Common Sexual Dysfunction Research Articles

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Objective 1) To identify patient barriers to help-seeking for non-motor symptoms (NMS) from their Parkinson’s healthcare provider, 2) To determine whether barriers are symptom specific (e.g. embarrassment disclosing sexual problems) or patient specific (e.g. misattribution of a range of NMS to old age). Background NMS are common in Parkinson’s disease (PD) and cause significant distress and decreased quality of life. A high rate of non-declaration of NMS by patients to healthcare providers means that many NMS remain unrecognized and untreated, even in specialist clinical services. Current understanding of the factors preventing disclosure of NMS to healthcare professions is limited. Method 358 PD patients completed the Non-motor Symptom Questionnaire and a barriers to help-seeking for NMS questionnaire developed from previous qualitative work. A Generalised Estimating Equation was used to determine whether barriers were symptom or individual specific. Results The sample had a mean age of 66.3 years, mean disease duration of 5.9 years and were 52.5% male. Urinary urgency was the most common NMS (65%) and sexual dysfunction was the symptom most frequently not disclosed (52%). Barriers to symptom disclosure varied dependent on symptom type. Pain and sleep problems were commonly not thought to be symptoms of PD. Bowel and bladder symptoms were often simply accepted as part of daily life and participants were unsure about the availability of effective treatments. Patients experienced embarrassment discussing sexual dysfunction. Conclusion Our results highlight the barriers which prevent PD patients reporting NMS to their Parkinson’s clinical team and the diversity of these barriers between different NMS. Strategies to improve rates of reporting must target individual NMS. For example, effective interventions might provide information regarding treatment efficacy for bowel and bladder symptoms or develop communication skills and normalising information for sexual dysfunction. The study provides the information needed to develop such individualised interventions. Increasing rates of disclosure of NMS by patients to their Parkinson’s healthcare providers will ensure patients receive appropriate clinical care which may increase quality of life and well-being.

Premature ejaculation: therapist perspectives

ABSTRACTPremature ejaculation (PE) is a common sexual dysfunction affecting approximately 20%–30% of men. Despite important issues relating to PE definition, diagnosis, and therapy, there is a paucity of research investigating the experiences of practitioners delivering PE treatment. For the present study, interviews were conducted with eight psychosexual therapists and subjected to interpretative phenomenological analysis. Four master themes emerged from the analysis. These were Romantic Relationships, Vulnerability, Culture, and Diagnosis and Assessment. The Romantic Relationships theme included three sub-themes: Intimacy; Involvement; and Distress. Two sub-themes formed the Vulnerability theme: Self-Esteem; and Anxiety. The Culture theme contained three sub-themes: Religion and Ethnicity; Pornography; and Masculinity. The Diagnosis and Assessment theme included two sub-themes: Referral and Definitions. Findings have important implications for the diagnosis and treatment of PE. Future research should investigate therapist perceptions further, including those factors which impact on engagement with clients and PE treatment success.

Evaluating the content and quality of information about premature ejaculation on the Internet: what are men being exposed to ?

Premature ejaculation is one of the most common male sexual dysfunctions; however, only a few patients with premature ejaculation are seeking professional help or advice. Internet has become an important source of knowledge, and thus, more patients are looking online for health information. According to our best knowledge, no study has evaluated the content and quality of websites on premature ejaculation. We, therefore, aimed to evaluate the content and quality of currently available Internet-based information on premature ejaculation. A sample was obtained comprising the 50 top sites retrieved from Google, Bing and Yahoo search engines using the terms 'premature ejaculation'. Each site then was reviewed based on some predefined evaluation criteria to determine the general quality, condition-specific content quality, popularity index and ownership. The websites reviewed were differed highly in terms of quality and ownership. Only a few sites provided comprehensive medical and complete information on premature ejaculation. The online information available is often of uncertain calibre; therefore, men are being exposed to information about premature ejaculation with a highly variable degree quality. This fact should be considered both by health professionals and website owners, and better online resources should be provided for these patients.

