Sexual Desire Domain Research Articles

MP45-06 SHOULD WE TREAT TESTOSTERONE DEFICIENCY IN PATIENTS WHO DO NOT HAVE SYMPTOMS?

INTRODUCTION AND OBJECTIVE: Testosterone replacement therapy (TRT) is effective for treating the symptoms and ameliorating the metabolic consequences of hypogonadism. TRT improves muscle mass, bone mineral density, mood, and sexual performance. However, a significant number of patients have low serum levels of testosterone without any subjective symptoms or complaints. We evaluated the suitability of TRT for patients with non-symptomatic late-onset hypogonadism. METHODS: Seventy patients whose initial serum levels of testosterone were < 300 ng/dL without any symptoms or complaints were consecutively enrolled and followed for 30 weeks. All patients received 1,000 mg parenteral testosterone undecanoate on day 1, followed by additional injections on weeks 6, 18, and 30. Serological tests (for total testosterone, lipid profile, glucose, and prostate-specific antigen [PSA]) were performed and Body Mass Index (BMI), International Index of Erectile Function (IIEF) score, International Prostate Symptom Score (IPSS), the Aging Males’ Symptoms (AMS) questionnaire, and the Global Assessment Questionnaire (GAQ) were performed at baseline and at the end of the study. RESULTS: Mean patient age was 56.2 ± 10.5 years. The total IIEF score increased from 44.9 ± 12.9 at baseline to 54.8 ± 13.0 on week 30 (p < 0.001). The AMS score improved from 37.9 ± 11.5 at baseline to 24.6 ± 13.2 on week 30 (p < 0.001). Baseline and 30-week total testosterone levels were 272.2 ± 48.2 and 598.2 ± 52.5 ng/dL, respectively (p < 0.0001). No significant changes were detected in the IPSS, lipid profiles, glucose, BMI, or PSA level. The percentage of patients reporting improvement in the GAQ was 58.6%. Improvements in the sexual desire domain of the IIEF, sexual subscale of the AMS, and change in total testosterone (>300 ng/dL) were significantly correlated with a positive GAQ response. The majority of adverse events were mild, reversible, and of short duration. CONCLUSIONS: Although a patient may not complain of any subjective symptoms at the initial visit, TRT can be considered in patients with low testosterone levels and decreased sexual desire and function. It is postulated that patients with low testosterone levels may not recognize their symptoms. Thus, more specific screening is needed for such patients. Source of Funding: None

The effect of transobturator tape operation on sexual functions of a patient with stress urinary incontinence and patient's spouse

This prospective study aimed to investigate the effects of transobturator tape (TOT) procedure on patients with stress urinary incontinence (SUI) and their spouses' sexual function. A total of 157 patients with SUI who underwent TOT operation between January 2017 and May 2019 and their spouses were included. All patients enrolled filled out the Incontinence Impact Questionnaire (IIQ-7), the Urogenital Distress Inventory (UDI-6), the Female Sexual Function Index (FSFI), and patients' spouses filled out International Index of Erectile Function (IIEF-5) before surgery and 6 months after the surgery. The mean value of IIQ-7 and UDI-6 questionnaires in the sixth month after the TOT surgery was lower than the mean scores of these questionnaires before surgery (P < .001). The mean value of the FSFI score was 21.84 ± 1.76 before the surgery and 25.43 ± 1.84 in the sixth month after the surgery (P < .001). There was a significant improvement in desire, arousal, lubrication, orgasm, satisfaction, and pain scores on the FSFI domains (P < .001, <.001, <.001, <.001, <.001 and <.05, respectively). The mean value of the IIEF-5 score of patients' spouses was 48.31 ± 5.23 before surgery and 57.87 ± 7.22 in the sixth month after the surgery (P < .001). Significant improvement was observed in IIEF-5 score regarding sexual desire, intercourse satisfaction, and overall satisfaction domains (P = .012, .002, and .006, respectively). TOT surgery significantly improves the sexual functions of both patients and their spouses.

