation exercises, supportive psychotherapy, anxiolytics, and antidepressants to broader and deeper research concerning cognitive behavior therapy. The presentation looks into DS as a model case highlighting the importance of exploring sexual health concerns in the Indian population in general and in particular need to reconsider DS in the light of the newly available literature. It makes a fervent appeal for the inclusion of DS in the mainstream diagnostic categories in the upcoming revisions of the diagnostic manuals which can pave the way for a better understanding and management of DS and sexual problems.

A Systemic Review on the Association Between Infertility and Sexual Dysfunction Among Women Utilizing Female Sexual Function Index as a Measuring Tool

The Center for Disease Control and Prevention describes infertility as the inability to conceive after one year or longer with adequate unprotected sex. Infertility affects both females and males, interfering with their everyday lives and significantly impacting their mental health. Sexual dysfunction is defined as an alteration of the sexual response cycle phases, preventing satisfaction during sexual activity. The prevalence of sexual dysfunction in the United States is high, with about 10%-52% among men and 25%-63% among women. Different scales can measure sexual satisfaction and double as a tool to diagnose sexual dysfunction. The Female Sexual Function Index (FSFI) is the gold standard for diagnosing sexual dysfunction in women. Overall, fertile women had a higher score on the FSFI than infertile women; however, both groups showed sexual dysfunctions even if the fertile group was classified as a mild disorder. The most common disorders were disorders of desire and lubrication. Desire and arousal dysfunction appeared more common in participants with secondary infertility, while lubrication dysfunctions were more common in older participants. In the future, it will be important to evaluate other factors that affect sexual function and fertility including mental health, male health, and couple factors.

Demystifying Dhat Syndrome: A Two-Session Therapy Proposal

Dhat syndrome is a common semen-loss related physical and psychological distress usually reported by young males. The treatment mainly centres around nonpharmacological strategies such as psychoeducation. Most of the patients present as outpatients to alternative medicine or nonpsychiatry branches and treatment is usually not delivered. Some of the reasons may include perceived need for longer duration of sessions with the patient, available literature with complex psychiatric jargon and barriers to treatment due to stigma attached to psychiatry. This article presents a two session therapy proposal for Dhat syndrome that could be useful as a brief intervention over tele-consultations, and in consultation liaison clinics by nonpsychiatrists as well.

Demographic Profile and Presenting Complaints of Patients of Psychosexual Disorders: A Study in a Specialized Psychosexual Clinic of a Tertiary Care Centre

Introduction:

Sexual disorders are practically not addressed in community and primary care settings in India. Understanding the profile of patients visiting tertiary care centers’ psychosexual clinics (PSC) may be of value, to map some critical gaps in the service utilization.

Aim:

To understand the demographic profile and presenting complaints of patients with psychosexual disorders visiting a PSC.

Methods:

An audit of patients’ case records, diagnosis based on ICD-10 classification system, in a PSC over last 1 month was done, noting demographic factors and their frequency distributions.

Results:

Out of 55 patients visiting the clinic, most common age group was 21 to 30 years (49.09%) and only 2 were females. Maximum patients had education up to higher-secondary level (69.09%), were married (65.4%), and had a sexual partner during past 3 months (70.09%). Premature ejaculation (occurring singly or along with other sexual disorders) was diagnosed in 45.28% patients.

Conclusion:

Further exploration is needed into the services provided by the PSC. There is scope for sensitizing female patients, customizing psychoeducation suitable to the educational status and work holistically in the PSC.

Determinants of Mental Health Care Access in a Tribal District of Central India: Findings from a Health Camp

Objective  Mental health care needs of urban, rural, and tribal regions of India are varied and challenging, which require region-specific approaches. A significant treatment gap calls out for a state-wise introspection of existing service delivery models to cater to the specific mental health needs. In Madhya Pradesh, key findings were noted from a camp conducted in one of the tribal districts. To establish patient-centered services, it is important to understand their mental health care needs. Materials and Methods  A cross-sectional study within a mental health camp was conducted in the east-central tribal district of Madhya Pradesh by using a semi-structured interview. Statistical Analysis  Treatment deficit, pathways to care, and treatment barriers were assessed for correlation with demographic and clinical variables and analyzed by using the Chi-square test and logistic regression method using SPSS version 20. Results  Among 113 patients who sought help, treatment deficit was 85% with patient factors contributing 76% predominantly affecting the unmarried group of patients. Common mental illnesses (CMIs) outnumbered severe mental illnesses (SMIs) of which anxiety spectrum disorder contributed the most. SMIs still appear to remain undiagnosed till late in the course of illness. Nicotine dependence was higher in males ( p < 0.001), and an increase in the dependence pattern was observed with increasing age ( p = 0.001). Conclusion  Rising awareness and recognition of CMIs as a common mental health concern while under-recognition of SMIs among tribal communities needs further research. Considering attribution of symptoms to unknown factors, treatment barriers revolving around patient factors, and higher nicotine dependence in males, a timely evaluation of a multitargeted intervention to establish the balance in access to mental health care among the tribal population of Madhya Pradesh is warranted.

