Impaired Sexual Function Research Articles

Secondary adrenal insufficiency and pituitary dysfunction in oral/transdermal opioid users with non-cancer pain.

Objective To evaluate pituitary function, sexual function and quality of life (QoL) in patients on oral or transdermal opioids. Design and methods Cross-sectional study comparing pituitary function, QoL and sexual function in people on long-term opioid therapy (n = 40) vs an age- and sex-matched control group (n = 25). Baseline pituitary function was assessed on blood samples collected prior to 0900 h. Further testing with corticotropin (250 µg IV) and metyrapone (30 mg/kg) stimulation tests was undertaken on participants with serum cortisol <250 nmol/L. Validated questionnaires completed to assess QoL, fatigue and sexual function. Results Secondary adrenal insufficiency (SAI) was identified on the basis of a failed stimulation test in 22.5% of opioid users vs no controls (P = 0.01). Opioid users with SAI had a higher median morphine-equivalent daily dose (MEDD), P = 0.037 - 50% with MEDD >200 mg and 0% with MEDD <60 mg had SAI. Among male participants, testosterone was inversely associated with BMI (P = 0.001) but not opioid use. A non-significant trend to low testosterone <8 nmol/L in male opioid users (11/24 opioid users vs 2/14 control, P = 0.08) suggests a small subgroup with opioid-induced androgen deficiency. Opioid users had greater fatigue, reduced quality of life in all subsections of the SF-36 and impaired sexual function in both males and females (all scores P < 0.001 compared to controls). Conclusion Long-term opioid therapy was associated with dose-related SAI in over 20% of chronic pain patients and is associated with poor quality of life, fatigue and sexual dysfunction. Obesity confounds the interpretation of opioid-induced male androgen deficiency.

A questionnaire based study of adverse drug effects of antiepileptic drugs in a tertiary care hospital in Central India

Background: Epilepsy is a common disorder of brain function which affects around 1% of world population. Due to nature of chronicity of this disease, long term medical treatment with Anti-Epileptic Drugs (AEDs) is required to achieve control of the seizures. Antiepileptic drugs are responsible for 5% of ADRs among all of the prescribed drugs. Due to the significant number of adverse drug reactions spontaneous reporting and knowledge about ADRs have gained the importance. Knowledge(K), attitude (A) and practices (P) studies are preferred nowadays so as to have the better understanding and implication of the studies for the benefit of the patients. Therefore, this study was planned to evaluate Knowledge, Attitude and Practices (KAP) regarding Anti-Epileptic Drug (AEDs) therapy in epileptic patients and their relatives and to create awareness regarding the same.Methods: A questionnaire based study for assessment of KAP during a period of 2 months in patients of epilepsy and their relatives.Results: The maximum side effects were seen in central nervous system and functions (80%) followed by dermatological problems (6.57%), visual defects (5.19%), GIT complaints (4.84%) and lastly sexual function impairment (3.34%). Carbamazepine was most commonly prescribed drug followed by phenytoin. Certain gender and age specific adverse events were found. 95% patients were found to be compliant with medicines’ dose and schedule.Conclusions: The chronicity of epilepsy calls for long duration of treatment so consideration and addressing ADRs are essential to maintain compliance among patients.

Early treatment narcissism associated with later social and sexual functioning among psychotherapy clients

AbstractBackgroundNarcissism is a significant mental health concern with some evidence of rising prevalence rates in the United States. Treatments have been theorised, yet empirical research documenting psychotherapy effectiveness is lacking. To begin to address this gap, we used an exploratory, practice‐based design and investigated whether adults’ narcissistic symptom scores would decrease during outpatient treatment.MethodologyTreatment occurred at a community mental health clinic in the North‐eastern United States and consisted of a contemporary relational psychoanalytic approach. We used paired‐sample t tests to examine whether narcissism improved from time 1 to time 2 and conducted path analysis of a cross‐lagged panel model for a half‐longitudinal design to determine mediation among variables.ResultsData analyses revealed that narcissism scores improved during psychotherapy treatment, as did depression, social conflict and sexual functioning from time 1 to time 2. Findings suggested that depression mediated the association between time 1 narcissism and later sexual functioning and levels of social conflict.ConclusionsFindings lay the groundwork for future longitudinal designs and highlight the importance of assessing connections between clients’ narcissistic symptoms and (a) mood regulation difficulties and (b) patterns of psychosocial impairment in social conflict and sexual functioning.