Erectile dysfunction.

Erectile dysfunction is a multidimensional but common male sexual dysfunction that involves an alteration in any of the components of the erectile response, including organic, relational and psychological. Roles for nonendocrine (neurogenic, vasculogenic and iatrogenic) and endocrine pathways have been proposed. Owing to its strong association with metabolic syndrome and cardiovascular disease, cardiac assessment may be warranted in men with symptoms of erectile dysfunction. Minimally invasive interventions to relieve the symptoms of erectile dysfunction include lifestyle modifications, oral drugs, injected vasodilator agents and vacuum erection devices. Surgical therapies are reserved for the subset of patients who have contraindications to these nonsurgical interventions, those who experience adverse effects from (or are refractory to) medical therapy and those who also have penile fibrosis or penile vascular insufficiency. Erectile dysfunction can have deleterious effects on a man's quality of life; most patients have symptoms of depression and anxiety related to sexual performance. These symptoms, in turn, affect his partner's sexual experience and the couple's quality of life. This Primer highlights numerous aspects of erectile dysfunction, summarizes new treatment targets and ongoing preclinical studies that evaluate new pharmacotherapies, and covers the topic of regenerative medicine, which represents the future of sexual medicine.

Flibanserin – a challenging drug in the treatment of hypoactive sexual desire disorder

Hypoactive sexual desire disorder (HSDD) is a condition characterized primarily by the decrease of sexual desire, affecting the quality of life. HSDD seems to be the most common sexual dysfunction in women. Therefore it should not be ignored, but treated. Recently the first drug for the treatment of HSDD, flibanserin, has been approved by FDA. Flibanserin is an agonist at 5-hydroxytryptamine (5HT1A) receptors and antagonist at 5HT2A receptors, acting also on dopamine receptors. It has been approved for premenopausal women but with certain restrictions. It was originally developed as an antidepressant drug, but studies have not supported its safety and efficacy. Its effect in HSDD was observed serendipitously. Studies conducted in North America and Europe have highlighted that flibanserin increases the number of satisfying sexual events and sexual desire, reducing the distress among premenopausal women.

The Female Sexual Response: Current Models, Neurobiological Underpinnings and Agents Currently Approved or Under Investigation for the Treatment of Hypoactive Sexual Desire Disorder.

How a woman responds to sexual cues is highly dependent on a number of distinct, yet related, factors. Researchers have attempted to explain the female sexual response for decades, but no single model reigns supreme. Proper female sexual function relies on the interplay of somatic, psychosocial and neurobiological factors; misregulation of any of these components could result in sexual dysfunction. The most common sexual dysfunction disorder is hypoactive sexual desire disorder (HSDD). HSDD is a disorder affecting women across the world; a recent in-person diagnostic interview study conducted in the USA found that an estimated 7.4% of US women suffer from HSDD. Despite the disorder's prevalence, it is often overlooked as a formal diagnosis. In a survey of primary care physicians and obstetrics/gynaecology specialists, the number one reason for not assigning an HSDD diagnosis was the lack of a safe and effective therapy approved by the US Food and Drug Administration (FDA). This changed with the recent FDA approval of flibanserin (Addyi™) for the treatment of premenopausal women with acquired, generalized HSDD; there are still, however, no treatments approved outside the USA. HSDD is characterized by a marked decrease in sexual desire, an absence of motivation (also known as avolition) to engage in sexual activity, and the condition's hallmark symptom, marked patient distress. Research suggests that HSDD may arise from an imbalance of the excitatory and inhibitory neurobiological pathways that regulate the mammalian sexual response; top-down inhibition from the prefrontal cortex may be hyperactive, and/or bottom-up excitation to the limbic system may be hypoactive. Key neuromodulators for the excitatory pathways include norepinephrine, oxytocin, dopamine and melanocortins. Serotonin, opioids and endocannabinoids serve as key neuromodulators for the inhibitory pathways. Evolving treatment strategies have relied heavily on these crucial research findings, as many of the agents currently being investigated as treatment options for HSDD target and influence key players within these excitatory and inhibitory pathways, including various hormone therapies and centrally acting drugs, such as buspirone, bupropion and bremelanotide.