Validação da escala curta de avaliação funcional do desejo sexual feminino

INTRODUÇÃO: a disfunção do desejo sexual feminino é prevalente e impacta negativamente sobre a função sexual e a qualidade de vida, mas não existem escalas funcionais que levem em conta função e disfunção. OBJETIVO: construir e validar uma escala curta para avaliação funcional do desejo sexual feminino. MÉTODO: Correlação dos resultados de função do desejo sexual avaliado pelo Índice de Função Sexual Feminina (FSFI) e a nova escala funcional, em uma amostra via internet da população feminina brasileira em geral por meio do teste T de Student e o coeficiente de Spearman. Curva ROC fomentou a análise de corroboração entre os dados do domínio disfunção do desejo do FSFI com a nova escala de avaliação funcional. RESULTADOS: Metade das mulheres da amostra apresentou disfunção sexual pelo FSFI, sendo que um terço apresentou disfunção do desejo sexual. Houve boa correlação entre os resultados da nova escala e do domínio desejo sexual do FSFI, bem como boa sensibilidade e especificidade do modelo pela curva ROC. CONCLUSÃO: a nova escala curta de avaliação funcional do desejo sexual feminino com base na Classificação Internacional de Funcionalidade, Incapacidade e Saúde pode ser uma ferramenta útil na avaliação da função do desejo sexual feminino.

Men's Sexual Health Questionnaire score changes vs spontaneous sexual adverse event reporting in men treated with dutasteride/tamsulosin combination therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: A post hoc analysis of a prospective, randomised, placebo-controlled study.

SummaryAimTo assess the impact of baseline characteristics on Men's Sexual Health Questionnaire (MSHQ) total scores and to evaluate the clinical relevance of MSHQ changes and their association with spontaneously reported sexual adverse events (SexAEs) in patients with benign prostatic hyperplasia.MethodsThis was a post hoc analysis of the Phase 4 FDC116115 study, in which patients aged ≥50 years were randomised 1:1 to receive a fixed‐dose combination of dutasteride 0.5 mg and tamsulosin 0.4 mg (DUT‐TAM FDC), or placebo. End‐points included: change in MSHQ total scores by baseline characteristics and SexAEs; cumulative distribution function for change from baseline to month 12 in MSHQ total score and the ejaculation, erection, satisfaction and sexual desire (libido) domain scores; and relationship between changes in MSHQ scores and SexAEs.ResultsThe intent‐to‐treat population comprised 489 patients (DUT‐TAM FDC, n = 243; placebo, n = 246). The mean reduction in total MSHQ score was greater in patients with SexAEs across both groups, compared with patients without SexAEs. Most patients reporting any SexAE (86% DUT‐TAM FDC, 67% placebo) had a worsening of the MSHQ total score at month 12 compared with baseline. Specifically, 90% (DUT‐TAM FDC) and 75% (placebo) of patients reporting an ejaculation SexAE and 73% (DUT‐TAM FDC) and 87% (placebo) of patients reporting an erection SexAE had a worsening of MSHQ ejaculation and erection domain scores, respectively, at month 12. A threshold effect for incident SexAE was observed; patients showing a decrease of approximately 6‐10 points in the total MSHQ score were more likely to report SexAEs.ConclusionFindings support the clinical utility of the MSHQ tool in assessing the impact of DUT‐TAM on sexual function by linking numerical changes in MSHQ scores to spontaneously reported SexAEs for the first time. The threshold effect for incidence of SexAEs warrants further investigation to determine its clinical relevance.

The prevalence of sexual dysfunctions and sexually related distress in young women: a cross-sectional survey

To document the prevalence of female sexual dysfunctions (FSDs) and factors associated with FSDs and sexually related personal distress in premenopausal women. Community-based cross-sectional study. Eastern states of Australia. Women aged 18-39 years. Not applicable. Women were classified as having sexually related personal distress if they had a Female Sexual Distress Scale-Revised score of ≥11, and as having an FSD if they had a low Profile of Female Sexual Function desire, arousal, orgasmic function, responsiveness, or sexual self-image domain score plus sexually related personal distress. Sociodemographic factors associated with an FSD were examined by means of multivariable logistic regression. The prevalence of sexually related personal distress was 50.2%. Sexually related personal distress without dysfunction affected 29.6%, and 20.6% had at least one FSD. The proportions of women with self-image, arousal, desire, orgasm, and responsiveness dysfunction were 11.1%, 9%, 8%, 7.9%, and 3.4% respectively. Sexual self-image dysfunction was associated with being overweight, obese, living together, not married, married, breastfeeding, and taking a psychotropic medication. Psychotropic medication was significantly associated with all FSDs. Independent risk factors for nonspecific sexually related personal distress included psychotropic medication., sexual inactivity, and infertility treatment. That one-half of young Australian women have sexually related personal distress and one in five women have at least an FSD, with sexual self-image predominating, is concerning. The high prevalence of distress signals the importance of health professionals being adequately prepared to discuss sexual health concerns.

