Common Sexual Problems Research Articles

Study on serum metabolomics characteristics of obese patients with erectile dysfunction.

Erectile dysfunction (ED) is a common male sexual health problem that can be associated with obesity. This study aimed to identify serum metabolic differences and pathways related to ED in obese men using non-targeted metabolomics techniques. We included 54 obese male patients with (n = 27) and without (n = 27) ED. We collected 5 mL of fasting elbow vein blood and analyzed serum metabolites using ultra-high-performance liquid chromatography-mass spectrometry. Multivariate statistical methods (principal component analysis and orthogonal partial least squares discriminant analysis) were used to identify differential metabolites between the groups. Finally, pathway analysis using the Kyoto encyclopedia of genes and genomes database identified 4 differential metabolic pathways in obese men with ED compared to obese men without ED. A total of 77 differential metabolites were identified in obese men with ED compared to the control group (obese men without ED) using a threshold of variable importance in the projection > 1 and P < .05. Pathway analysis revealed 4 main differences: glycine, serine and threonine metabolism, glycerophospholipid metabolism, aminoacyl-tRNA biosynthesis, and D-glutamine and D-glutamate metabolism. Specific metabolites associated with these pathways included betaine aldehyde, choline, L-threonine, phosphatidylcholine, L-serine, and D-glutamine. Our findings suggest abnormalities in fatty acid metabolism, phospholipid metabolism, and amino acid metabolism between obese men with and without ED. Metabolites such as betaine aldehyde, choline, L-threonine, phosphatidylcholine, L-serine, and D-glutamine may be potential biomarkers for distinguishing obese men with ED.

What should we be studying? Research priorities according to women and gender-diverse individuals with sexual interest/arousal disorder and their partners.

Sexual interest/arousal disorder (SIAD) is one of the most common sexual problems for women. In clinical research, there are often misalignments between the research priorities of patients and researchers, which can negatively impact care, and gender-diverse individuals are often excluded from research. Inclusion of patient perspectives when establishing research priorities may help to reduce these gaps; however, the research priorities of couples coping with SIAD remain unclear. Identify the research priorities of women and gender-diverse individuals with SIAD and their partners. In an online survey, couples coping with SIAD provided consent and responded to an open-ended question asking them to list the top 3 things they think are important for researchers to focus on related to couples coping with low sexual desire. A team-based content analysis was conducted to identify themes and their frequency of endorsement. An author-developed open-ended question. Analysis of 1279 responses (n = 667 from women and gender-diverse individuals with SIAD, n =612 from partners) resulted in our identification of 6 main themes: general causes, general treatment and coping, biophysiological, relationship, psychological, and environmental/contextual. Additionally, we identified 4 sub-themes within each of the latter 4 main themes: general, cause, treatment, and impact. For women and gender-diverse individuals with SIAD, their partners, and specifically gender-diverse participants, the 3 most endorsed themes were psychological general factors (24.3%, 21.2%, 24.3%; eg, stress and the link between SIAD and anxiety), relationship general factors (15.7%, 13.2%, 18.6%; eg, relationship length and communication on sexual desire), and biophysiological general factors (12.3%, 12.4%, 14.3%; eg, research on medications and hormones). Clinical researchers should consider the research priorities of couples coping with SIAD to ensure their work aligns with the needs of the affected population. This study is the first to identify the research priorities of both women and gender-diverse individuals with SIAD and their partners. Most participants identified as heterosexual, North American, and of middle to high socioeconomic status; results may not generalize. Responses were sometimes brief and/or vague; interpretation of these responses was therefore limited and may have required more contextual information. Findings suggest that women and gender-diverse individuals with SIAD, their partners, and gender-diverse participants have similar research priorities that are consistent with a biopsychosocial approach to research. Heterogeneity of responses across themes supports a multidisciplinary, patient-oriented approach to SIAD research.

Evaluation of efficacy and safety of Botulinum toxin-A injection at three deferent sites in treatment of premature ejaculation.

