Future Sexual Function Research Articles

Sexual Function in Women With Pelvic Floor Disorders Who Have Sex with Women: A Qualitative Study

BackgroundUrogynecologic literature confirms that pelvic floor disorders are detrimental to sexual function in heterosexual women and that sexual function improves following treatment. Few data exist regarding these issues in women who have sex with women, potentially affecting patient-provider interactions, treatment choices and outcomes. ObjectiveTo describe sexual function concerns of women with pelvic floor disorders among women who have sex with women. Study DesignThis was a multi-center qualitative study conducted to explore the sexual function of women who have sex with women and to investigate how pelvic floor dysfunction affected their sexual function. A semi-structured interview guide was created to conduct one-on-one interviews via digital conferencing. The audio interviews were transcribed and deidentified. Transcripts were then analyzed with line-by-line coding by at least two independent researchers and organized into themes using a team-based approach. Interviews were conducted until thematic saturation was reached. Domains investigated included: knowledge and beliefs regarding pelvic floor disorders, impact of pelvic floor disorders on sexual function, and sexual function in general. ResultsEighteen women who have sex with women participated in cognitive interviews. Thematic saturation was reached. Participants’ average age was 49.0 (+/-16.6) years, the majority self-identified as Non-Hispanic White, were healthy with minimal chronic medical conditions, and were married or living with a partner. Four major concepts emerged from the focus groups: (1) pelvic floor disorders resulted in fear and embarrassment and negatively affected sexual function, (2) women adapted their sexual lives to accommodate PFDs, (3) partner choice & communication with that partner could ameliorate PFD effects on sexual function, and (4) women shared impressions potentially affecting future sexual function research and clinical care of women who have sex with women; a need for broader interpretation of sexual activity, the importance of non-judgment and recognition of potential history of sexual trauma. ConclusionA major theme reported by women with pelvic floor disorders who have sex with women mirrored those of heterosexual women; fear and embarrassment regarding their pelvic floor disorders and their effect on sexual function. These women also voiced novel viewpoints regarding sexual function and amelioration of pelvic floor disorder effects on sexual activity by partner choice and partner communication. Novel issues that could affect future sexual function research and clinical care of women who have sex with women include broadening the definition of sexual activity and emphasizing the importance of non-judgmental and trauma-informed care.

Sex Reassignment Dilemma in 4 Yemeni Siblings with Five Alpha-Reductase Type 2 Deficiency

5α-Reductase two deficiency (5αR2D) is an autosomal recessive 46, XY disorder impacting the HeRD5A2 gene, causing ambiguous genitalia. Four Yemeni siblings with this condition sought guidance from the Sudanese Intersex Working Group (SIWG) in adulthood. A multidisciplinary evaluation was conducted, encompassing physical, mental, hormonal, and imaging examinations, although genetic mutation analysis of the srd5a2 gene was precluded due to limited facilities. Participants were initially assigned as females by an untrained birth attendant; the siblings later manifested virilisation before puberty, prompting a reassignment to the male sex. Despite presenting with 46 XY DSD due to 5αR2D, their sexual identity conflict led them to seek counsel from the SIWG. Comprehensive assessments confirmed the 5αR2D diagnosis. Extensive counselling with the family revealed their resolute decision to maintain the male sex despite concerns highlighted by the SIWG regarding future sexual function and fertility. This case underscores the significant challenges stemming from inadequate knowledge and interventions, emphasising the critical need for early diagnosis, proper genetic counselling, and expert management. Timely referrals to specialised facilities and consideration of options such as in vitro fertilisation (IVF) and preimplantation genetic diagnosis (PGD) for subsequent children are imperative. This report advocates for proactive measures in similar cases, emphasising the importance of tertiary care facilities for accurate diagnosis, informed decision-making, and optimal management of 5αR2D-related dilemmas.