A Prospective Clinical Study of a Prosexual Nutrient: Nano Leo for Evaluation of Libido, Erection, and Orgasm in Indian Men with Erectile Dysfunction.

Aim The present study aimed to assess the effects of Nano Leo, a prosexual nutrient formulation, on libido, erection, and orgasm in patients with erectile dysfunction (ED). Methods This was a prospective, single-center, phase IV efficacy study. Patients received two capsules for 7 days and thereafter one capsule through 90 days. Main outcome measures: primary endpoint was change in erectile function assessed using the International Index of Erectile Function (IIEF) questionnaire. Secondary endpoints included improvement in testosterone levels, FSH, LH, and prolactin levels; seminal parameters; and overall quality of life (QoL). Results Our study included 99 men (mean age 32.2 ± 4.71 years). Mean erectile function domain score increased from 18.9 ± 5.67 at baseline to 23.7 ± 4.01 on day 90 (P < 0.001). Similar improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains of IIEF score which was seen as early as day 30. Improved IIEF corroborated with improvement in all QoL domains. From baseline to day 90, treatment with Nano Leo increased testosterone levels (5.04 ± 2.22 vs. 5.57 ± 1.53 ng/mL, P < 0.001). Similar improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains of IIEF score which was seen as early as day 30. Improved IIEF corroborated with improvement in all QoL domains. From baseline to day 90, treatment with Nano Leo increased testosterone levels (5.04 ± 2.22 vs. 5.57 ± 1.53 ng/mL, Conclusion Nano Leo showed improved libido, erection, and orgasm as evaluated by IIEF and QoL and was well tolerated. Therefore, Nano Leo could be an effective and safe pronutrient supplement in managing ED.

A comparison of sexual desire in opiate-dependent men receiving methadone and buprenorphine maintenance treatment

BackgroundMethadone is an effective therapy for opiate dependence. However, one of the commonest side effects is sexual dysfunction among male patients. Buprenorphine is an alternative to methadone. This study aimed to compare sexual desire among opiate-dependent male patients on buprenorphine (BMT) and methadone maintenance therapy (MMT).MethodsThis cross-sectional study involved 126 male opiate-dependent patient who were tested for total testosterone (TT) and prolactin levels, and were interviewed and completed the Sexual Desire Inventory-2 (SDI-2), Malay language of International Index of Erectile Function (Mal-IIEF-15) and the Malay version of the self-rated Montgomery-Asberg Depression Rating Scale (MADRS-BM) questionnaires.ResultsThere were 95 (75.4%) patients on MMT and 31 (24.6%) on BMT. Patients on MMT scored significantly lower in the sexual desire domain (Mal-IIEF-15 scores) (p < 0.01), dyadic sexual desire (p = 0.04) and TT plasma level (p < 0.01) when compared to BMT group after controlling all the confounders.ConclusionsPatients on MMT are associated with lower sexual desire when compared with patients on BMT. Smoking may further lower testosterone and, hence, sexual desire in those already on methadone.

Sexual function improvement of the menopausal women in South Sumatra, Indonesia after ‘Mentari’ health education

The onset of menopause declines the sexual activity, that may contribute to divorce among married couples. This study aimed to identify the effect of "Mentari" health education on sexual function among menopausal women in South Sumatra, Indonesia. A quasi experimental pre-post tests with control group design was used in this study. A total of 64 menopausal women participated in the study (32 participants in each groups). We used Female Sexual Functioning Index (FSFI) questionnaire to assess the participants' sexual function. The participants reported improvement in their sexual function within the domains of sexual desire, arousal, lubrication, orgasm, satisfaction, and pain during sexual intercourse after taking part in the "Mentari" health education. These changes were found to have a significant difference compared with the control group (p<0.05). "Mentari" health education may help improve the sexual function of the women having menopause. This health education can be provided by the nurses to this group of women.