Premature ejaculation (PE) is a common sexual problem, resulting in adverse effects on the quality of life, of both the patient and the partner. The idea of muscular contraction inhibition during the ejection phase of ejaculation by Botulinum toxin-A injection may delay ejaculation. This study was performed to assess the efficacy and safety of Botulinum toxin-A injection in PE treatment. This study included 45 married male patients diagnosed with primary PE. All included patients were injected with 75 units of Dysport equal efficacy of 25 units of Botulinum toxin-A (Botox) into three sites: the root of the penis (Group 1), glans penis (Group 2), and each side of the ischiocavernosus muscle (Group 3). All patients were subjected to an assessment of intravaginal ejaculation latency time (IELT) using a stopwatch and answering the Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire before and after treatment. There was a statistically significant improvement in IELT after treatment in all groups. The most significant improvement was shown in Group 3 (average 108% increase), followed by Group 1 (74%) and Group 2 (40%), respectively. There was a positive correlation between age and the improvement in improved IELT. There was a statistically significant improvement in PEDTq scores in Group 1 and Group 3. Botulinum toxin-A injection into the root of the penis and ischiocavernosus muscle could be recommended in the treatment of premature ejaculation.

The Reality of Common Sexual Problems for Students with Down’s Syndrome in Saudi Arabia

Introduction: The current study aimed to identify the sexual problems of students with Down’s syndrome in Saudi Arabia from the point of view of their parents and teachers in the light of a range of variables (student’s age, educational program, and family’s economic situation). Method: This descriptive comparative study was based on a sample of 120 participants consisting of 68 parents and 52 teachers caring for students with Down’s syndrome. The questionnaire of sexual problems for students with disabilities was applied and the data was statically analyzed using Analysis of Variance (ANOVA) and One- way ANOVA. The findings indicated that the most prevalent sexual problems experienced by students with Down’s syndrome according to their parents and teachers are a lack of knowledge of sexual development, difficulties in the child presenting themselves in front of others, and the inability to distinguish between normal and abnormal physical contact. Findings: The arithmetic one-way analysis of variance (ANOVA), mean, standard deviation, and t-test were used to calculate the findings that revealed no statistically significant differences between the perspectives of the parents and teachers of students with intellectual disability regarding the most prevalent sexual problems. Moreover, there was no statistically significant correlation between the student’s age and the sexual problems they encountered. Finally, the findings found statistically significant differences in the sexual problems encountered according to the of the program variables to which the students with Down’s syndrome belong and the family’s economic situation Discussion: It is recommended that a group counseling program be devised for the parents of students with Down’s syndrome to advance their knowledge of sexual development and to obtain an understanding of how to deal with the variables resulting from such development. Develop training programs for families, teachers, psychologists, and social workers working in special needs care on how to identify the sexual problems experienced by intellectually disabled students. Raise parents’ awareness of the importance of communication and dialogue with teachers to identify the most important sexual problems their children face and collaborate to resolve them through training courses.

(227) Vaginismus - Current State of Knowledge

Abstract Introduction Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles due to actual or anticipated pain associated with vaginal penetration. Vaginismus is predominantly unknown among clinicians and women. Vaginismus causes women to feel pain, fear and anxiety with penetration attempts. It is a poorly understood and underdiagnosed condition, for which many women do not gain support. This is due to the lack of knowledge of the condition, for the shame and embarrassment felt by vaginismus sufferers which means many do not discuss the issue. Objective Vaginismus is commonly experienced medical issue, affecting about 1–7% of the female population worldwide. Female pain is often viewed not as a medical fact, but as a misimpression or misinterpretation of bodily events. Vaginismus is not the only condition that has been placed in context of neglect. Other sexual pain disorders, such as vestibulodynia, vulvodynia and dyspareunia, have also been met with doubt and disbelief. An examination of the disbelief surrounding female reportage of their own bodily events will not only be beneficial in terms of perception of vaginismus, but also for general women’s health. Methods This systematic review will provide an assessment of the current state of vaginismus. The following databases has been searched from the study inception to July 2023: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used. Results Vaginismus influences the quality of life, in the most serious form it can result in unconsumated marriage, sterility and thus can lead to the separation of a couple. When adequately approached, the problem can mostly be solved. Treatment often involves multimodal approaches such as education, medication, cognitive behavioral therapy, physical therapy and possibly surgery. Conclusions Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners. There are women for whom vaginismus is a serious problem and who are not able to cope with the situation without professional help of specialists. Deepening the specialists knowledge in this field is essential for successful treatment. Vaginismus is a well recognized clinical condition associated with non-consummation and considerable distress in women. It has received little scientific attention, and further well designed studies are needed. Disclosure No.

Erectile dysfunction among men with chronic kidney disease undergoing hemodialysis in a Brazilian Amazon urban setting: an epidemiological study.