Evaluation of Turkish Women's Thoughts on Their First Sexual Experience

Objective This study aims to determine the need for sexual health education, whose importance is also emphasized by the World Health Organization, so that the youths can develop a responsible, healthy, and satisfactory sexual life and evaluates Turkish women's thoughts about their first sexual experience. Methods A total of 100 persons who were willing to participate in the research, selected through random sampling from among the women above 18 years of age who have had their first sexual experiences, and applied to the Private Diva Gynecological Diseases and Women's Health Clinic in Cankaya district of Ankara province for gynecological examination, hymen examination, or pregnancy diagnosis from 01/06/2020 to 01/09/2020. Results Of the participants, 63% were undergraduate students and 47% had stated that their first sexual experience is a private experience, while 42% stated that they were not careful about protection during their first sexual experience. It is worth noting that those who were careful about protection were the participants in the age range of 18-25 (45.5%). It was seen that 80% of those who live in the Black Sea Region have not had any sexual activity before their first sexual experience and that 46.7% of participants who live in this region again were not careful about protection. Conclusion In the link from healthy individuals to a healthy society, sexual education must be started before their first sexual experience and continued throughout life.

Promising role of medicinal plants in the regulation and management of male erectile dysfunction

Male erectile dysfunction (ED) refers to incompetency to reaching and retaining adequate penile tumescence for sexual intercourse. Over 152 million men globally suffer from ED and by 2025, the number of affected individuals is anticipated to be around 322 million. Pharmacological and nonpharmacological therapies such as phosphodiesterase (PDE) inhibitors, alprostadil, penile prosthesis surgery, and hormonal replacement are available for management and recuperation of ED. Nevertheless, such therapies are reported to have adverse effects as well as life-threatening. Accordingly, diversity of medicinal plant species and bioactive active compounds are preferred as therapeutic options because they are natural, abundant, available, low-cost and cause fewer or no side effects. This current review will emphasise the aetiology, risk factors, mechanisms underlying the pathophysiology of ED, treatments of ED as well as their side effects. It also provides medicinal plants that are proven effective in vivo and in vitro for the mitigation and treatment of male ED. This knowledge could be used in the future in drug discovery for the development of more natural drugs with no side effects.

Chemotherapeutic Potential of Epimedium brevicornum Extract: The cGMP-Specific PDE5 Inhibitor as Anti-Infertility Agent Following Long-Term Administration of Tramadol in Male Rats

Epimedium brevicornum Maxim (EbM) is a well-known Chinese herb that has been widely used for the treatment of several diseases. The main purpose of this study is to examine the role of Epimedium brevicornum extract in certain andrological parameters in rats as a natural modulator for adverse viewpoints associated with chronic administration of tramadol (TAM). Fifty rats were categorized into five groups. Untreated rats were known as Group I, whereas rats in Groups II and III were administered 2.43 g/kg/day of E. brevicornum extract and 50 mg/kg/day of TAM for 130 consecutive days, respectively. Both of Groups IV and V were administered TAM for 65 successive days, followed by concomitant use of both drugs for another 65 days, with the E. brevicornum extract at doses of 0.81 and 2.43 g/kg/day, respectively. TAM showed an injurious effect on sperm attributes, serum hormones, tissue malondialdehyde, superoxide dismutase, and nitric oxide. Elevation of the apoptotic marker Bax and a reduction of Bcl2 were recorded. Histopathological abnormalities have been reported in rat testicles. Rats treated with E. brevicornum extract with TAM showed an improvement in all the parameters tested. It could be presumed that E. brevicornum extract plus TAM exhibits a promising effect on the enhancement of male anti-infertility effects.

Sexual Disorders: Progress Made and Way Ahead

Although sexuality has a long history in the Indian literature, it is not discussed openly due to various reasons. Although sexual medicine has seen a reasonable growth in the last 70 years, somehow, psychological factors associated with the development of various sexual dysfunctions have not received due importance. Cultural factors which contribute to development and persistence of sexual disorders have not been evaluated properly. In terms of training, there is a wide variation across different centers in this country. There are very few indigenously designed instruments for the assessment of sexual disorders and there is limited data on well-evaluated indigenously designed interventions for the management of various sexual disorders. There is a need to homogenize the training and liaise with other specialists working in this area. Centers with well-developed services for sexual disorders need to start observerships and postdoctoral fellowship programs to train the interested clinicians. There is a need for multicentric studies to generate national-level data.