Sexual dysfunction in women with human papilloma virus infection in the Turkish population

Human papilloma virus infection (HPV) is the most common sexually transmitted disease. It may increase the risk of several cancers, including those of the cervix, vulva, vagina, head and neck. HPV is usually transmitted during sexual intercourse; there are limited data about sexual dysfunction (SD) after infection with this virus. We aimed to measure the incidence of SD in women with HPV. In this study, we evaluated 67 HPV-infected female patients and 66 healthy controls. The Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Socio Demographic Form were used for evaluation. Gynaecologists and psychiatrists evaluated the participants. Women with HPV were found to have significantly higher Arizona Sexual Experience Scale (ASEX) total scores and ASEX sub scores than the control group in the domains of sexual desire, arousal, genital response, orgasmic experience and their satisfaction from orgasm (p ≤ .05). The study group shows a statistically significant difference in the Beck Depression Inventory (BDI), but Beck Anxiety Inventory (BAI) scores show no significant differences between the experimental and control groups. Our study shows that HPV positivity in female patients is associated with a significant impairment in sexual function and that this impairment is not related to depression or anxiety. Impact statement What is already known on this subject? There are only a few studies concerned with sexual dysfunction in HPV patients. These studies have methodological problems, as they do not rule out the effect of depression on sexual dysfunction. It is very difficult to perform studies on sexual dysfunction and sexually transmitted diseases, because both physicians and patients are reluctant to talk about sexual problems. In the present study, only 6 out of 15 physicians accepted to contribute to the study. Although the physicians gave a questionnaire to more than 400 patients, only 133 of them completed that questionnaire. The most important difficulties in this study was to find enough patients. What do the results of this study add? Depression and sexual dysfunction are frequently seen in HPV patients. Although depression is one of the most common causes of sexual dysfunction, an HPV infection may lead to sexual dysfunction even in the patients without depression. What are the implications of these findings for clinical practice and/or further research? HPV infections may be associated with mental health problems and sexual dysfunction. The gynaecologists and other clinicians working with HPV patients should also evaluate patients psychologically and refer patients to psychiatry if required. The psychiatric problems associated with an HPV infection do not only impair sexual functions, but also may lead to difficulties in social life.

Sexual Dysfunction among Male Patients with Tramadol abuse: A Case-Control Study

Objective: Here we have investigated the association between tramadol abuse and male sexual function. Methods: Eighty-two male tramadol abuse patients and 55 healthy controls (20- to 45-years-old) were included in the study. Data from a sociodemographic questionnaire and the International Index of Erectile Function Questionnaire were collected and analyzed. Results: The tramadol abuse patients were 5 times more likely than their healthy counterparts to have erectile dysfunction. The tramadol abuse patients also had worse scores in the orgasmic, sexual desire, intercourse satisfaction, and overall satisfaction domains compared to the controls. Conclusion: Sexual dysfunctions are common among tramadol abuse patients.

Evaluation of the impact of dutasteride/tamsulosin combination therapy on libido in sexually active men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH): A post hoc analysis of a prospective randomised placebo-controlled study.

SummaryAimsFive‐α reductase inhibitor (5ARI) therapy has been associated with sexual dysfunction in some patients. This study assessed the impact of a fixed‐dose combination of the 5ARI dutasteride 0.5 mg and the α1‐adrenoceptor antagonist tamsulosin 0.4 mg (DUT‐TAM FDC) on Men's Sexual Health Questionnaire (MSHQ) domain scores in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH).MethodsThis was a post hoc analysis of a double‐blind, randomised, placebo‐controlled, parallel‐group, multicentre study in sexually active patients, aged ≥50 years, with a confirmed clinical diagnosis of BPH. Sexual activity, sexual desire, and bother domain scores of the MSHQ were assessed at baseline and at Months 1, 3, 6, 9, and 12. Correlation between MSHQ sexual activity/desire scores and ejaculation, erection, and satisfaction domains at baseline was also evaluated.ResultsIn the intent‐to‐treat population (N = 489), 243 and 246 patients were randomised to DUT‐TAM FDC and placebo groups, respectively. Compared with placebo, DUT‐TAM FDC therapy resulted in statistically significant reductions (worsening) from baseline in adjusted mean MSHQ sexual activity and bother domain scores at Months 1, 3, 6, 9, and 12 (all P < 0.05) and in adjusted mean MSHQ sexual desire domain scores at Months 6, 9, and 12 (all P < 0.05). Significant moderate correlations in the expected direction were observed at baseline between the sexual activity/desire domains and the ejaculation, erection, and satisfaction domains (P < 0.0001).ConclusionsThese findings help clarify the degree and impact of libido changes in sexually active men treated with DUT‐TAM FDC and may support clinical decision‐making.