Erectile dysfunction (ED) is a common sexual problem among men with chronic kidney disease (CKD). The severity of sexual dysfunction tends to worsen with kidney damage. This study aims to evaluate the erectile function and sexual quality of life of adult male CKD patients undergoing hemodialysis (HD) in a hospital located in the Brazilian Amazon. A cross-sectional quantitative study was performed within the HD Sector of the Nephrology Unit including men with CKD aged ≥ 18 years, undergoing ≥ 3 weekly HD sessions for ≥ 3 months who had been sexually active for ≥ 6 months. We used the Male Sexual Quotient (MSQ) to measure sexual satisfaction and the International Index of Erectile Function (IIEF5) to establish erectile function. Statistical analysis was performed with SPSS 21.0 using appropriate tests, such as Mann-Whitney and Kruskal-Wallis (P < 0.05). Ninety-eight patients (51.68 ± 15.28 years) were evaluated. They were primarily married/or living with a partner (60.20%), with HD time between 1 to 5 years (55.10%), and an average KTV of 1.17. ED prevalence was 66.30%, and it was associated with a higher age group (p = 0.01), lower family income (p = 0.02), diabetes (p = 0.01), lower mean corpuscular hemoglobin (p = 0.04), higher total calcium (p = 0.04), and lower albumin (p = 0.03). Around 75% classified their sex life as regular to excellent. Despite the high ED prevalence, most men with CKD in HD reported experiencing regular to excellent sex life. The study underscores the importance of establishing effective screening and conducting routine evaluations regarding sexual issues in these men.

Prevalence, severity, and correlates of erectile dysfunction among male adult patients of a primary care clinic in North-West Nigeria.

Erectile dysfunction (ED) is a common sexual problem that profoundly affects intimate relationships. It is poorly studied in North-western Nigeria. To assess the prevalence, severity and predictors of ED among adult males attending a primary care clinic in Northwest Nigeria. A cross-section of 392 males (aged ≥25 years) were randomly selected from attendees of a family medicine clinic in Kano, Nigeria. Information regarding their biodata, lifestyle factors, and clinical characteristics was obtained using a structured questionnaire. The International Index of Erectile Function Questionnaire (version 5) and Patient Health Questionnaire-2 assessed ED and depression, respectively. The participants' mean age was 45±14.1 years (range: 26-86 years). Most participants were married (88.8%), had one sexual partner (71.7%), had tertiary education (44.4%) and were traders (49.7%). The prevalence of ED was 52.3% (205/392) [comprising mild (36.0%), mild-to-moderate (14.3%), moderate (1.5%) and severe (0.5%)]. Age, body mass index (BMI), marital status, number of sexual partners, monthly income, type of exercise, hypertension history, blood pressure reading, antihypertensive and peptic ulcer drug use were associated with ED (P<0.05). However, age (≥50years) (OR= 1.91, 95%CI [1.28-2.85], P=0.001) and overweight/obesity (OR =1.81, 95%CI [1.18-2.77], P=0.007) were the predictors of ED in this population. ED prevalence was high, although mainly of the mild form. Age (≥50years) and overweight/obesity predicted ED. Hence, the need for early screening, objective grading of ED, identification of modifiable risk factors (e.g., overweight/obesity) and commencing proper treatment and prevention in this setting.