(057) Influence of Circadian Disruption on Erectile Function in Chronic Jet-Lagged Young Rats

Abstract Introduction Sleep is crucial during the developing stage of one’s life and has been associated with physical activity. However, as the number of 24-hour stores such as convenience stores and supermarkets have increased, along with increased internet usage, people have developed the habit of staying up late, resulting in sleep deprivation due to disruption in the light-dark cycle. Jet lag is widely used in animal models for inducing irregular circadian rhythms. Chronic jet lagged model animals are known to develop a variety of disorders. Objective To investigate the influences of chronic jet lag on erectile function in rats in order to elucidate the effects of irregular circadian rhythms on future sexual function. Methods 4-week-old rats underwent randomly assigned to remain either under the control light/dark cycle (Cont group) or under chronic light/dark shift schedule to simulate the conditions of chronic jet lag (CJL group). The shift-lag protocol consisted of 8 h light/dark phase advances repeated every 3 days for 4 weeks. Erectile function was examined at 1, 2, and 4 weeks post CJL treatment. After 4 weeks of CJL treatment, the rats were returned to control light/dark cycle for 4 and 8 weeks, as CJL(4w)+Rest(4w) group and CJL(4w)+Rest(8w) group, and erectile function was examined correspondingly. Erectile function was tested using intracavernous pharmacotherapy (ICP) measurements, and endothelial function was tested through an isometric tension study. Western blot analysis was used to assess the levels of endothelial nitric oxide (eNOS) and phosphorylated eNOS (p-eNOS). Additionally, mRNA expressions of clock genes (Bmal1 and Cry 1) and growth factors (TGF-β1 and ICAM-1) were tested using real-time PCR. Results The ICP/MAP ratio was significantly lower in the CJL group (0.35 ± 0.05) at 4 weeks than in the control group (0.66 ± 0.05) (P < 0.05). CJL group exhibited significantly lower testosterone levels, Bmal1, Cry 1, TGF-β1, and ICAM-1 expression, and p-eNOS and cGMP levels. The ICP/MAP ratio in the CJL(4w)+Rest(4w) group (0.47 ± 0.06) was lower than that in the control group (P < 0.01) whereas the ratio in the CJL(4w)+Rest(8w) group (0.81 ± 0.03) was similar to that in the control group (P > 0.05). Conclusions In this study, chronic jet lagged (4 weeks) rats exhibited a decreased ICP/MAP ratio, reduced testosterone level, and decreased p-eNOS expression, indicating the development of erectile dysfunction (ED). Upon 8 weeks of normal light/dark shift schedule, erectile function was recovered. This study suggests that irregular circadian rhythms induced by repeated jet lag, especially in childhood, may affect the production of sex hormones and erectile function in the future. Therefore, it is necessary for children to follow a regular circadian rhythm and healthy lifestyle. Disclosure No.

(012) Sexual Dysfunction in Men After Failed Hypospadias Repair

Abstract Introduction Hypospadias is commonly treated in childhood, and future sexual function of such patients is sometimes overlooked. Some published reports reveal excellent sexual function following hypospadias repair at long term, while other authors state high prevalence of sexual dysfunction which depends on original position of urethral meatus. Patients with complications of primary hypospadias repair are one of the most difficult subpopulations to evaluate. This is a unique subset of patients who should be described separately from men who underwent successful hypospadias repair. Objective To describe the spectrum of sexual dysfunction in patients with sequelae of failed hypospadias repair and our experience in its management. Methods We evaluated 112 patients with a history of failed hypospadias repair, defined as presence of voiding symptoms or cosmetic problems remaining despite previous surgery or caused by it. Patients’ median age was 29.5 years (range: 18–62). There were no intersex cases. Only 9.8% (11/112) underwent single attempt at surgical reconstruction, the median number of attempts was 3.5 (range: 1–9). Patients with IIEF-EF score ≤ 25 were considered to have erectile dysfunction; those with IIEF-EF ≤ 16 underwent penile doppler ultrasound, penile electromyography and endocrine assessment. Results 64.2% of patients (72/112) were dissatisfied with penile appearance, 40.2% (45/112) had ED, 71.4% (80/112) had ejaculation disorders. Psychogenic ED was diagnosed in 21 patients with preserved non-coital erections and no evidence of organic ED. Median IIEF-EF in ED patients was 20 (range: 8–25). Asthenic ejaculation, delayed ejaculation and anejaculation were present in 63.4% (71/112), 7.1% (8/112) and 3.5% (4/112) patients, respectively. Premature ejaculation was present in 28.6% (32/112) patients, but its association with hypospadias or previous surgery is unlikely. On univariate analysis only the number of previous attempts at surgical repair was a significant predictor of sexual dysfunction following definitive surgery (p = 0.033). Rate of normal sexual function was 37.5%, 23.5% and 9.1% among patients with history of ≤ 3, 4–6 and ≥ 7 procedures, respectively. Conclusions Failed hypospadias repair may lead to a wide spectrum of sexual dysfunction, involving sexual desire, erection and ejaculation. Repeated surgery leads to increased risk of sexual dysfunction which may be devastating for patient’s quality of life. Disclosure No.