Selective Penile Arterial Embolization Preserves Long-Term Erectile Function in Patients with Nonischemic Priapism: An 18-Year Experience

ObjectiveTo report long term outcomes of selective arterial embolization for nonischemic priapism on erectile function utilizing validated outcome questionnaires after selective arterial embolization. Materials and MethodsTwenty men, mean age of 36 years (range: 8-58 years), underwent selective penile embolization for nonischemic priapism between December 1997 and February 2016 (218 months). Each identified case of nonischemic priapism was embolized using gelatin sponge, autologous blood clot, platinum microcoils, polyvinyl alcohol particles, or a combination of these. A variety of procedural details, immediate complications, recurrence of nonischemic priapism, post-procedure performance on Sexual Health Inventory for Men and International Index of Erectile Function Questionnaires, and follow-up duration were recorded. ResultsMean time from development of symptoms until treatment was 117 days (range: 1-1,042 days). After selective arterial embolization, nonischemic priapism resolved in 18 (90%) patients. No patients with successful treatment of their nonischemic priapism developed a recurrence of nonischemic priapism during the study period following the initial treatment. Eight (40%) patients experienced ischemic priapism following embolization with 4 (50%) resolving after treatment. Mean post-procedure Sexual Health Inventory for Men score was 22.1 (range: 16-25). Mean post-embolization erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains on the International Index of Erectile Function were 25.8 (range: 16-30), 7.8 (range: 6-10), 7.4 (range: 5-10), 10.9 (range: 6-14), and 7.9 (range: 6-10), respectively. Mean follow-up was 4,601 days (range: 970-6,711 days). ConclusionResolution of nonischemic priapism following selective arterial embolization occurred in 90% of the patients. Two validated questionnaires showed no erectile dysfunction following treatment. Mild orgasmic dysfunction, sexual desire dysfunction, intercourse dissatisfaction, and overall satisfaction dysfunction were noted following treatment.

Prevalence of Sexual Dysfunction among Reproductive-age Women in Iran: A Systematic Review and Meta-analysis

Background & aim: Sexual dysfunction is one of the most common problems in women which negatively affect their quality of life, self-esteem, and interpersonal relationships. The prevalence of this problem varies in different studies. Regarding this, this review was conducted to provide a clear picture of the prevalence of sexual dysfunction among reproductive-age women in Iran using a systematic review and meta-analysis. Methods: The relevant articles published up to April 9, 2017 were searched both in the international including Google Scholar, PubMed, Scopus and national electronic databases such as SID, IranMedex, Magiran, and Irandoc. The searching process was accomplished using a set of standard keywords. The data were analyzed using RevMan software, version 5.3. Results: Thedatabase search resulted in the retrieval of 1,024 articles, 9 cases of which were selected for systematic review. Out of the selected studies, seven articles were eligible to be included in the meta-analysis. According to the results of the reviewed studies, the pooled prevalence rate of sexual dysfunction among the reproductive-age women was estimated as 52% (95% CI: 39-66%). Furthermore, the pooled prevalence of sexual dysfunction in the domains of sexual desire, sexual arousal, lubrication, sexual pain, and orgasm was estimated as 39% (95% CI: 35-42%), 34% (95% CI: 21-46%), 32% (95% CI: 21-43%), 38% (95% CI: 24-51%), and 30% (95% CI: 22-38%), respectively. Conclusion: The results of the retrieved studies demonstrated that sexual dysfunction is a common health problem among the Iranian women of reproductive age. However, more high-quality research is needed in this area.

Validity and Clinically Meaningful Changes in the Psychosexual Daily Questionnaire and Derogatis Interview for Sexual Function Assessment: Results From the Testosterone Trials