Setting Up Psychosexual Medicine Unit: Insights From a Private University-Based Medical College Hospital

Introduction: Sexual health issues are highly prevalent but are underdiagnosed and underrecognized in day-to-day clinical practice. The lack of awareness of the specific health care needs of the patients with sexual dysfunctions and resource limitations might be certain reasons why many hospitals are not been equipped with the sexual health care units. There is paucity of specialized psychosexual health care services across the country. Trained interdisciplinary team with prepared environment in sexual medicine is the need of the hour. We started this psychosexual medicine unit with an emphasis on sexual wellness to deliver comprehensive sexual health care which will be a primary care linkage to patients presenting with symptoms of sexual disorders, so also treatment emergent sexual dysfunction in psychiatry and other medical and surgical branches.

Aim: To portray the methods, opportunities, and challenges that we experienced in establishing a specialty psychosexual medicine facility as a different unit in a private university-based medical college and hospital in Mysuru, India.

Methods: This triweekly psychosexual medicine unit is situated in the Outpatient Division of Psychiatry and is staffed with a multidisciplinary group of health care professionals. Structured survey tools and proforma are utilized to assess all patients. Case conclusions are made according to International Classification of Diseases, Tenth Revision, symptomatic/clinical explanations and diagnostic recommendations, and furthermore Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) when required. Patient care included interventions in the form of psychotherapy and pharmacotherapy.

Results: It is possible to set up a functional psychosexual medicine facility as a different unit with a trained interdisciplinary group of professionals. Patient-centered approach is vital in our care plan and management. Postgraduate students and internees posted in psychiatry division have been undertaking rotations respectively as per their duty rota. There is also a robust academic program that includes once-weekly seminars pertaining to topics of psychosexual health and monthly journal club gatherings interchanging with seminars on sexual health and well-being appraisal devices.

Conclusion: By investing on improving infrastructure and available human resources, the specialty psychosexual medicine unit was established. The psychosexual medicine unit not only gave chances for a more comprehensive assessment of individuals with sexual disorders but also improved training and education for residents with focused interdisciplinary research in the field of sexual medicine. It portrays a versatile model that can be replicated in settings of similar type.

Is psychosexual therapy a reliable alternative to bupropion extended-release to promote the sexual function in infertile women? An RCT

BACKGROUND

Various treatment methods are used to deal with sexual problems.

OBJECTIVE

This study was applied to answer the question of whether psychosexual therapy (PST) can be a reliable alternative to bupropion extended-release (BUP ER) to promote sexual function in infertile women.

MATERIALS AND METHODS

In this randomized clinical trial, 105 infertile women with sexual dysfunction were randomly allocated to three groups: PST, BUP ER, and a control group. The PST group participated in a total of eight 2-hr group sessions. In BUP ER group, 150 mg/day Bupropion ER was administered for eight weeks. The control group did not receive any interventions. The female sexual function index (FSFI) and a clinical interview were used to assess their sexual dysfunction.

RESULTS

The mean pre-to-post treatment scores of FSFI and its subscales increased significantly in PST and BUP ER groups (except in the subscale of sexual pain) (p = 0.0001, p = 0.0001). The changes in the subjects were not significant in the control group. After adjusting for the baseline values, the results remained significant for the mean FSFI (p = 0.0001), and its subscales between the groups. Compared to the control group, a significant increase was observed in the mean FSFI (p = 0.0001, p = 0.002) and its subscales in the PST group and in the BUP ER group (except in the subscale of sexual pain). Comparison of two intervention methods showed that PST had the better effect on the sexual function improving (p = 0.0001) and its subscales (exempting the subscale of orgasm) than BUP ER.

CONCLUSION

PST can be considered not only a reliable alternative to pharmacotherapy; it also produces better results in terms of improving sexual function in infertile women.

Why Psychosexual Disorders Equally Important in India

Human sexuality is a complex with multidimensional aspects such as biological, psychological, social, and cultural. Cultural factors influence their development as prevalence rates of these disorders vary in different communities. The nature of problems and their psychological consequences make it difficult to assess the exact prevalence of these dysfunctions, even more difficult in developing countries like India. In India, care for people is not proper as large number of patients suffering from psychosexual problems visit unauthorized “sex clinics” rather than an authorized hospital setting. Specialists like dermatologists are often consulted for these problems in their routine practice as common belief shared by them is that these problems are caused by dysfunctions in their sex organs. So they are hesitant to go to sexual clinics and psychiatrists for the same in the first place. The question that arises is where does sexual medicine stand, as asked by many in the past too but remains unanswered in terms of general medicine and psychiatry. Thus, the need of the hour is to identify these cases in early stages, which can prevent a lot of other disorders occurring due to them such as homicide, suicide, domestic violence, battered wife syndrome, etc. in society. The advance in psychosexual medicine is much needed. Despite the importance of these disorders and sensitivity, in India, there is scarcity of data about the burden of sexual health disorders from community-based studies, unlike Western countries.