Time-to-onset and -resolution of adverse events before/after atomoxetine discontinuation in adult patients with ADHD

Background. Adults with attention-deficit/hyperactivity disorder treated with atomoxetine were examined for time-to-onset and -resolution of common treatment-emergent adverse events (TEAEs) and male sexual dysfunction, and for changes in blood pressure (BP) and heart rate (HR) upon atomoxetine discontinuation. Methods. 12-week open-label atomoxetine (40–100 mg/day) was followed by 12-week double-blind maintenance treatment (atomoxetine 80 or 100 mg/day). Responders were then randomized to atomoxetine (n = 266) or placebo (n = 258) for 25-week randomized withdrawal. Examined were (1) median time-to-onset and -resolution of TEAEs during atomoxetine treatment, and (2) within group, visitwise mean changes for sitting HR, systolic BP, and diastolic BP for the postrandomization placebo group. Results. Common adverse events (AEs) appeared early, within week 1 of atomoxetine treatment. Some AEs resolve relatively rapidly, whereas others have a more lingering course of resolution (including male sexual side effects); median resolution times were 3 – 53 days. BP and HR increases during atomoxetine treatment returned to baseline upon atomoxetine discontinuation. Conclusion. Atomoxetine is associated with common AEs, with 3- to 53-day median resolution times. Trial registration: ClincialTrials.gov – NCT00700427.

Tramadol for the management of premature ejaculation: a timely systematic review.

Premature ejaculation (PE) represents a common sexual dysfunction and is associated with a negative impact on quality of life and relationships. Recent evidence suggests that on-demand dosing of tramadol is effective at increasing intra-vaginal ejaculatory latency time (IELT) and improving subjective measures of satisfaction. A literature review was performed of journal articles published between January 2000 and July 2014 that matched the keywords 'tramadol' and 'premature ejaculation'. We identified eight relevant articles with the criteria that each article be published in a peer-reviewed journal, represent original work and be written in English. IELT was used as the primary outcome in each of the papers reviewed for efficacy. Additional subjective outcome measures were reviewed where available. Safety was assessed using adverse event data from the individual studies. We found that tramadol in on-demand dosing is effective at lengthening IELT in men with varying degrees of PE and improves patient satisfaction. Tramadol was generally well tolerated, particularly among those taking 25 and 50 mg doses. Although there is a risk of abuse and dependence, these events are rare, particularly at low doses taken intermittently. In conclusion, tramadol is an effective oral therapy for PE that is overall safe and well tolerated.

Female sexual dysfunction: focus on low desire.

Low or absent sexual desire is the most common sexual dysfunction in women, and its prevalence peaks during midlife. Its etiology is complex and may include biologic, psychologic, and social elements. Major risk factors for its development include poor health status, depression, certain medications, dissatisfaction with partner relationship, and history of physical abuse, sexual abuse, or both. Diagnosis is based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders (5th Edition) and requires that a woman experience personal distress. Clinical evaluation should include medical history, sexual history, and, sometimes, a physical examination. Laboratory data are of limited value, except when warranted by history or physical examination. Treatment options include nonpharmacologic interventions such as education, office-based counseling, and psychotherapy. Although there are no U.S. Food and Drug Administration (FDA)-approved treatments for low desire, pharmacologic agents have been used off-label for this purpose. Bupropion is an antidepressant that has been shown to improve desire in some women with and without depression. Systemic estrogen therapy is not recommended in the absence of vasomotor symptoms and is not directly associated with desire. However, vaginal estrogen is useful in patients presenting with concomitant vaginal atrophy and dyspareunia. Ospemifene is a selective estrogen receptor modulator that can be used as an alternative to vaginal estrogen. Exogenous testosterone has demonstrated efficacy in treating loss of desire in postmenopausal women. However, patients should be counseled that it is not FDA-approved for this purpose and there are limited published long-term safety data. Several agents for the treatment of low desire are currently in development. Gynecologists are in a unique position to address concerns about sexual desire in women.

Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India.

Introduction:Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital.Materials and Methods:Hundred consecutive male patients presenting with sexual dysfunction were screened using Arizona Sexual Experiences Scale for clinical sexual dysfunction and after obtaining their informed consent were included in this study. They were assessed using a semi-structured proforma, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria, Mini-International Neuropsychiatric Interview, and Dyadic Adjustment Scale.Results:Majority of our respondents were in the 18–30 years age group and were married. The main source of sex knowledge for 69% of them was peer group. Age of onset of masturbation was 11–13 years for 43% of them. Premature ejaculation was the most common sexual dysfunction seen in the respondents. Marital discord was seen in significantly lesser number of respondents (32.35%) as also major depressive disorder that was seen in only 16%.Discussion:Premature ejaculation was the most common sexual dysfunction in our sample. Despite the sexual dysfunction, marital discord and depression were seen less commonly in our respondents.

Sexual dysfunctions in patients with obsessive compulsive disorder

ABSTRACT Objective: Obsessive compulsive disorder (OCD) is known to have a negative impact on sexual functioning. The aim of the present study was to compare patients with OCD and healthy subjects in terms of the sexual dysfunctions. Method: Seventy eight patients, between 18-52 years of age, sexually active who were admitted to the outpatient unit of a university psychiatry department, and who were diagnosed with OCD according to the DSM-IV diagnostic criteria were enrolled in the study. The control group encompassed 60 healthy subjects. The severity of OCD was rated by using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and all participants were evaluated with the Arizona Sexual Experiences Scale (ASEX) for sexual dysfunction. Results: The rate of sexual dysfunction (SD) was determined in 65.4% of OCD patients and 28.3% of the control group. While anorgasmia was the most reported complaint in females with OCD (51.2 %), hypoactive sexual desire was the most reported in males with OCD (18.2 %). ASEX scores of sexual desire, excitement, vaginal lubrication, orgasm and orgasmic satisfaction were found to be significantly higher in females with OCD compared to healthy subjects.While erectile dysfunction was found significantly higher in healthy males compared to OCD patients, no significant difference was found between the two groups for other sexual functions. Conclusion: In this study, all phases of sexual function were impaired in females with OCD. Though orgasmic dysfunction was identified as the most common sexual dysfunction in females with OCD, this issue is controversial. We did not detect a significant sexual dysfunction in males with OCD, and these findings may suggest that antidepressant drugs might have a positive effect on sexual dysfunction in males or at least did not cause a significant negative effect on sexual functions in male patients.

Premature ejaculation is associated with glycemic control in Type 1 diabetes.