BackgroundLimited information is available on the performance characteristics of 2 questionnaires commonly used in clinical research, the Psychosexual Daily Questionnaire (PDQ) and the Derogatis Interview for Sexual Function (DISF)-II Assessment, especially in older men with low testosterone (T) and impaired sexual function. AimTo determine reliability of PDQ and DISF-II by assessing the correlation within and between domains in the questionnaires and to define clinically meaningful changes in sexual activity (PDQ question 4 [Q4]) and desire (DISF-II sexual desire domain [SDD]) domains. MethodsData from 470 men participating in the T Trials were used to calculate Spearman correlation coefficients of individual items and total score among questionnaires to determine convergent and construct validity. Clinically meaningful changes for sexual desire and activity were determined by randomly dividing the sample into training and validation sets. Anchor- and distribution-based clinically meaningful change criteria were defined in the training set, and selected changes were evaluated in the validation set. OutcomesValidity of the PDQ and DISF-II and clinically meaningful changes in sexual desire and activity were determined in older men in T Trials. ResultsModerate to strong correlations were shown within and between domains from different questionnaires. Using Patient Global Impression of Change as an anchor, clinically meaningful change in PDQ sexual activity was ≥0.6, and in DISF-SDD was ≥5.0. Applying these change cut-points to the validation set, a greater proportion of T-treated men achieved clinically meaningful improvement in their sexual desire and activity compared to placebo-treated men. Clinical ImplicationsThe PDQ-Q4 and DISF-II-SDD can be used to reliably assess clinically meaningful changes in sexual activity and sexual desire in hypogonadal men treated with T. Strengths & LimitationsStrengths of this study include a large sample size, long trial duration, and inclusion of men with low libido and unequivocally low T levels. Limitations include using data from a single study that enrolled only older hypogonadal men, and only 1 anchor for both sexual desire and activity. ConclusionModerate to strong correlations were demonstrated within and between different sexual domains of the PDQ and DISF-II confirming construct and convergent validity. Clinically meaningful improvement in elderly hypogonadal men was change of ≥0.6 score in the PDQ-Q4 and ≥5.0 in the DISF-SDD. Improvements in sexual activity and desire in the T Trials were modest but clinically meaningful.Wang C, Stephens-Shields AJ, DeRogatis LR, et al. Validity and Clinically Meaningful Changes in the Psychosexual Daily Questionnaire and Derogatis Interview for Sexual Function Assessment: Results From the Testosterone Trials. J Sex Med 2018;15:997–1009.

Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study

BackgroundAlthough erectile dysfunction (ED) has been associated with low circulating total testosterone (TT) levels, the utility of free testosterone (FT) over TT is debatable. AimTo assess the relative impact of low TT and low calculated FT (cFT) on androgen-related sexual symptoms in men with ED. MethodsData from 485 men were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) and the Beck Inventory for Depression (BDI). Descriptive statistics tested differences between patients with normal TT levels (>3 ng/mL) and normal cFT levels (>65 pg/mL; group 1) and men with normal TT and low cFT (group 2), low TT and normal cFT (group 3), and low TT and low cFT (group 4). Linear regression models tested the association between clinical predictors and sexual function impairment. OutcomesWe assessed the impact of different hormonal categories on androgen-related symptoms and the clinical utility of measuring cFT in men with ED. ResultsGroups 1, 2, 3, and 4 were composed of 338 (69.6%), 44 (9.1%), 34 (7.0%), and 69 (14.3%) patients, respectively. Compared with group 1, patients in group 2 were older (P < .001), had a higher body mass index (P < .01), and had a larger proportion with CCI scores of at least 1 (P = .006). Likewise, group 2 presented lower scores for the IIEF erectile function (P = .07), sexual desire (P = .04), and orgasmic function (P = .007) domains and lower BDI scores (P = .02) than group 1. Similar findings were found for group 4 vs 1. Conversely, patients in group 3 had similar scores on the questionnaires to those in group 1. Low cFT and normal or low TT achieved independent predictor status for pathologic IIEF domains and BDI scores after accounting for age, CCI, and body mass index. Conversely, low TT and normal cFT status was not associated with pathologic scores on the questionnaires. Clinical ImplicationsThe inclusion of cFT in the first-line assessment of hypogonadal symptoms in men with ED has major clinical utility. Strengths and LimitationsThis is the first study evaluating the concomitant impact of TT and cFT on men with ED using well-validated instruments to assess patients’ sexuality and depressive symptoms. Limitations are the retrospective nature of the study and lack of physical function data and bone ultrasound measurements. ConclusionsAlthough normal cFT was not associated with signs and symptoms suggestive of testosterone deficiency, even when concomitant with low TT or low cFT irrespective of TT values, it was indicative of poorer clinical profiles and impaired sexual and depressive parameters compared with normal TT and normal cFT in a cohort of patients with ED.Boeri L, Capogrosso P, Ventimiglia E, et al. Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. J Sex Med 2017;14:1549–1557.