(051) Gut Microbiota and Sexual Desire Disorder in Women

Abstract Introduction Hyposexual desire disorder (HSDD) is a common female sexual health problem. HSDD mainly refers to women's continuous lack of sexual fantasy or desire for sexual activities, accompanied by obvious personal pain or affecting the partnership. In humans, sexual desire is regulated by a variety of neurotransmitters in key areas of the brain. Norepinephrine, dopamine, melanocortin, oxytocin and vasopressin mediate excitability, while serotonin, opioids, prolactin and endogenous cannabinoid system mediate inhibition. HSDD may be related to neuropsychological state of increased inhibition or decreased excitation, or both. There is a close relationship between gut microbiota and a variety of mental and neurological diseases. The changes of gut microbiota richness and diversity affect the functions of 5-hydroxytryptamine, norepinephrine and dopaminergic nervous systems in the brain, and these pathways and molecules have been proved to be closely related to the level of human sexual desire. At present, the understanding of the role of gut microbiota in the regulation of sexual desire and the mechanism of HSDD is limited. Objective In order to study the composition of gut microbiota and fecal metabolites in HSDD women, and increase the understanding of the possible relationship between low sexual desire and intestinal microbiota, this study hypothesized that the composition of intestinal microorganisms and fecal metabolites in HSDD patients was different from that in normal people. Methods We recruited and diagnosed HSDD women through Case-Control study, and performed the 16S rRNA sequencing, non targeted LC-MS metabonomics detection and targeted SCFAs quantitative detection of intestinal microorganisms to explore and evaluate the differences of gut microbiota and fecal metabolites composition between HSDD women and control group. Results In this study, 24 women with HSDD and 22 women without history of sexual dysfunction (NHSD) were included. The 16S rRNA gene sequencing of 46 fecal samples showed that the richness and diversity of intestinal flora in HSDD women were higher than those in NHSD women, and there were significant differences in the composition of gut microbiota between the two groups. At the genus level, Bifidobacterium, Lactobacillus, Sphingomonas, Phenylbacillus, Corynebacterium and some unclassified actinomycetes were enriched in the feces of HSDD women, while Ruminococcus were enriched in the feces of NHSD women. The results of non-targeted metabonomics of fecal samples showed that there were significant differences between HSDD and NHSD women in fecal metabolic phenotype. The main metabolites included histamine, deoxycorticosterone, tryptamine, tyramine, 6-methylquinoline, etc. The results of targeted SCFAs quantitative analysis showed that the content of butyric acid in feces of HSDD group was significantly higher than that of NHSD group. Spearman correlation analysis showed that the difference of gut microbiota and fecal metabolites between the two groups were associated with clinical characteristics including FSFI-D score. Conclusions The composition of gut microbiota and metabolites in HSDD women is different from that in NHSD women. The effect of characteristic bacteria and metabolites on the function of neurotransmitter system may be part of the pathogenesis of HSDD. Further studies may bring new theories of the gut microbiota brain sexual desire axis. Disclosure No

Changes in male sexuality after urologic cancer: a narrative review.

To describe the most common sexual problems and changes experienced by male urological cancer survivors, focusing on evidence-based practices for assessment and intervention. We search the PubMed, Embase, and SciELO databases between 1994 and 2022, using the following key words: "urological cancer", "urological malignances", "genitourinary cancer", "male sexual health", and "male sexual dysfunction". This narrative review provides an overview of the current literature involving the impact of diagnosis and treatment of urological cancers on male sexual function. Male "genital" or "reproductive" tumors, such as prostate, penile, and testicular tumors, clearly appear to affect sexual function. However, tumors that do not involve genital parts of the body, such as the bladder and kidney, can also affect male sexual function. Male sexual dysfunction is very common after urologic cancer diagnosis and treatment. Changes in body image and anatomical damage can be associated with impaired masculinity and sexual function, especially after prostate, penile or testicular cancer treatment. Moreover, anxiety, depression, and fear of recurrence have an impact on quality of life and sexual function regardless of the cancer location. Therefore, patients need be counseled about the likely changes in sexual function before treatment of any urological cancer.

Sexual Rehabilitation of Cancer Patients: A Less Noticed Domain in Cancer Care

Background: Sexual problems are associated with almost all types of cancers, especially those of the genital regions. Sexual problems can occur due to cancer itself or due to its treatment (chemotherapy, radiotherapy, or surgery) across all the stages of cancer and its management.Methods: The researcher reviewed the current research status of this less-discussed issue. 115 articles were identified using predefined keywords in Pubmed, Pubmed Central, Embase, and Google Scholar databases from January 1, 2000, to March 31, 2022. First, the articles were screened based on the abstracts followed by checking for the availability of their full-text versions. A total of 28 articles fulfilling the inclusion criteria were finally selected and analyzed. Results: Common sexual problems found in men were erectile dysfunction, decreased libido, dry ejaculation, and performance anxiety. On the other hand, women usually complained of reduced intimacy, lack of sexual desire, vaginal dryness, pain during intercourse, lack of sexual sensation, and reduced self-esteem for sexual activities. There is a significant prevalence of sexual problems with effects on marital relationships in cancer patients. Psychiatric disorders were found to be associated with a higher prevalence of sexual dysfunction ranging from 70 to 90% compared to the general population. Up to 50% and 40% of female and male patients with depression (a common occurrence in cancer) respectively may have sexual dysfunctions. Conclusions: Management of these problems is necessary, as it can be a contributing factor to the poor quality of life. Communication and discussion about sexual health from patients as well as the healthcare provider side are needed. The urgency of seeking a specialist’s help such as a psychiatrist or a sex therapist is also discussed. The researcher reviewed common sexual problems, causes, and treatment modalities, and suggested a few recommendations for making sexual health a part of routine cancer check-ups.