Premature ejaculation (PE) is the most common male sexual dysfunction. Its prevalence in Type 1 diabetes is unknown. The aim of this study was to assess the prevalence of PE in Type 1 diabetes and the influence of glycemic control on ejaculatory function. One hundred Type 1 diabetic male patients (age < 40 years) and 51 age-matched nondiabetic control subjects were evaluated for PE. A subgroup of 30 diabetic patients (20 with PE and 10 without) were also evaluated for blood glucose variability. The presence of PE was assessed with the premature ejaculation diagnostic tool (PEDT) and the self-estimated intravaginal ejaculatory latency time (IELT). Glucose variability was evaluated by continuous glucose monitoring for a 7-day period with a DexCom G4 CGM system: the mean amplitude of glycemic excursions (MAGEs), low (LBGI) and high (HBGI) blood glucose indices, and the standard deviation of blood glucose (BGSD) were calculated. PE prevalence did not differ significantly between the two groups: pathological values of the PEDT score (>8) and IELT score (<1 minute) were recorded in 24 out of 100 diabetic patients (24%) and in 12 out of 51 controls (23.5%). There were significant associations between hemoglobin A1c and the PEDT score (r = 0.27; P = 0.006) and IELT (r = -0.3; P = 0.01). In the subgroup assessed for glucose variability, the PEDT score was associated with LBGI (r = 0.43; P = 0.01), but not with BGSD (r = 0.1, P = 0.6), MAGE (r = -0.1; P = 0.4), or HBGI (r = 0.1; P = 0.6). Our results show a similar prevalence of PE in young male patients with Type 1 diabetes and in the age-matched control population; in diabetic patients with PE, a higher glycemic variability in the hypoglycemic domain is significantly associated with the PEDT score.

The role of dapoxetine hydrochloride on-demand for the treatment of men with premature ejaculation.

Premature ejaculation (PE) is the most common male sexual dysfunction. Dapoxetine hydrochloride, belonging to a class of drugs known as selective serotonin reuptake inhibitors or, was the first drug originally approved for the on-demand treatment of men with PE. We aimed to compare the intravaginal ejaculatory latency time (IELT), patient-reported global impression of change (PGIC), and adverse effect (AE) incidence associated with the use of dapoxetine (30 mg and 60 mg) versus placebo, and evaluate the differences in administering 60 mg versus 30 mg as on-demand medical oral therapy for the treatment of PE via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (Cochrane Library) databases. Ultimately, a total of seven RCTs with 8039 patients were included. Our meta-analysis demonstrated that dapoxetine (in the 30 mg and 60 mg subgroup) resulted in significantly higher IELT, PGIC, and AE incidence relative to the placebo, with higher proportions observed for 60 mg versus 30 mg of dapoxetine administration. The most common AEs were mild and tolerable. We conclude that dapoxetine (particularly the 60 mg dosage) may be considered a safe and effective drug for patients with PE.

AB54. Pathophysiology of premature ejaculation and serotonin

According to the epidemiologic studies conducted so far, premature ejaculation (PE) is the most common male sexual dysfunction in younger men (<30 years); its prevalence is higher than that of ED, and varies from 9% and up to 31% of the male population. The etiology of PE is uncertain in almost all cases, and might include a combination of organic and psychogenic factors. Negative conditioning and penile hypersensitivity are the most frequently cited etiological factors in PE, although neither mechanism has received adequate experimental support to date. Accordingly from a scientific perspective, it is fair to state that PE pathophysiology is largely unknown.Serotonin or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract (GI tract), platelets, and the central nervous system (CNS) of animals, including humans. It is popularly thought to be a contributor to feelings of well-being and happiness. There are currently 15 known 5-HT receptor subtypes, which are grouped into seven major classes (5-HT1–7). With the exception of the 5-HT3 receptor, all 5-HT receptors are coupled to second messengers by G proteins. All 5-HT receptors have been reported to exist postsynaptically. Although some authors have suggested the existence of facilitatory 5-HT3 autoreceptors, only the 5-HT1 receptor subtypes (5-HT1A and 5-HT1B) are widely accepted to function as presynaptic autoreceptors. At least three of the 5-HT receptor subtypes have a role in ejaculation: 5-HT1A, 5-HT1B and 5-HT2C receptors. Activation of postsynaptic 5-HT2C or 5-HT1B receptors prolongs ejaculatory latency, whereas activation of presynaptic 5-HT1A autoreceptors, which inhibits 5-HT release, decreases ejaculatory latency. Subcutaneous administration of the 5-HT1B receptor agonists anpirtoline and m-trifluoromethylphenyl piperazine and systemic, acute administration of the 5-HT2C agonist 2, 5-dimethoxy-4-iodoamphetamine have been shown to impair ejaculation in rats. Based on the role of 5-HT neurotransmission in the physiology of ejaculatory control and possibly in the pathogenesis of PE, and because SSRI antidepressants have the well-established side-effect of delaying ejaculation when used to treat depressed patients, currently marketed SSRIs such as paroxetine, fluoxetine, and sertraline, which increase synaptic 5-HT concentration via blockade of 5-HT transporters, have been investigated in numerous clinical studies for managing PE. Paroxetine and sertraline have provided significant benefits in patients with PE, either via daily administration or on-demand use before intercourse, and fluoxetine has shown some efficacy for PE as continuously dosed therapy. Although none of these agents has received an indication for the treatment of PE, current guidelines from the AUA and recommendations from the Second International Consultation on Sexual Dysfunctions recommend the off-label use of SSRIs for managing PE.