Sexual functioning in patients with chronic hepatitis C: a systematic review

Chronic hepatitis C virus (HCV) infection is a systematic disease that affects several aspects of patients' well-being, including physical, mental, social, and sexual quality of life. In recent years, there has been a growing body of literature focusing on HCV patients' sexual health, providing evidence of clinically significant and enduring disturbances that disrupt everyday living, but commonly evade clinicians' attention. Relevant studies are characterized by considerable methodological heterogeneity and their findings should be interpreted using a systematic and integrative approach. In this context, we performed a systematic literature review on the topic of HCV patients' sexual functioning aiming at identifying high-quality investigations reporting scientifically sound and clinically useful data. We performed a thorough search of PudMed, ScienceDirect, and GoogleScholar according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol. Twenty-five articles were included to the review, reporting data from over 5300 chronic HCV patients. Sexual dysfunction, predominantly in the domains of sexual desire, drive, and satisfaction, is commonly reported by HCV patients at rates ranging between 19 and 88%. The current review yielded three distinct patterns of sexual impairment, namely, precirrhotic sexual impairment, cirrhosis-induced sexual decline, and interferon-associated sexual difficulties. Our search yielded significant findings on the prevalence, the characteristics, and the determinants of HCV-associated sexual dysfunction. In addition, we detected several areas of scientific controversy and inadequate information, thus highlighting novel directions for future research.

Does ligation of internal iliac artery for postpartum hemorrhage affect clitoral artery blood flow and postpartum sexual functions?

ObjectiveTo investigate whether internal iliac artery ligation (IIAL) for postpartum hemorrhage (PPH) affects the sexual life in the postpartum period or significantly reduces the clitoral artery blood flow. Study designThe women who underwent IIAL due to PPH during cesarean section (CS) were compared with healthy postpartum women delivered by CS between October 2014 and February 2016 in the Gaziantep Women’s Health and Maternity Hospital, Gaziantep, Turkey. Clitoral Doppler flow measurements and the Female Sexual Function Index questionnaire (FSFIQ) were performed in all women in the 3rd and 6th postpartum months. This study was registered at ClinicalTrials.gov with the identification number NCT02409602. ResultsMean age, gravidity and parity, body mass index (BMI), first sexual intercourse after childbirth, and education years were similar in both groups. There was no statistically significant difference in the measurements of RI, PI, PSV, EDV, and S/D between the study and control groups in the 3rd month. Lack of statistical significance was also noted between the study and control groups values in the 6th month, as well as between the 3rd and 6th month’s values within both the study group and the control group. Additionally, there were no statistically significant differences in the total FSFI scores including sexual desire, sexual arousal, lubrication, orgasm, sexual satisfaction, and pain domain scores between the study and control groups in the 3rd month; between the study and control groups 6th months; whereas all scores were higher in the 6th month compared to the 3rd month within each group. ConclusionIIAL does not affect the blood flow of the dorsal clitoral artery between the 3rd and 6th months postpartum and between the women who underwent IIAL due to PPH and healthy postpartum women. The sexual function scores were significantly higher in the 6th month compared to the 3rd month in both groups.

Female sexual dysfunction: a focus on flibanserin.

Flibanserin is the first US Food and Drug Administration (FDA)-approved option for sexual dysfunction, specifically low sexual desire. Until recently, there were no FDA-approved medication options to assist the ~40% of women affected by female sexual dysfunction (FSD). Often, patients report feeling uncomfortable discussing sexual health, identifying a strong need for health care professionals (HCPs) to proactively reach out to patients to identify concerns and initiate a discussion about sexual health and the available treatment options. Within the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DMS-5), the criteria of female sexual interest/arousal disorder (FSIAD) are outlined, encompassing one of the most common sexual concerns, formerly in its own category defined as hypoactive sexual desire disorder (HSDD) or low sexual desire. HSDD is the absence or deficiency of sexual interest and/or desire leading to significant distress and interpersonal difficulties. HCPs offer an important service in assessing their patients and providing information about treatment considerations while ensuring patient comfort with this topic. This article provides an overview of the types and potential causes associated with FSD and the role of flibanserin in practice as a treatment option. Despite a need for additional study in diverse populations, flibanserin has demonstrated efficacy with increased female sexual function index (FSFI) total and desire domain scores in clinical studies indicating benefit in sexual desire. Common patient or provider-administered assessment tools to assist in identifying affected patients and patient counseling strategies are reviewed.