Epithelial thinning in vaginal atrophy related to lowering of calcitonin gene-related protein, vascular endothelial growth factor, and nerve growth factor expressions in a menopausal rat model

Context: Vaginal atrophy has been observed as a common sexual problem in post-menopausal women. The targeted protein to counteract menopause problems related to vaginal epithelial thinning is currently a research problem that has not been fully investigated. Aims: To explore the possible mechanism underlying vaginal atrophy in rat models. Methods: Following three-week ovariectomy (OVX), Sprague-Dawley female rats were randomly divided into two groups and orally administered estradiol for two weeks in the treated group. In parallel with this, six rats with sham surgery were used as control. Marker-related vaginal atrophy, including calcitonin gene-related protein (CGRP), vascular endothelial growth factor (VEGF), and nerve growth factor (NGF) in the vaginal wall, were compared using immunohistochemistry. Results: OVX as a menopausal model significantly induced vaginal epithelial cell thinning and decreased the expression of CGRP, VEGF, and NGF compared with sham surgery animals (p&lt;0.05). Estrogen replacement in OVX rats reversed the vaginal atrophic by recovering the protein expression CGRP, VEGF, and NGF (p&lt;0.05). Conclusions: Thus, it may be concluded that a possible mechanism underlying the OVX-induced vaginal atrophy may be related to the downregulation expression of CGRP, VEGF, and NGF in vaginal tissue.

Nursing counseling utilizing BETTER model on sexuality, marital satisfaction and quality of life among cervical cancer women

Background The most common sexual dysfunction problem for women with cervical cancer is decreased sexual desire. Aim The aim of the present study was to evaluate the effect of nursing counseling guided by BETTER model on sexuality, marital satisfaction, and quality of life among cervical cancer women. Design A quasi-experimental design was used. Patients and methods A purposive sample of 44 women with cervical cancer who attended the oncology outpatient clinic at Zagazig University Hospital and Elmabera Hospital in the Sharkia Governorate was recruited. Tools A structured interviewing questionnaire, Female Sexual Function Index (FSFI), and a short version of the Quality of Life Enjoyment and Satisfaction Questionnaire were used to gather data. Results The mean score of all female sexual function index domains was improved significantly (P&lt;0.001) after intervention as compared with before intervention. Moreover, following applying nursing counseling guided by the BETTER model compared with before intervention, there was a highly significant improvement (P=0.0001) in the quality of life enjoyment and satisfaction among study participants. Following the adoption of the nursing instructions, there was a positive association between the overall Female Sexual Function Index score and quality of life. Conclusion The quality of life and sexual function of women with cervical cancer have improved. Recommendation Implement a BETTER sexual counseling model to handle sexual dysfunction in oncology units. The availability of facilities and decision-making aids for individuals in need, as well as the promotion of women counseling activities about cervical cancer and sexuality, are all necessary.

Brain Regions and its Correlates of Multifarious Sexual Desire Disorders from the Vantage Point of Neuropsychology

Purpose: The most a set of illnesses that impact both men, as well as women; include sexual aversion disorder (S.A.D) and hypoactive sexual desire disorder (H.S.D.D). Nevertheless being common, those same two illnesses are frequently ignored by medical professionals as well as clients owing to their private and more intimate character. In order to accurately handle our clients' sexual difficulties and execute effective therapy, we as clinicians must go over our own discomfort and in this paper, common sexual disorders will be addressed with the touch of their neuropsychological etiology. Objective: The major objective of this article is to describe numerous sexual desire issues and how they relate to the brain. Erectile dysfunction and a few other sexually transmitted diseases are at least known to people (STDs). In addition to having a limited understanding of sexual problems brought on by viruses and other microbes, society also has little to no awareness of those brought on by brain injury or the dysfunction of certain brain areas. Therefore, one of the primary goals of this essay is to clarify popular and widespread diseases of sexual desire and their relationship to illnesses of the brain or other pathologies. Design/Methodology/Approach: The scientific and secondary clinical data for this work were gathered from reliable sources like Google Scholar, Academia, Researchgate, and others. The results of national and international studies on the topic issue have been assembled methodically and scientifically. In order to make this document more scientifically sound, reliable, and accurate, each scientific journal research result underwent a thorough, methodical, and scientific assessment. To increase this paper's uniqueness and reliability, we gathered the thoughts of a variety of experienced experts. Findings/Result: According to emerging knowledge, the temporal areas play a critical role in the regulation of erotic functioning. The amygdala is assumed to play a major role in managing human sexual impulses. This approach emphasizes the need for more study into the neural mechanisms behind this fundamental and permanent aspect of human nature. It is hoped that such an examination would lead to more studies, particularly through key brain regions that have already been identified by researchers. Another viewpoint is that sexual arousal disorders are poorly understood and treated, which leads to significant comorbidity as well as mortality in romantic relationships. Originality and Value: An innovative attempt has been made to provide information on a number of common sexual desire problems and how they may be treated with psychotherapy and psychopharmacology. Information is gathered from researchers and subject-matter specialists to make the paper vibrant and precise. The report was written so that everyone who read it, regardless of academic background, could grasp this clinical problem. A fresh attempt has been undertaken to spread a clinical understanding of sexual desire problems and their relationship to the brain in a more straightforward manner. This paper was created in the hopes that readers will be able to comprehend problems of sexual desire by bearing in mind how they relate to the brain. Paper Type: Clinical analysis paper