Effect of botulinum-A toxin injection into bulbospongiosus muscle on ejaculation latency in male rats.

Premature ejaculation (PE) is the most common male sexual dysfunction. A variety of pharmacotherapeutic strategies have been employed to treat men suffering with lifelong PE. However, there are currently no pharmaceuticals approved by the U.S. Food and Drug Administration specifically designed for PE treatment. Given that the bulbospongiosus muscle is involved in the ejaculatory reflex in both humans and rodents and that local administration of botulinum-A can abolish muscle contractions, the current study examined the effect of injection of botulinum-A toxin into the bulbospongiosus muscle on the ejaculatory latency of male rats. After screening for normal sexual activity with sexually receptive female rats, 33 sexually experienced male Long-Evans rats (Harlan Laboratories, Indianapolis, IN, USA) underwent an additional four pretreatment sexual exposures over the course of the following week, during which all components of sexual behavior were video recorded by trained observers. On the day after their fourth experience, rats were anesthetized and received a single injection of either 0.5 unit (n = 11) or 1 unit (n = 11) of botulinum-A toxin or saline vehicle (n = 11). Botulinum-A toxin was dissolved in 0.1 mL of saline vehicle and injected bilaterally into the bulbospongiosus muscle by the percutaneous route. Beginning 2 days after treatment, sexual behaviors were reexamined over the course of the following week on four separate occasions. The latency to achieve ejaculation, and the frequencies and latencies of mounts and intromissions were video recorded by trained observers in a blinded fashion. Relative to pretreatment measurements, bilateral injection of saline vehicle into the bulbospongiosus muscle did not affect ejaculation latencies. However, rats treated with either 0.5 or 1 unit of botulinum-A toxin exhibited significantly longer latencies to achieve ejaculation relative to pretreatment performance. Of note, botulinum-A toxin did not affect the ability to achieve mounts, intromissions, or ejaculation. These results demonstrate that botulinum-A toxin injection into the bulbospongiosus muscle is a safe and effective treatment that extends ejaculatory latency in rats without affecting the ability to engage in sexual activity or achieve ejaculation. Further studies are required to evaluate this therapeutic concept in PE patients.

Vaginismus and its correlates in an Iranian clinical sample.

Although vaginismus is a relatively common female sexual dysfunction in Iran, there are scant studies reporting on its clinical and social features. The aim of the present study was to compare the social and clinical characteristics of women with vaginismus with those of healthy women. The study comprises 22 patients with vaginismus and 22 healthy controls who presented to the health clinics of Tehran University of Medical Sciences, Iran. We used three assessment tools: interview, a (34-item) questionnaire for demographic and clinical characteristics of vaginismus and a 13-item questionnaire of Female Sexual Distress Scale-Revised (FSDS-R) for sexual distress. The majority (73%) of women with vaginismus had primary vaginismus (unconsummated marriage). These women demonstrated significant higher phobia than healthy women, including fear of genital pain and penetration, fear of bleeding during intercourse, height phobia, aversion to looking or touching the genitalia, fear of vaginal disproportion and also disgust of semen. Compared with the healthy women, these women displayed a significantly higher sexual distress score, defecation or urination problems, general anxiety, higher education levels and lower self-esteem. Our findings suggest that there is a strong correlation between vaginismus, phobia and anxiety.