성분화질환을 둘러싼 법적 문제

Sexual differentiation disease is the abnormal condition in development situation of sexual differentiation which is the basis of gender determination. This thesis reviewed for the person born with this disease to enable normal growth without emotional disorders and inferiority complex under the system of male or female choice. The points are summarized as follows. First, it is about the malpractice of medical operation for gender confirmation. Malpractice cannot be admitted because the medical operation for gender confirmation of the son was suitable medical level at that time. Second, it is about the relation with the guarantee of gender determination of the son. About this, all unnecessary surgical operations should be postponed until the time when the son becomes mature and decides for himself. In addition, the doctor has the obligation to provide all information to the person with parental rights when the doctor is going to perform the gender confirmation operation on the patient with sexual differentiation disease. Especially, if the gender confirmation operation is not an emergency, the doctor should explain to the person with parental rights, thus the person with parental rights should not be misunderstood as emergency situation and not to perform early gender confirmation operation. Furthermore, the doctor should explain the side effect that the newborn baby can lose fertility through the gender confirmation operation. That is an important matter about basic human right to body, so if these information were not provided, it is against informed consent. Even in case the patient with sexual differentiation disease can live as male or female either, the son should be able to decide his gender as best interest not facing identity problem when he grow up. Third, it is about the birth registration of the person with sexual differentiation disease. About this, like family registration practice in Japan, birth registration should be reported in an undetermined state for happiness of the son, and the irreversible treatment like genital organ removal should be prohibited until the son can decide for himself. In addition, it is appropriate for the son to decide his gender and complete family relation register subsequently after adolescence appearing second sexual characteristics through sexual differentiation of brain. Fourth, it is about the decision criteria of gender correction to sexual differentiation disease. Recently, as the decision criteria, not only sex chromosome as the sole absolute criteria but also cause of abnormality, condition of internal and external genital organs, composition of sex chromosome, surgical operation possibility of external genital organs and prediction of future sexual function should be considered, and simultaneously, it also should be considered which gender would secure for his happy life, and then the doctor shall select the gender to perform operational treatment.

Sexual function in male cancer survivors is not correlated to sperm quality

PurposeBoth infertility and erectile dysfunction (ED) are known long-term consequences of cancer treatment in young male cancer survivors. In the present study, we aimed to assess whether sperm quality and sexual function in male cancer survivors are associated.MethodsIn this prospective study, n = 244 patients male cancer survivors who underwent sperm analysis and cryopreservation between 2008 and 2018 prior to the initiation of gonadotoxic treatment were invited. In total n = 50 had a follow-up sperm analysis and completed two questionnaires, the Aging Males’ Symptom Scale (AMS) and the International Index of Erectile Function (IIEF-EF). Differences between the individual parameters were analyzed using the Wilcoxon or Mann Whitney test.ResultsAzoospermia was present in n = 16/50 (32.0%) patients at time of follow-up. ED occurred in n = 9/43 (20.9%) patients and was observed more frequently in patients with oligo- or azoospermia than in those with normospermia, even though this association was not statistically significant. Sperm parameters (total sperm count, sperm concentration, progressive motility) did not differ between time of cryopreservation and time of follow-up. Mean total, somatic, psychological, and sexual AMS score was 23.6, 9.9, 6.6, and 6.8, respectively. Mean total IIEF-EF score was 27.3, indicating mainly mild ED.ConclusionsMore than one-third of cancer patients suffered from azoospermia, and ED was primarily present in this subgroup. We recommend implementing the screening of sexual dysfunction in the annual sperm testing that should be offered to all men after gonadotoxic treatment. Our study highlights the importance of counseling young cancer patients on both aspects—future infertility and sexual function—prior to treatment and at follow-up visits.