Современные методы малоинвазивного лечения преждевременной (ранней) эякуляции.

Introduction. Premature (early) ejaculation is a common male sexual problem. Despite a significant number of proposed methods, there is still no consensus among doctors about the most effective methods of conservative and surgical treatment of this pathology. Materials and methods. The results of publications of domestic and foreign authors devoted to various approaches to the surgical treatment of premature ejaculation were analyzed: circumcision, injections of fillers into the glans penis, various techniques for performing selective dorsal neurotomy, injection of botulinum toxin into the bulbospongiosus muscle, radiofrequency neuromodulation of the dorsal nerve of the penis, selective cryoablation of the dorsal nerve of the penis. Results. The most controversial surgical techniques for the treatment of premature ejaculation. Indications for surgery, technical performance are still variable, and the results are difficult to predict. Selective dorsal neurotomy, radiofrequency ablation, and cryoablation seem promising. It is necessary to develop standard approaches to the selection of patients and the method of performing operations based on a sufficient number of clinical studies. Conclusion. Despite the sufficient number of proposed methods for the surgical treatment of premature ejaculation, it is necessary to standardize approaches to the selection of patients and the choice of surgical technique.

The relationship between cognitive schemas activated in sexual context and early maladaptive schemas among married women of childbearing age

BackgroundHealthy sex can be affected by cognitive schemas activated in the sexual context (CSASCs) and early maladaptive schemas (EMSs). Cognitive schemas are the nuclear structure of the cognitive system which facilitate the interaction between individuals and their environments. CSASCs are emotional and behavioral responses in the sexual context. EMSs are extremely stable, enduring and are developed throughout the life of the individual, beginning in childhood. The present study investigated the relationship between CSASCs and EMSs among married women of childbearing age.MethodsIn a cross-sectional study, 260 married women of childbearing age participated. Using two-stage sampling, ten comprehensive urban health centers were first randomly selected and then 26 individuals from each center were invited to participate. Data collection included demographic variables, the Young Schema Questionnaire-Short Form (YSQ-SF) with 15 EMSs (emotional deprivation, abandonment, mistrust/abuse, social alienation, defectiveness, incompetence, dependency, vulnerability to harm, enmeshment, subjugation of needs, self-sacrifice, emotional inhibition, unrelenting standards, entitlement, and insufficient self-control), and the Cognitive Schema Activation in Sexual Context Questionnaires (CSASCQ) with five subscales (undesirability/rejection, incompetence, self-depreciation, difference/loneliness, and helplessness). Data analysis was performed using a uni-variable and multi-variable linear regression model with a stepwise method at a significance level of 0.05.ResultsThe mean age of the participants was 32.48 years and the average duration of their marriage was 10.34 years. The average score of early maladaptive schemas on the YSQ-SF was 151.5 (out of 450). Higher scores indicate more severe maladaptive schemas, although the total score has no defined cutoff point. Scores greater than 15 on each subscale constitute the internalization of that particular maladaptive schema. The highest average subscale scores were the schemas of self-sacrifice and unrelenting standards (M = 16.12, 15.90, respectively), indicating that these two schemas play important roles in the cognition of the participants. The mean score on the CSASCQ was 34.60 (SD ± 12.59; range: 25–125), with the highest mean reported on the loneliness subscale. Hypoactive sexual desire was the most common unpleasant sexual problem (6.9%) and disillusion was the most dominant feeling experienced by participants (33.3%). The results of the multivariable model showed that the following were significant predictors of the CSASC: three subscales of EMS (emotional deprivation [β = 0.28], social isolation [β = 0.31], and emotional inhibition [β = 0.14]) and two demographic variables (job [β = 0.11] and consanguineous marriage [β = 0.20]). In total, the multi-variable model explained 92% of variance of CSASCs.ConclusionsThe present study found a significant and meaningful association between EMSs and CSASCs adjusting for the effect of socio-demographic characteristics. The findings indicate that the study of schemas and schema therapy should be considered in both premarital and marital counseling.