Sexual Disorders in Asians

The inseparable relationship between mind and body, though known since ages, has been acknowledged in modern medicine only in recent times. There is abundant literature about the effects of various illnesses on different organ systems, but their effect on sexuality has not been emphasized. Research on sexuality has been fore fronted by the West and data, though available, cannot be extrapolated to the Asian population due to marked differences in physical and socio-cultural aspects. The authors have reviewed articles published in Clinical Key, PubMed and Scopus.

Young psychiatrists' opinion on the activities of Indian Psychiatric Society: A survey under the aegis of Research, Education, and Training Foundation of Indian Psychiatric Society

AIM

The aim of the study is to assess the opinion of young psychiatrists (aged ≤45 years) about the various scientific activities of Indian Psychiatric Society (IPS).

MATERIALS AND METHODS

An online survey using SurveyMonkey electronic platform was conducted. Data of 350 participants were available for analysis.

RESULTS

The mean age of the participants (spread across 115 institutes/medical colleges) was 33.61 (standard deviation [SD] - 5.32) years and their mean number of years of experience in psychiatry including the training period was 8.25 (SD - 5.5) years. About 70% of the participants (n = 243) rated the current format of the Annual National Conference of the IPS (ANCIPS) to be "good/very good," and more than half of the participants agreed that the conferences at the zonal and state level help in enhancing the academic knowledge of the participants as well as such activities help in enhancing the social interaction among fellow colleagues. Among the various scientific sessions of the ANCIPS, workshops and guest lectures were rated as very useful by three-fifth of the participants. Regarding opinion in terms of changes required in the current format of the ANCIPS and other conferences/continuing medical educations (CMEs) being conducted by IPS, more than half to about two-third of the participants reported that having more hands-on workshops, having sessions like meet the experts, having mentorship programs, and more expert speakers from India will "definitely" be useful. Majority of the participants expressed that reduction of concurrent sessions would be definitely be beneficial. In terms of modification of ongoing activities and introduction of new activities, about two-third of the participants expressed that having IPS supported travel fellowship programs within the country and abroad, having subject/topic-focused conferences, and starting online CMEs will be definitely be useful.

CONCLUSIONS

The present survey reflects that there is a need to have more subject/topic-focused conferences/CMEs, need to introduce online CME activities, reduction of concurrent sessions during the conferences and strengthening the travel fellowship programs. All these can be considered as expectations of the young generation of psychiatrists from the organization like IPS, which should be duly considered while planning future conferences and CMEs.

Documentation of Sexual History by Psychiatry Postgraduate Trainees: Lessons to Be Learnt

Aim: The author reports on whether sexual history was documented in files of persons with alcohol-use disorders as part of initial intake by psychiatry postgraduate trainees.

Methodology: Chart review of files of persons with alcohol use disorders.

Results: A total of 53 charts were reviewed to determine whether sexual history was documented. Sexual history was not documented in 79.24% of the files as part of the initial psychiatric intake.

Conclusions: Postgraduate psychiatric trainees do not document sexual history in files of persons with alcohol-use disorders as part of initial intake. This is an important issue to be addressed as part of postgraduate psychiatry training.

Challenges in Taking Sexual History: A Qualitative Study of Indian Postgraduate Psychiatry Trainees

CONTEXT

In India, psychiatrist is an important point of helpseeking for sexual complaints. A detailed sexual history can go a long way in understanding sexual difficulties. In this background, there is inadequate information on the difficulties that psychiatry postgraduate trainees experience while taking a sexual history as part of a routine mental health evaluation.

AIMS

The aim was to study the difficulties experienced by postgraduate psychiatry trainees while taking sexual history as a part of routine mental health evaluation.

SETTING

This study was conducted in an Indian medical college general hospital psychiatry setting.

MATERIALS AND METHODS

This is a qualitative study using focus group discussions and in-depth interviews with postgraduate psychiatry trainees.

STATISTICAL ANALYSIS

Content analysis was used to identify direct and latent themes.

RESULTS

Thematic saturation was achieved with 17 participants. Major themes of difficulties that emerged included trainee-related factors such as gender and sociocultural background of the trainee; patient-related factors such as age, gender, and sexual orientation; setting-related factors; and language-related difficulties.

CONCLUSIONS

Specific and regular training in taking a sexual history is essential in addressing the difficulties faced by postgraduate psychiatry trainees in India.