Pelvic Floor Dysfunction: Women’s Sexual Concerns Unraveled

Sexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem. To gain a more in-depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study. Qualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings. The impact of POP and/or UI on female sexual function. Only 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: "drive" and "motivation." Although "drive," i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in "motivation" or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned. Body image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's "motivation."

Current Diagnosis and Management of Premature Ejaculation

Premature ejaculation (PE) is a common sexual dysfunction characterized by reduced intravaginal ejaculatory latency time (IELT), inability to delay ejaculation, and personal distress. Increasing understanding of pathophysiologic mechanisms has yielded diverse and effective therapies. The current review discusses contemporary evaluation and management of PE, with a review of all randomized, controlled trials (RCT) performed. Therapies with RCT data include behavioral modification/psychotherapy, topical anesthetics, narcotic-like pain relievers, phosphodiesterase-5 (PDE-5) inhibitors, selective serotonin/norepinephrine reuptake inhibitors and receptor antagonists, tricyclic antidepressants, and surgery. As data are insufficient to define optimal therapies, treatment decisions are based on clinical factors (comorbid conditions, PE mechanism and patient preference), trial outcomes, and adverse event profiles. Combination therapies demonstrate superior efficacy to single agents, with concomitant use of behavioral/psychosexual modifications with pharmacotherapy recommended. The role of surgery in PE remains undefined, with additional data required. Further comparative RCTs are required to define optimal treatment algorithms.

Male sexual dysfunction and HIV—a clinical perspective

Sexual dysfunction in men with HIV is often overlooked by clinicians owing to many factors, including the taboo of sexuality. The improved life expectancy of patients with HIV requires physicians to consider their general wellbeing and sexual health with a renewed interest. However, data on sexual dysfunction in those with HIV are scarce. Erectile dysfunction (ED) is the most common sexual dysfunction in men, with a prevalence of ∼30-50% and is frequent even in men <40 years of age. HIV infection itself is the strongest predictor of ED, and many factors related to the infection-fear of virus transmission, changes in body image, HIV-related comorbidities, infection stigma, obligatory condom use-all impair erectile function. The diagnosis and treatment of sexual dysfunction is based on a multidisciplinary approach, which involves specialists in both infectious diseases and sexual medicine. Particular attention should be paid to the promotion of safer sex in these patients. This Review, describes the issues surrounding sexual dysfunction in men with HIV and aims to provide clinical advice for the physician treating these patients.

Factores biopsicosociales asociados a la disfunción sexual femenina en una población mexicana

PALABRAS CLAVE: Disfuncion sexual femenina, factores biopsicosociales SUMMARY Objective: To determine the biopsychosocial factors associated with female sexual dysfunction in a Mexican population. Methods: A comparative study in women who were attended at a Family Medicine Unit of Queretaro, Mexico. Surveys of Laumman, Chavez and Velazco, Faces III, and Grajales, were applied to assess sexuality, marital functionality, familiar functionality and state self-esteem.The results were analyzed with Odds Ratios, chi-square and Student t test. Results: Of 110 women interviewed, 65 (59%) reported sexual dysfunction and 45 (41%) denied. They formed two groups randomly from 44 women with and without sexual dysfunction. Factors that were significantly associated with sexual disorders were: age greater than 40 years, labor outside the home, presence of obesity and / or overweight, hypertension, diabetes mellitus, prior hysterectomy, maternity, marital dysfunction, high self-esteem, mild to severe depression, dysfunctional family, low socioeconomic status. The most common sexual dysfunction were: decrease in sexual desire (34.1%), erectile dysfunction couples (22.7%), dyspareunia and lack of arousal