Preservation of organs related to future sexual function during prostate stereotactic body radiotherapy: feasibility analysis through a re-optimization process.

Preserving the quality of life and sexual function of patients with a localized prostate cancer remains a challenge for physicians and a major issue for patients. The present study aimed at demonstrating the feasibility of a dosimetric preservation of the sexual organs during prostate stereotactic radiotherapy planning. Patients from a single centre were retrospectively included in the RPAH-2 trial and randomized in Arm B if they presented with either a low- or intermediate- risk prostate cancer. A 37.5Gy in 5 fractions stereotactic body radiotherapy was delivered on the prostate gland. The corpus cavernosum, penile bulb and internal pudental arteries were retrospectively delineated before a re-optimization process. During this process, RPAH-2 trial dose constraints were respected on Gross Tumor Volume (GTV), Planning Target Volume and usual organs at risk. Pre-defined dose setting delivered to corpus cavernosum, penile bulb and internal pudental arteries were collected and compared before and after the re-optimization process. Nine patients were included in the study. A decrease of the median of each investigated dose setting (except D90% for corpus cavernosum) was reported after the re-optimization for corpus cavernosum, penile bulb and internal pudental arteries. Our study demonstrated the feasibility of a dosimetric preservation of structures considered as relevant to preserve sexual function after prostate stereotactic radiotherapy.

Gender-Affirming Surgeries in Transgender and Gender Diverse Adolescent and Young Adults: A Pediatric and Adolescent Gynecology Primer.

Transgender and gender diverse adolescent and young adults (AYA) may seek gender-affirming surgeries (GAS) as part of their gender affirmation. A number of GAS are related to reproductive and sexual health, and pediatric and adolescent gynecology (PAG) clinicians are well positioned as sexual and reproductive health experts to provide care in this area. PAG clinicians may encounter patients presenting for preoperative counseling (including discussions regarding fertility, family building, future sexual function, and choice of oophorectomy at time of hysterectomy), requesting referrals to GAS clinicians, or requiring GAS aftercare, or those seeking general sexual and reproductive health care who have a history of GAS. This article reviews presurgical considerations for AYA seeking GAS, types of GAS, their impact on pelvic, sexual, and reproductive health, and aftercare that may involve PAG providers, with the goal of helping PAG clinicians to better understand these procedures and to empower them to engage collaboratively with GAS teams. With this knowledge, reproductive health clinicians can have an integral role as skilled collaborators in the world of AYA GAS in partnership with GAS surgeons.

Patient Preferences and Treatment Decisions for Prostate Cancer: Results From A Statewide Urological Quality Improvement Collaborative

ObjectivesTo examine the relationship between influential factors and treatment decisions among men with newly diagnosed prostate cancer (PCa). MethodsWe identified men in the Michigan Urological Surgery Improvement Collaborative registry diagnosed with localized PCa between 2018-2020 who completed Personal Patient Profile-Prostate. We analyzed the proportion of active surveillance (AS) between men who stated future bladder, bowel, and sexual problems (termed influential factors) had “a lot of influence” on their treatment decisions versus other responses. We also assessed the relationship between influential factors, confirmatory testing results and choice of AS. ResultsA total of 509 men completed Personal Patient Profile-Prostate. Treatment decisions aligned with influential factors for 88% of men with favorable risk and 49% with unfavorable risk PCa. A higher proportion of men who identified bladder, bowel and sexual concerns as having “a lot of influence” on their treatment decision chose AS, compared with men with other influential factors, although not statistically significant (44% vs 35%, P = .11). Similar results were also found when men were stratified based on PCa risk groups (favorable risk: 78% vs 67%; unfavorable risk: 17% vs 9%, respectively). Despite a small sample size, a higher proportion of men with non-reassuring confirmatory testing selected AS if influential factors had “a lot of influence” compared to “no influence” on their treatment decisions. ConclusionMen's concerns for future bladder, bowel, and sexual function problems, as elicited by a decision aid, may help explain treatment selection that differs from traditional clinical recommendation.