Relationship Between Use of Videogames and Sexual Health in Adult Males

BackgroundVideogame use is increasingly prevalent in people of all ages, and despite the wide amount of scientific evidence proving a role for electronic entertainment in human health, there is no evidence about the relation between use of videogames and sexual health. AimTo investigate the association between use of videogames and male sexual health. MethodsWe administered the two validated questionnaires, the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function (IIEF-15), to men 18 to 50 years old recruited through social networks and specific websites. In addition to the questionnaires, volunteers were asked to provide information on their gaming habit and lifestyle. OutcomesAn extended version of the IIEF-15 and PEDT, including data about gaming habits and relevant lifestyles. ResultsFrom June 18, 2014 through July 31, 2014, 599 men 18 to 50 years old completed the questionnaires. One hundred ninety-nine men reported no sexual activity during the previous 4 weeks; four records were rejected because of inherent errors. The remaining 396 questionnaires were analyzed, with 287 “gamers” (playing >1 hour/day on average) and 109 “non-gamers” providing all the required information. We found a lower prevalence of premature ejaculation in gamers compared with non-gamers (mean PEDT score = 3.57 ± 3.38 vs 4.52 ± 3.7, P < .05, respectively). Analysis of the IIEF-15 showed no significant differences between gamers and non-gamers in the domains of erectile function, orgasmic function, and overall satisfaction. Median scores for the sexual desire domain were higher for non-gamers (median score [interquartile range] 9 [8–9] vs 9 [8–10], respectively; P = .0227). Clinical ImplicationsThese results support the correlation between videogame use and male sexual health. Compared with non-gamers, men playing videogames for more than 1 hour/day were less likely to have premature ejaculation but more likely to have decreased sexual desire. Strengths and LimitationsThis is the first study aimed to assess male sexual health in gamers. We identified an association between PEDT and IIEF scores and videogame use; however, these findings require validation through interventional studies. Furthermore, volunteers were recruited through social networks, thus increasing the risk of recruitment bias. ConclusionTo our knowledge, this is the first observational study investigating the link between electronic entertainment and male sexuality, specifically for ejaculatory response and sexual desire.Sansone A, Sansone M, Proietti M, et al. Relationship Between Use of Videogames and Sexual Health in Adult Males. J Sex Med 2017;14:898–903.

Distinguishing Failure to Cure From Complication After Penile Prosthesis Implantation

BackgroundA successful penile prosthesis implantation (PPI) surgery can be defined by outcomes beyond the absence of complications. AimTo introduce the concept of failure to cure (FTC) in the context of PPI to more accurately gauge postoperative outcomes after PPI. MethodsConsecutive patients from our sexual function registry who underwent PPI from January 2011 to December 2013 were analyzed. Demographics, previous treatment of erectile dysfunction, comorbidities, social history, postoperative problems (POPs), and surgical outcomes were tabulated. Patients completed the International Index of Erection Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaires. We defined a complication, according to the Clavien-Dindo classification, as any deviation from the ideal postoperative course that is not inherent in the procedure and does not constitute an FTC. FTC was defined as a POP that was not a complication. The χ2 tests, t-tests, or Wilcoxon rank-sum tests were used. OutcomesPatient-reported and objective outcomes after PPI. ResultsOur enrollment consisted of 185 patients, and we contacted 124 (67%). Of these, 16 (12.9%) had a POP requiring reoperation. Eight patients developed surgical complications (three infections, four erosions, and one chronic pain). Eight patients had FTC (four malpositions and four malfunctions). Factors that correlated with POPs were previous PPI, body mass index higher than 30 kg/m2, and previous treatment with intracorporal injections (P < .05 for all comparisons). Patients who had POPs scored significantly lower on the IIEF erectile function and intercourse satisfaction domains (P < .05 for the two comparisons), but not on the orgasmic function, sexual desire, and overall satisfaction domains (P > .05 for all comparisons). Clinical ImplicationsPOPs after PPI surgery can be more accurately categorized using the Clavien-Dindo classification of surgical complications to more clearly distinguish surgical complications from FTC. Strengths and LimitationsLimitations of our study include its retrospective approach. Our series included a large proportion of patients treated for prostate cancer, which limits the generalizability of our findings. We also had a relatively short median follow-up time of 27 months. ConclusionsPatient-reported outcome assessments can vary greatly from what physicians determine to be successful PPI. An assessment of POPs encompasses more than just complication rates; it also reflects FTC. Even when POPs occur, patients can still derive satisfaction if they are correctively managed. Factors that possibly predispose to POPs include previous PPI surgery, body mass index greater than 30 kg/m2, and history of intracorporal injections.Pineda M, Burnett AL. Distinguishing Failure to Cure From Complication After Penile Prosthesis Implantation. J Sex Med 2017;14:731–737.