Androgen Receptor Polymorphism and Female Sexual Function and Desire

IntroductionThe effect of testosterone depends on the exposure of and the sensitivity of the androgen receptor (AR). It has been shown that a cytosine–adenine–guanine (CAG) trinucleotide repeat polymorphism in the AR gene has an impact on AR functional capacity in men. However, large studies are lacking on the impact of this polymorphism on female sexual function. AimTo determine whether the CAG repeat length was associated with different aspects of women’s sexual function and dysfunction, including desire, arousal, lubrication, orgasm, satisfaction, sexual pain, and sexually related personal distress. MethodsThis cross-sectional study included 529 healthy women, aged 19–65 years. Participants completed a questionnaire to provide demographic and sexual data. The CAG repeat length was analyzed in a blood sample. The correlations between CAG repeat lengths and different aspects of sexual function were calculated. Independent Student t-tests were performed to evaluate differences in the mean number of CAG repeats in the short and long allele and of the biallelic mean length determined by simple calculation and X-inactivation analysis, respectively, between women with sexual problems and women without sexual problems. P values <.05 were considered statistically significant. Main Outcome MeasureWe used the Female Sexual Function Index, with 6 subdomains, to distinguish between women without and women with impaired sexual function; low sexual desire; impaired arousal, lubrication, or orgasm; diminished satisfaction; or pain during sex. The Female Sexual Distress Scale was used to measure sexually related personal distress. ResultsOverall, we found that increasing numbers of CAG repeats were correlated to increased sexual function. We found that women with problems achieving orgasm had a significantly lower number of CAG repeats than women that reported no problems reaching orgasm. We found no associations between CAG repeat lengths and other aspects of female sexual dysfunction, including hypoactive sexual desire disorder. Clinical ImplicationsThe results could indicate an impact of the AR on women’s sexual function, including the ability to reach orgasm. Strength & LimitationsThis is a large study using validated sexual questionnaires. A limitation is the cross-sectional design. Owing to the study design, this study is explorative and hypothesis generating. ConclusionIn this large cross-sectional study, we demonstrated that CAG repeat length is positively correlated to sexual function and that women with a reduced ability to reach orgasm had smaller numbers of CAG repeats in the AR gene than women with no orgasmic problems. These findings indicated that androgens and ARs might play a role in women’s sexual function.Wåhlin-Jacobsen S, Flanagan JN, Pedersen AT, Kristensen E, Arver S, Giraldi A. Androgen Receptor Polymorphism and Female Sexual Function and Desire. J Sex Med 2018;15:1537–1546.

Managing vulvovaginal atrophy after breast cancer

Cancer treatment may result in loss of ovarian function through surgical removal of the ovaries, chemotherapy or radiation. While menopausal symptoms, such as hot flushes, night sweats, sleep disturbance, memory concerns and mood issues can be extremely bothersome to some women going through menopause naturally, women who undergo an induced menopause usually experience more sudden and severe symptoms. Pain and vaginal dryness can occur whether a woman has a sexual partner or not. In women with breast cancer, the aetiology of impaired sexual functioning, and lowered sexual desire, is often multifactorial, and may be related to physical and/or psychological reasons. Pain and vaginal dryness in women without a history of breast cancer can usually be safely treated with vaginal estrogens, in the form of a cream, pessary or ring, and simple lubricants or vaginal moisturisers. Safe usage of vaginal estrogen replacement therapy in breast cancer patients has not been studied within randomised clinical trials of long duration; the guidelines below reflect a clinical consensus.

Sexual function in women with polycystic ovary syndrome: a systematic review and meta-analysis.

We present the first systematic review and meta-analysis of sexual function in women with polycystic ovary syndrome (PCOS) compared with women without PCOS. Data on this topic are limited and often contradicting. Sexual function is influenced by endocrine, mental and social factors, which are often compromised in women with PCOS. The main outcome measures were validated sexual function questionnaires and visual analogue scales (VAS). We identified and assessed 1925 original articles; 18 articles were included. Significant small effect sizes were found on sexual function subscales (total score: P = 0.006; arousal: P = 0.019; lubrication: P = 0.023; satisfaction: P = 0.015; orgasm: P = 0.028), indicating impaired sexual function in women with PCOS. Large effect sizes for the effect of body hair on sex were shown on VAS (P = 0.006); social effect of appearance (P = 0.007); sexual attractiveness (P < 0.001). Satisfaction with sex life was impaired (P < 0.001), but sexual satisfaction was rated equally important in women with PCOS and controls. We conclude that a satisfying sex life is important for women with PCOS; however, sexual function and feelings of sexual attractiveness are impaired. The findings imply that sexual function, sexual satisfaction and psychosocial functioning need to be part of every clinical assessment of women with PCOS.