Melanocortin-4 receptor agonism modulates sexual brain processing in women with low sexual desire

ABSTRACT Introduction Hypoactive sexual desire disorder (HSDD) is characterized by a persistent lack of sexual desire and sexual fantasies, causing marked interpersonal distress1. It is the most common global female sexual health problem, affecting up to 1 in 10 women2,3. Despite its significant social and economic burden4,5, the exact pathophysiology of this condition remains unknown. Furthermore, existing treatment options are limited by their efficacy and side effects6. Melanocortin-4 receptor (MC4R) agonists are a promising therapeutic avenue, although their exact mechanism of action within the CNS remains unknown. Investigating the neural pathways through which MC4Ra's exert their effect will deepen our knowledge of normal and abnormal sexual behaviour, and hence provide information which could contribute to the development of novel treatment strategies. Objective To determine the mechanism by which MC4R agonists mediate their effects on sexual behaviour in women with HSDD. Methods We performed a randomized, double-blind, placebo-controlled crossover study in 31 premenopausal women with HSDD. A combination of psychometric, functional neuroimaging and hormonal analyses was used to investigate the effect of MC4R agonism versus placebo on sexual brain processing. A standard fMRI block design task with short (20 second) erotic videos was used to examine brain activation. Additionally, a ‘naturalistic’ fMRI paradigm was used with long (ten minute) erotic videos to examine functional brain connectivity. Results MC4R agonism increased self-reported sexual desire for up to 24-hours following administration, when compared with placebo (P=0.007). The mechanism of action behind this effect may be explained by the changes in brain activation and connectivity, in response to visual erotic stimuli. In the short video task, MC4R agonism led to increased activation of the supplementary motor area and cerebellum, alongside deactivation of the secondary somatosensory cortex, when compared with placebo (Z=2.3, P&amp;lt;0.05). In the long video task, a reduction of functional connectivity between the amygdala and insula in response to erotic stimuli was prevented by MC4R agonism (F (1,30) = 5.553, P=0.025). Regarding hormonal analyses, MC4R agonism led to a small mean increase in LH of 1.1iU/L (F [1,58] = 13.38, P=0.0005) and FSH of 0.35iU/L (F [1,60] = 10.97, P=0.0016) during the study, with no effect on estradiol or progesterone levels. Conclusions This is the first study investigating the effect of MC4R agonism on sexual brain processing in women with HSDD. These results shed light on the neural substrates through which MC4R agonism increases sexual desire. The observed changes in brain activation may serve to ease self-consciousness, enhance sexual imagery and disinhibit the sexual response in women with HSDD. This is in line with the “top-down” neurofunctional model of HSDD whereby inspecting and monitoring one's sexual response interferes with desire7. This information is important for the ongoing development of therapies for HSDD, as well as MC4R agonist development more widely, such as in obesity medicine where there their use is being rapidly developed. Disclosure Work supported by industry: yes, by AMAG Pharmaceuticals Inc.

Vaginismus: An overview

ABSTRACT Introduction Vaginismus is defined as a penetration disorder in which any form of vaginal penetration is often painful or impossible. It has traditionally been referred to as an involuntary contraction of the pelvic floor muscles due to actual or anticipated pain associated with vaginal penetration. Vaginismus is predominantly unknown among clinicians and women. Vaginismus causes women to feel pain, fear and anxiety with penetration attempts. It is a poorly understood and underdiagnosed condition, for which many women do not gain support. This is due to the lack of knowledge of the condition, for the shame and embarrassment felt by vaginismus sufferers which means many do not discuss the issue. Objective Vaginismus is commonly experienced medical issue, affecting about 1-7% of the female population worldwide. Female pain is often viewed not as a medical fact, but as a misimpression or misinterpretation of bodily events. Vaginismus is not the only condition that has been placed in context of neglect. Other sexual pain disorders, such as vestibulodynia, vulvodynia and dyspareunia, have also been met with doubt and disbelief. An examination of the disbelief surrounding female reportage of their own bodily events will not only be beneficial in terms of perception of vaginismus, but also for general women's health. Methods This systematic review will provide an assessment of the current state of vaginismus. The following databases has been searched from the study inception to July 2021: the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, MEDLINE, Embase, Scopus, Web Of Science, ProQuest, ScienceDirect, UpToDate, Polish Medical Bibliography and consultations of Polish specialists and discussion forums of patients have been used. Results Vaginismus influences the quality of life, in the most serious form it can result in unconsumated marriage, sterility and thus can lead to the separation of a couple. When adequately approached, the problem can mostly be solved. Conclusions Vaginismus is a common and significant sexual problem that causes distress and frustration for both partners. There are women for whom vaginismus is a serious problem and who are not able to cope with the situation without professional help of specialists. Deepening the specialists knowledge in this field is essential for successful treatment. Vaginismus is a well recognized clinical condition associated with non-consummation and considerable distress in women. It has received little scientific attention, and further well designed studies are needed. Disclosure Work supported by industry: no.

Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis

The role of masturbation frequency and pornography use on sexual response during partnered sex has been controversial, the result of mixed and inconsistent findings. However, studies investigating this relationship have often suffered from methodological shortcomings. We investigated the role of masturbation frequency and pornography use on both the occurrence and severity of delayed/inhibited ejaculation (DE), an increasingly common sexual problem among men. We did so in a large (nonclinical) multinational sample of cisgender men (N = 2332; mean age = 40.3, SE = 0.31) within a multivariate context that relied on multiple (and, when possible, standardized) assessments of sexual dysfunctions while controlling for possible confounding variables. Results indicated a weak, inconsistent, and sometimes absent association between the frequency of pornography use and DE symptomology and/or severity. In contrast, both poorer erectile functioning and anxiety/depression represented consistent and strong predictors of DE and, to a lesser extent, DE severity. Other factors, including relationship satisfaction, sexual interest, and masturbation frequency, were significantly though moderately to weakly associated with DE. In conclusion, associations (or sometimes lack thereof) between masturbation frequency, pornography use, and delayed ejaculation are more clearly understood when analyzed in a multivariate context that controls for possible confounding effects.

The management of sexual problems in cancer patients

. The management of sexual problems in cancer patients. Sexual dysfunction is one of the most common and distressing consequences of cancer treatment. Many survivors face long-term effects such as treatment-induced menopause, altered gonadal function, and significant surgical disfigurement but some treatment-related sexual adverse effects are short-term. Many survivors do not feel prepared for potential sexual changes and often do not receive adequate support to manage sexual dysfunction. A concise review of the most common sexual problems experienced by cancer ptients is presented together with the main evidence based interventions to suggest to address sexual dysfunction.

Comparing prevalence of sexual dysfunctions between narcissists and healthy persons

Introduction: Sexual dysfunction is considered a common sexual problem affecting different aspects of life, and it seems to be rooted in individual's personality. Aim: This paper aims to compare prevalence of sexual dysfunctions between those with narcissistic personality disorder (NPD) and healthy persons. Method: This is a causal – comparative research. To do so, 700 males and females from Tehran City were screened in 2021, among them 120 persons were diagnosed with NPD and 41 persons were selected through convenience sampling as individuals with disorder. Data of 40 healthy persons were analyzed for comparative purposes. Millon Clinical Multiaxial Inventory (MCMI3), Female Sexual Functions Index (FSFI) and International Index of Erectile Function (ILEF) were used. Data were analyzed by comparing two independent groups in SPSS, Version 26. Results: In females, there were no significant differences in sexual function (t=1.011, P=0.320), moisture (t=0.537, P=0.595), orgasm (t=-0.539, P=0.594), sexual pleasure (t=0.164, P=0.871) and pain (t=0.999, P=0.327) between narcissists and healthy persons. Difference in sexuality (t=2.289, P&lt;0.05) and arousal (t=2.107, P&lt;0.05) in healthy persons was more significant than narcissists. Moreover, in males, the difference in sexual function (t=7.545, P&lt;0.001), sexuality (t=12.871, P&lt;0.001) and erection (t=4.832, P&lt;0.001) in healthy persons was more significant than narcissists, and orgasm (t=-3.426, P&lt;0.01) in narcissists was less than in healthy persons. However, there was no significant difference between sexual pleasure in both groups (t=-0.866, P=0.393). Conclusion: The results show that prevalence of sexual dysfunctions in narcissists is more than healthy persons. Therefore, it is recommended that counselors and psychologists consider personality traits in diagnosis and treatment of sexual disorders.