Access to male fertility preservation information and referrals at National Cancer Institute Cancer Centers.

Cancer treatment can lead to infertility, which is a significant source of financial and emotional distress for cancer patients and survivors. Given that future fertility and sexual function are critical quality of life issues, we hypothesise that access to subspecialist care is not uniformly distributed. Therefore, we sought to identify access gaps in male sexual health and infertility care at NCI cancer centres across US Census Regions. All 64 clinical NCI cancer centre websites were examined for language related to male sexual health and fertility. A phone-based survey was used to establish cancer centre referral patterns to andrologists and sperm banks. We utilised the Society for the Study of Male Reproduction member directory to determine geographic locations for andrologists relative to each centre. We found that the presence of information regarding male sexual health information was not associated with region. The presence of andrologists within 5-miles of a CC was significantly higher in the Northeast compared to all other census regions. Our work describes the access gap in fertility services at NCI cancer centres and how this differs by region of the country. These data can inform patients, and encourage centres to provide improved access to oncofertility care.

Challenges in pediatric urologic practice: a lifelong view.

The role of the pediatric urologic surgeon does not end with initial reconstructive surgery. Many of the congenital anomalies encountered require multiple staged operations while others may not involve further surgery but require a life-long follow-up and often revisions. Management of most of these disordersmust extend into and through adolescence before transitioning these patients to adult colleagues. The primary goal of management of all congenital uropathies is protection and/or reversal of renal insult. For posterior urethral valves, in particular, avoidance of end-stage renal failure may not be possible in severe cases due to the congenital nephropathy but usually can be prolonged. Likewise, prevention or minimization of urinary tract infections is important for overall health and eventual renal function. Attainment of urinary continence is an important goal for most with a proven positive impact on quality of life; however, measures to achieve that goal can require significant efforts for those with neuropathic bladder dysfunction, obstructive uropathies, and bladder exstrophy. A particular challenge is maximizing future self-esteem, sexual function, and reproductive potential for those with genital anomalies such as hypospadias, the bladder exstrophy epispadias complex, prune belly syndrome, and Mullerian anomalies. Few endeavors are rewarding as working with children and their families throughout childhood and adolescence to help them attain these goals, and modern advances have enhanced our ability to get them to adulthood in better physical and mental health than ever before.

3.4 Gender Confirming Surgical Care in Adolescence: Evidence, Timing, Options, and Outcomes

Requests for gender- confirming surgical procedures have dramatically increased, particularly for adolescents with gender dysphoria. Although there is mounting evidence that surgery is safe, effective, and leads to improved quality of life for transgender adults, there are significant ethical challenges with respect to offering irreversible interventions for minors. Surgeons depend on mental health providers to assess for eligibility and readiness criteria for certain irreversible procedures in minors, particularly chest masculinization (“top surgery”) for the transmasculine population. In contrast, mental health professionals need to know about the surgical aspects care, across pre-, peri-, and postoperative stages. Lastly, mental health providers’ knowledge of potential future surgeries that may be sought during adulthood is important when families and youth have questions on current decisions (puberty blockers, hormones, and their effects on future surgical outcomes) and future emotional and sexual functioning.