The influence of partnership quality and breastfeeding on postpartum female sexual function.

Female sexual dysfunction is known to have a huge impact on quality of life and is highly prevalent during the peripartum period. Several influencing variables were found to be associated with impaired sexual function postpartum, among them breastfeeding and partnership quality. However, little is known about the predictive value of these variables. Therefore, this longitudinal cohort study aimed to examine prospectively the influence of the two variables on sexual function 4-month postpartum. Questionnaires were administered to 330 women prenatally (TI, third trimester) and postpartum (TII, 1week; TIII, 4months). Medical data were collected from the respondents' hospital records. The Female Sexual Function Index (FSFI) was used to determine overall sexual function, desire, arousal, lubrication, orgasm, satisfaction, and pain perinatally. At all timepoints, mean FSFI scores were below the critical FSFI-score of 26.55. Partnership quality, breastfeeding, high maternal education, and maternal depressive symptoms correlated significantly with FSFI scores postpartum. Further analyses confirmed antenatal partnership quality and breastfeeding behavior as strong predictors of sexual function 4-month postpartum, explaining 24.3% of variance. Women who stopped breastfeeding or never breastfed at all showed the highest FSFI scores. Our findings indicate that exclusively breastfeeding women and those who report low partnership quality have an increased likelihood of sexual functioning problems 4-month postpartum. Health-care providers need to be encouraged to counsel on postpartum sexuality and influencing factors during prenatal classes to de-pathologize those changes and to foster a positive approach to peripartum sexuality.

Balanitis xerotica obliterans: a review of diagnosis and management.

Balanitis xerotica obliterans (BXO), or penile lichen sclerosus, is a progressive sclerosing inflammatory dermatosis of the glans penis and foreskin. It is associated with significant morbidity and may result in impaired urinary and sexual function. It was initially described by Stuhmer in 1928, named after its pathological features, and is considered the male equivalent of vulvar lichen sclerosis (LS).3,40 The etiology of BXO is uncertain; however, autoimmune disease, local trauma, and genetic and infective causes have been proposed. BXO occurs most commonly on the prepuce and glans penis. It is considered to have premalignant potential to transform into squamous neoplasia. This postulation rests on retrospective studies and parallels drawn with vulvar LS and squamous cell carcinoma (SCC) development. Histologically, BXO and vulvar LS are considered the same disease.41 There is a paucity of evidence-based guidelines to assist with appropriate follow-up for patients with BXO.

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

Obesity and Sexual Functioning.

Sexual functioning is an important, yet often overlooked, aspect of quality of life for many individuals with obesity. With the growing recognition of obesity as a significant, international public health issue, a developing body of research has investigated the relationship between obesity and sexual functioning. Several studies have found that obesity is associated with impairments in sexual functioning. The mechanisms of this relationship, whether physiological, psychosocial, or a combination of the two, are yet to be fully elucidated. Other studies have suggested that weight loss, whether induced by bariatric surgery or less intensive interventions, is associated with significant and clinically meaningful change in sexual functioning and relevant reproductive hormones. This chapter reviews the research in these areas and provides recommendations for future research on these relationships.

Major and minor complications after resection without bowel resection for deeply infiltrating endometriosis.

To analyze major and minor complications following surgery for deeply infiltrating endometriosis including long-term impairment of intestinal, bladder, and sexual function. Patients who had undergone resection for deeply infiltrating endometriosis without anterior rectal resection between 2001 and 2011 were included (n = 134). Clinical and surgical data, as well as minor and major complications, were recorded. A questionnaire was sent to the patients and to a healthy control group (n = 100). Major complications occurred in 3.7% and minor complications in 12.7% of the patients. Surgical revision was necessary in five cases. The questionnaire response rate was 66.4%, with a mean follow-up period of 75.6months. Weak urinary flow was reported by 26.4% of the patients; a feeling of residual urine by 16.1%; constipation by 13.5%; more than one bowel movement/day by 16.9%; insufficient lubrication during intercourse by 30.3%. The findings for weak urinary flow, feeling of residual urine, and insufficient lubrication differed significantly from the control group. Subgroup analysis did not identify any statistical associations between questionnaire responses and dyspareunia or dysmenorrhea as reasons for surgery, or previous endometriosis surgery in the patient's history. The major and minor complication rates were consistent with or lower than the literature data. Few studies have investigated complication rates associated with treatment for endometriosis in the sacrouterine ligaments and/or the rectovaginal septum. The high rates of impaired bladder function and sexual function after endometriosis surgery, as well as inadequate data, make further prospective studies on this topic necessary.

Why Is Impaired Sexual Function Distressing to Men? Consequences of Impaired Male Sexual Function and Their Associations With Sexual Well-Being

IntroductionAccording to theoretical models of sexual dysfunction, the complex association between male sexual function and subjective sexual well-being (ie, sexual satisfaction and distress) may be partially mediated by specific “consequences” of impaired function, but little research has assessed the frequency of specific consequences or their association with well-being. AimTo pilot a scale assessing consequences of impaired male sexual function, and test whether specific consequences (eg, disruption of sexual activity, negative partner responses) mediated the association between sexual function and well-being. Methods166 men in sexually active heterosexual relationships completed self-report measures. A majority of men self-identified as experiencing impaired sexual function in the past month. Main Outcome MeasureSexual Satisfaction Scale, International Index of Erectile Function, and Measure of Sexual Consequences. Results17 specific consequences were reported with at least moderate frequency and were rated at least somewhat distressing. A factor analysis suggested 3 distinct categories of consequences: barrier to sex and pleasure, negative partner emotional responses, and impaired partner sexual function. These factors and the overall scale exhibited acceptable internal and test-retest reliability and each was significantly associated with multiple facets of sexual function and well-being. Frequency of sexual consequences significantly mediated the association between sexual function and well-being, with the strongest and most consistent indirect effects being found for the barrier to sex and pleasure factor. Clinical ImplicationsConsequences of impaired sexual function on one’s sexual experiences may be an important maintaining factor of sexual dysfunction and reduction in these consequences may represent a mechanism of action for psychological treatments. Strength and LimitationsStrengths included a relatively large sample with a diverse range of sexual function and well-being, as well as modern statistical analyses to assess factor structure and mediation effects. Limitations included the use of self-report scales with limited independent evidence of validity and reliability for use with male samples, as well as the cross-sectional methods that preclude strong conclusions regarding causal relationships. ConclusionSexual consequences represent potential maintaining factors of male sexual dysfunction and may represent key targets of cognitive behavioral treatments.Stephenson KR, Truong L, Shimazu L. Why is impaired sexual function distressing to men? Consequences of impaired male sexual function and their associations with sexual well-being. J Sex Med 2018;15:1336–1349.

Effect of Lurasidone on Sexual Function in Major Depressive Disorder Patients With Subthreshold Hypomanic Symptoms (Mixed Features): Results From a Placebo-Controlled Trial.

The aim of this secondary analysis was to evaluate whether treatment with lurasidone was associated with impairment in sexual functioning in major depressive disorder (MDD) patients with subthreshold hypomanic symptoms (mixed features). Patients meeting DSM-IV-TR criteria for MDD, who presented with 2 or 3 protocol-specified manic symptoms, were randomized to 6 weeks of double-blind treatment with flexible doses of either lurasidone 20-60 mg/d (n = 109) or placebo (n = 100). The study was conducted between September 2011 and October 2014. Change in sexual functioning was assessed utilizing the 14-item self-report Changes in Sexual Functioning Questionnaire (CSFQ-14) administered at baseline and week 6 endpoint. Change from baseline to week 6 in depression severity was assessed utilizing the Montgomery-Asberg Depression Rating Scale (MADRS) total score, the primary efficacy endpoint. Lurasidone significantly reduced mean MADRS total scores at week 6 endpoint (-20.5 vs -13.0; P < .001). Treatment with lurasidone was associated with significant endpoint improvement in CSFQ total scores versus placebo (+5.1 vs +3.1; P < .05). Fewer patients treated with lurasidone versus placebo shifted from normal to abnormal sexual function. The proportion of patients with a baseline-to-endpoint shift from normal to abnormal sexual function was smaller for lurasidone versus placebo (1.9% vs 4.3%; CSFQ criteria) at study endpoint. Use of higher lurasidone doses was not associated with greater impairment in sexual functioning. No treatment-emergent adverse events related to sexual function were reported during lurasidone treatment. In this secondary analysis of a placebo-controlled trial involving patients with MDD and mixed features, lurasidone was not associated with treatment-related sexual dysfunction. These findings were consistent across both structured assessments using a validated sexual functioning questionnaire (CSFQ) as well as adverse event reporting. ClinicalTrials.gov identifier: NCT01421134.