Sexual Function and Contraception Use in Women With Inflammatory Bowel Disease

Introduction: IBD likely influences sexual function in women. Prior studies show impaired sexual function in female IBD patients, pain during sexual intercourse, low desire, and difficulty attaining orgasm[1,2]. The aim of our study was to evaluate sexual function and contraceptive methods in IBD patients vs. controls. Methods: A prospective, cross-sectional study was conducted at Women & Infants Hospital of RI, Center for Women's Gastrointestinal Health. Women aged 18-45 with and without IBD completed a questionnaire that assessed 6 subdomains of the Female Sexual Function Index (FSFI), similar to a study by Bel et al.1,3 Contraception and age at diagnosis were assessed, which have been previously studied in varying cohorts2,4. Results: Surveys were completed by 32 IBD patients and 45 controls. Total FSFI score did not vary significantly between IBD and control groups, but IBD patients scored lower than controls in all subdomains. Within the IBD group, a statistically significant correlation was found between age at diagnosis and sexual function. Patients diagnosed at age 16 or younger (N=4) scored lower than patients diagnosed at age 17 or older (N=20) in total FSFI score and in four subdomains (Table 1). Although no differences were found in contraception rates between IBD and control groups, IBD patients were more likely to have received a tubal ligation (Table 2). Conclusion: This study suggests that age at IBD diagnosis may be a determinant of future sexual function. Women with IBD were more likely to have a tubal ligation, suggesting that voluntary childlessness, found to be higher in IBD patients5, may have a role in decisions regarding contraception. A limitation of this study was sample size. The results of this study suggest that gastroenterologists can improve the sexual function and reproductive health of their female IBD patients through history and referral for psychological or sexual-therapeutic interventions.721_A Figure 1. Independent samples test for mean FSFI scores between IBD patients diagnosed at age 16 or younger vs. those diagnosed at age 17 or older721_B Figure 2. Chi-square test for differences in rates of tubal ligation in IBD Group vs. Control Group

MP84-08 NEW INSIGHT INTO THE ASSOCIATION OF BICYCLE RELATED GENITAL NUMBNESS AND SEXUAL FUNCTION: RESULTS FROM A LARGE, MULTINATIONAL, CROSS-SECTIONAL STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease II1 Apr 2018MP84-08 NEW INSIGHT INTO THE ASSOCIATION OF BICYCLE RELATED GENITAL NUMBNESS AND SEXUAL FUNCTION: RESULTS FROM A LARGE, MULTINATIONAL, CROSS-SECTIONAL STUDY Nima Baradaran, Mohannad Awad, Thomas Gaither, Kirkpatrick Fergus, Aron Liaw, Tom Sanford, Michael Eisenberg, and Benjamin Breyer Nima BaradaranNima Baradaran More articles by this author , Mohannad AwadMohannad Awad More articles by this author , Thomas GaitherThomas Gaither More articles by this author , Kirkpatrick FergusKirkpatrick Fergus More articles by this author , Aron LiawAron Liaw More articles by this author , Tom SanfordTom Sanford More articles by this author , Michael EisenbergMichael Eisenberg More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2776AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prolonged time in the saddle is associated with decreased penile and perineal blood flow and temporary genital numbness (GN). The impact of numbness on future sexual function is unclear. We aim to assess the association of GN and sexual dysfunction in cyclists. METHODS Cyclists were recruited through Facebook advertisements and outreach to sporting clubs. This is a secondary analysis of a larger epidemiologic population based study that examined sexual and urinary wellness in athletes. We queried cycling habits and erectile function using Sexual Health Inventory for Men (SHIM). RESULTS The demographic and cycling habits of 2,774 male cyclists are summarized in table 1. Among cyclists, there was a statistically significant increase in trend of GN with more years of biking (p=0.002), more frequent weekly biking (p<0.001), and longer biking distance at each ride (p<0.001). Less frequent use of padded shorts (OR 0.14, p<0.001), lower handlebar (OR 0.49, p<0.001) were associated with GN but BMI (OR 1.1, p=0.33) and age (OR 1.2, p=0.15) were not. In a multivariate logistic regression model, after adjusting for age, BMI, and lifetime miles (calculated by average daily cycling mileage x cycling days/week x cycling years.), there were no statistically significant differences in mean SHIM score between cyclists with and cyclists without GN (20.3 vs. 20.2, p=0.83). Interestingly however, the subset of cyclists who reported GN in the buttock reported statistically significantly worse SHIM (20.3 vs. 18.4, p<0.001). This association was not present in cyclists with GN in the scrotum, penis, or perineum and remained significant after adjusting for overall biking intensity. CONCLUSIONS Cyclists report GN in proportion with biking intensity but GN is not associated with worse sexual function in this cohort. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1127-e1128 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nima Baradaran More articles by this author Mohannad Awad More articles by this author Thomas Gaither More articles by this author Kirkpatrick Fergus More articles by this author Aron Liaw More articles by this author Tom Sanford More articles by this author Michael Eisenberg More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Optimizing assessment of sexual arousal in postmenopausal women using erotic film clips