Neue minimalinvasive Therapieoptionen des benignen Prostatasyndroms

The main objective of novel minimally invasive treatment options is to be equally effective to current reference techniques while providing a superior safety profile. Especially the preservation of sexual function, including ejaculatory function, is of great interest to patients facing surgical treatment of lower urinary tract symptoms (LUTS). Ideally, a truly minimally invasive procedure can be performed under local anaesthesia in an outpatient setting. Among emerging medical devices, the prostatic urethral lift (PUL; Urolift) demonstrated rapid and durable relief of LUTS in selected patients without a prominent middle lobe. Compared to the reference method TURP, it was superior in terms of preservation of sexual function and recovery experience. The first clinical evaluation of the "Temporary Implantable Nitinol Device" (TIND) proved its feasibility, efficacy and safety for the treatment of LUTS over a 3-year follow-up period. However, prospective randomised controlled trials are still needed to evaluate its true benefit. New ablative technologies like Rezũm are based on convective water vapour energy and have shown good results in a sham-controlled randomised clinical trial for the treatment of LUTS over a follow-up period of 3 years. Of note, this procedure was also successful in patients with a prominent middle lobe, and no impairment of sexual function was reported after Rezũm. Innovative technologies like Aquablation (AquaBeam) are still in their infancy, but the first clinical outcomes are promising, even in comparison with the reference method TURP.

Counseling in Pediatric Populations at Risk for Infertility and/or Sexual Function Concerns

Reproductive health is an important yet often overlooked topic in pediatric health care; when addressed, the focus is generally on prevention of sexually transmitted infections and unwanted pregnancy. Two aspects of reproductive health counseling that have received minimal attention in pediatrics are fertility and sexual function for at-risk pediatric populations, and youth across many disciplines are affected. Although professional organizations, such as the American Academy of Pediatrics and the American Society of Clinical Oncology, have published recommendations about fertility preservation discussions, none of these guidelines address how to have ongoing conversations with at-risk youth and their families about the potential for future infertility and sexual dysfunction in developmentally appropriate ways. Researchers suggest many pediatric patients at risk for reproductive problems remain uncertain and confused about their fertility or sexual function status well into young adulthood. Potential infertility may cause distress and anxiety, has been shown to affect formation of romantic relationships, and may lead to unplanned pregnancy in those who incorrectly assumed they were infertile. Sexual dysfunction is also common and may lead to problems with intimacy and self-esteem; survivors of pediatric conditions consistently report inadequate guidance from clinicians in this area. Health care providers and parents report challenges in knowing how and when to discuss these issues. In this context, the goal of this clinical report is to review evidence and considerations for providers related to information sharing about impaired fertility and sexual function in pediatric patients attributable to congenital and acquired conditions or treatments.

Novel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review

Besides erectile dysfunction, premature ejaculation (PE) is the most frequent male sexual disorder and shows a high level of bother and distress. The negative consequences of long-term and unsuccessfully treated PE on both patient and partner are well established in the literature and include personal distress, impairment of the partner's sexual function, and interpersonal difficulties. To outline the consequences of untreated PE and the advantages and disadvantages of currently available treatment options with a special focus on a new topical eutectic lidocaine/prilocaine metered dose spray (Fortacin; Lidocaine/Prilocaine, Recordati, Milan, Italy) which represents the second officially approved drug in this indication. Narrative overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases such as Web of Science, Medline, PubMed, and Google Scholar, hand searches, and authoritative texts. Combinations of keywords including premature ejaculation, ejaculatory control, intravaginal ejaculation latency time, IELT, PE, PDE5 inhibitors (PDE5i), SSRIs, topical anesthetics, lidocaine, prilocaine, and treatment were used. In the end, 59 studies published between 2000 and 2018 were considered relevant for this review. Published studies on PE-related negative psychosocial outcomes, as well as advantages and disadvantages of currently available off-label and officially approved treatment options. Although a variety of treatment options for PE have shown marked improvements in stopwatch-measured intravaginal ejaculation latency time (IELT) and patient-reported outcomes as assessed by the Premature Ejaculation Profile (PEP), none of the investigated drugs has reached market approval. The only so far officially approved medication-dapoxetine-is characterized by high discontinuation rates of up to 90%, mostly because of high side effects, cost issues, efficacy below expectations, and the need for scheduling sexual intercourse. With the official approval in Europe the new dose-metered lidocaine-prilocaine spray (Fortacin) may become a real first-line therapy option for PE and may offer a satisfactory and affordable solution, especially because of its unique galenic preparation, making its handling easy and customer friendly. In addition, it has the potential to significantly increase the currently low patients' acceptance of available monotherapies and become an established second-line therapy for the severe PE patients with IELTs <1 to 2 minutes or with ante-portal ejaculation in combination with oral therapy. Porst H, Burri A. Novel treatment for premature ejaculation in the light of currently used therapies: A review. Sex Med Rev 2019; 7:129-140.

595 Analyzes of male sexual function and sperm parameters in contusive spinal cord injured rats: therapeutic efficacy of mucuna pruriens(Linn.)

Sexual dysfunction is often impaired after spinal cord injury due to nerve damage affecting motor, sensory & autonomic functioning. Spinal cord injury (SCI) causes impairment of sexual function, fertility, erection and ejaculation in multifaceted way. Erectile Dysfunction is a common occurrence after SCI which has an intense effect on quality of life. Mucuna pruriens( Linn). (M. pruriens) a leguminous plant used to manage several free radical-mediated diseases like rheumatoid arthritis, diabetes, atherosclerosis, nervous disorders and male infertility. Our previous studies proved that ethanolic seed extract of M.pruriens has a good sexual enhancer and increases sperm count and motility in normal rat. Animals were divided as control, control and M. pruriens (Cont+MP), Spinal Cord Injury (SCI) (Contusive spinal cord injury carried out using ‘MACSIS Spinal Cord Injury impactor version III’), SCI and M. pruriens (SCI+MP) administrated with ethanolic extract of M. pruriens seed extract 200 mg/kg b. w. The M. pruriens were administrated orally, once daily for a period of 90 days, accordingly. At the intervals of 15, 30, 60 and 90 days, all the animals were subjected to mating behavior analyses and libido and test of potency. The sperm were collected from caudal portion of the epididymis was subjected to various analyses.

Urology as rehabilitation medicine: a literature review.

As a urologist, we usually encounter with two representative functional behaviors, namely, voiding and sexual function. These are not only important but also complex and synchronized so if these functions are impaired, patients need active functional rehabilitation to recover. These functional impairments should be recognized and corrected early because they could not only cause direct damage to the affected functions but also have harmful consecutive consequences such as kidney damage due to voiding abnormality and self-esteem damage due to decreased sexual function. Numerous rehabilitative methods are currently available, which help minimize the negative effects of these functional impairments. In terms of voiding function, pelvic floor muscle exercise, biofeedback, functional magnetic stimulation, neuromodulation, and clean intermittent self-catheterization are representative rehabilitation modalities. In case of children, extra-attention should be paid because this might affect their entire life. In impairment of sexual function, early intervention to maintain male erection is the main target of rehabilitation to prevent corporal fibrosis and penile deformity and increase recovery chance in patients who underwent radical prostatectomy or major surgery. In this review, we will elucidate various rehabilitation methods in urology to further increase our understanding of the rehabilitative characteristics of urology and widen our view of rehabilitation medicine.

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.

Development of a Sexual Dysfunction Scale for Women With Inflammatory Bowel Disease.

Women with inflammatory bowel disease (IBD) may have decreased sexual function. To understand how common this condition is in our female patients, we developed a new IBD-specific Female Sexual Dysfunction Scale (the IBD-FSDS). We performed a prospective cross-sectional study of 454 female IBD patients ≥18 years of age attending 1 of 3 IBD clinics in the United States or Denmark. We gathered information on sexual function via a de novo 23-item scale. General sexual functioning was measured with the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9). Medical history and sociodemographic data were collected via chart review. Exploratory factor analyses (EFAs) of the English language version of IBD-FSDS assessed unidimensionality, factor structure, reliability, criterion validity, and construct validity. EFAs suggested retaining 15-items creating a unidimensional scale with strong internal consistency reliability (α = 0.93). Validity of the English language IBD-FSDS was measured using Spearman's coefficient, demonstrating significant criterion validity with the FSDS-R (P < 0.05) and the FSFI (P < 0.05) and significant construct validity with the composite for cases of active IBD (P < 0.05) and PHQ-9 (P < 0.05). Sexual dysfunction in women with IBD was significantly associated with depression (P = 0.042), active IBD (P = 0.002), and no history of surgery (P = 0.044). We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD in women. This novel screening questionnaire may help health care providers recognize factors contributing to impaired sexual function in their female patients.