ObjectivesThis study sought to assess sexual arousal in a subgroup of women by identifying erotic film clips that would be most mentally appealing and physically arousing to postmenopausal women. Study designBy measuring levels of mental appeal and self-reported physical arousal using a bidirectional scale, we aimed to elucidate the clips that would best be utilized for sexual health research in the postmenopausal or over 50-year-old subpopulation. ResultsOur results showed that postmenopausal women did not rate clips with older versus younger actors differently (p>0.05). The mean mental and mean physical scores were significantly correlated for both premenopausal subject ratings (r=0.69, p<0.001) and postmenopausal subject ratings (r=0.94, p<0.001). ConclusionsThus postmenopausal women do not show a preference for the age of actors used in erotic film clips; this knowledge is relevant for design of future sexual function research.

Sexual Functioning in Adolescents With Major Depressive Disorder.

To examine sexual functioning in adolescents with depression. Between September 2010 and March 2014, 235 participants who were between 15 and 20 years old and were unmedicated or within 1 month of beginning antidepressant treatment completed the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Changes in Sexual Functioning Questionnaire (CSFQ). They were also assessed to establish the presence of a DSM-IV-TR major depressive episode (MDE). The Student t test and χ² test were used to compare continuous and categorical variables, respectively, across participants with versus without MDE. Multivariable linear regression analysis examined the association between depression and sexual functioning. After the investigators controlled for age, female sex, antidepressant use, and the presence of generalized anxiety disorder, the presence of MDE was associated with a lower score on the CSFQ overall (P < .0007) and on its desire (P < .09), arousal (P < .001), and orgasm (P < .007) subscales. Antidepressants were not associated with sexual functioning either in the sample overall or in those with MDE. Beck Depression Inventory items related to affective symptoms (P < .03), rather than those tapping into neurovegetative or cognitive functioning, accounted for the association between depression and lower sexual functioning. Furthermore, with higher BDI scores, males exhibited a steeper decline than females in both the CSFQ total score and the desire subscale (sex × BDI score interaction effect: P < .03). Anxiety was not significantly associated with sexual functioning. Major depressive disorder in older adolescents is associated with lower sexual functioning, particularly in males. This appears most related to affective symptoms. The potential impact of such impairment on future sexual functioning deserves further examination. ClinicalTrials.gov identifier: NCT02147184.

Sexual Excitation and Sexual Inhibition as Predictors of Sexual Function in Women: A Cross-Sectional and Longitudinal Study

To date, no longitudinal studies have evaluated the predictive value of the two factors of the dual control model—sexual excitation (SE) and sexual inhibition (SI)—for future sexual function. The aims of the present study were to investigate the associations between SE/SI and sexual function and estimate their predictive value for future sexual function in a sample of women. Overall, 2,214 women participated in a web-based survey that assessed SE, SI, and sexual function as well as symptoms of depression. The one- and two-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and hierarchical regression analyses were conducted to analyze the relationships between predictor and outcome variables. Four factors of SE (Arousability, Partner Characteristics, Sexual Power Dynamics, and Setting) and two factors of SI (Concerns about Sexual Function and Arousal Contingency), as well as symptoms of depression and partnership status, were significant predictors of concurrent and future sexual function. Several subscales of SE and SI contributed to the prediction of future sexual function above and beyond prior sexual function levels. Our study provides the first supportive evidence for the assumptions of the dual control model that propensities for low SE and high SI influence future sexual function.

Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine by Ellen K. Feder

Reviewed by: Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine by Ellen K. Feder Erika Alm Ellen K. Feder, Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine Bloomington: Indiana University Press, 2014, 261pp. ISBN 978-0-253-01228-9 Learning to love, in Nietzsche’s terms, is the enactment of a corporeal generosity; it entails changes in the one who ‘must learn’ to love. Distinguishing what, following Gail Weiss, we might term an ‘embodied ethics’ (1999, 158) from an ethics of ressentiment is the embodied transformation of the one who loves. Rather than seeking changes in the bodies of children with atypically sexed anatomies, the imperative for change is located in the bodies of parents, in physicians, in the rest of us. (87) In Making Sense of Intersex: Changing Ethical Perspectives in Biomedicine, Ellen K. Feder asks what philosophy can add to the understanding of the harmful practices of intersex management. With a strong conviction that narratives of those most acutely affected need to be in focus, Feder has conducted interviews with adult intersex people, parents of intersex children, and physicians. Situating her study in the recent changes in the standards of care, published as “Consensus Statement on Management of Intersex Conditions” (2006), following a conference with U.S. and European endocrinological societies in 2005, Feder sets out to understand why normalizing surgeries are still being [End Page 161] performed, and justified as ethically sound, given that intersex activists and allies have testified for decades to the psychological and physical harm caused by normalizing surgeries. Feder opens up with a genealogical inquiry into the scientific and clinical contexts of intersex management. It is a U.S.-centered history, but Feder points to aspects not recognized in contemporary discussions, like the convergence of Western, colonial understandings of genital modification in African tribes and the modernist project of medicalization as the solution to the perceived problem of nature being more diverse than culture bargained for (128). One of the main points in Making Sense of Intersex is the unpacking of the notion that it is the parents of intersex children that push for normalizing surgery, that parental anxiety is at the root of the status quo. Consequently, Feder argues that the widely held assumptions about parental unconditional love is one of the fundamental problems with the dominating bioethical approach towards intersex management. To challenge this approach, she turns to Eva Kittay’s work on the vulnerability of so-called dependency workers, and the derivative dependency that they experience through their reliance on expert knowledge, i.e., the medical providers. The regulatory ideal for dependent workers is the “transparent self ” (53), which presupposes a complete identification with the caretaker on the dependency worker’s part. Feder explores how this ideal of identification might be complicated by the birth of a child other than the one expected. She asks if the focus on genital appearance and the question of future sexual sensitivity and function—so central in the clinical discussions about the pros and cons of normalizing surgeries—may hinder the expected identification. Through the narratives of adult intersex activists, she also explores the potential harm done by all aspects of intersex management—surgical interventions as well as discourses of shame, secrecy, and pathologization—through putting Lacan’s understanding of the mirror stage in conversation with Merleau-Ponty’s insights into the constitution of body schemata, and ends up arguing for an embodied ethics of corporeal generosity that is based in human vulnerability and relationality. The stakes in her critical intervention become apparent when Feder engages in direct dialogue with feminist theorists and ethicists; for example, in her discussions about how envy might be an instigating affect in intersex management. Building on Freud’s theory of the infant’s polymorphic desire, and Judith Butler’s and Jane Flax’s readings of the melancholic identification that is an effect of the unmournable loss of this desire, she argues that the disgust physicians express is rooted in envy. Using Nietzsche’s concept of ressentiment as a prism, Feder wants us to focus “not on the bodies of those born with intersex conditions, which have been the privileged objects of attention both in medical...

Ethical perspectives on the management of disorders of sex development in children

Ethical perspectives on the management of disorders of sex development in children Breanna Lathrop,1,2 Teresa B Cheney3 1Good Samaritan Health Center, Atlanta, GA, USA; 2South University, Savannah, GA, USA; 3AppleCare Immediate Care, LLC, Statesboro, GA, USA Abstract: The management of a child with disorders of sex development is complex from both a medical and sociocultural perspective. Decisions impacting the future sexual function and sex identity of the child are made on behalf of the child by their parents and health care providers. Such decisions are rarely straightforward and outcome data to guide practice are limited and conflicting. This manuscript explores the ethical issues present in prenatal diagnosis, sex assignment, medical management, and surgical intervention in the case of children with disorders of sex development. Suggestions for an ethics-based approach to management are offered including the use of multidisciplinary teams and guidelines, improved communication between providers and parents, the early and continued inclusion of mental health professionals, and the use of an independent review of treatment plans. The goal of an ethics-based management approach is the promotion of the autonomy and wellbeing of the affected child. Keywords: intersex, disorders of sex development, ethics, decision-making&nbsp

Quality of life, pain, anxiety and depression in patients surgically treated with cancer of rectum.

BackgroundThe rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals.AimTo evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention.MethodsA descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales.ResultsOf the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed.ConclusionEvaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was observed.