Sex Therapy Research Articles

A novel management algorithm and long-term treatment outcome of men with unusual sexual dysfunctions

ABSTRACT Introduction The most commonly treated sexual dysfunctions in men are erectile dysfunction, Peyronie's disease, premature and delayed ejaculation, and decreased sexual desire. While urologists have expertise treating these sexual dysfunctions, there are unusual sexual health concerns in men that can prove a management quandary to many clinicians. These include persistent genital arousal, spontaneous ejaculation/orgasm, penile pain with arousal, and severe ejaculatory pain, which may be secondary to a radiculopathy of the sacral spinal nerve roots (SSNR). Men with these unusual problems often experience despair, emotional lability, catastrophization, and/or suicidality. Objective The objective was to examine the management of men presenting to our multidisciplinary sexual medicine clinic with unusual sexual dysfunctions including persistent genital arousal, spontaneous ejaculation/orgasm, penile pain with arousal and severe ejaculatory pain, using a novel diagnostic and treatment algorithm. Methods We performed a retrospective chart review of men who presented to our clinic from 2015 through 2020 with a history of an unusual sexual dysfunction lasting for more than 3 months and had, at minimum, a follow-up of one year post treatment. All were managed using the novel algorithm, which included a sex therapy evaluation, neurogenital sensory testing of both the pudendal and sciatic nerves, measurement of the bulbocavernosus reflex latency, regional dorsal and pudendal nerve diagnostic anesthesia testing, lumbosacral MRI, and diagnostic transforaminal epidural spinal injection (TFESI) with an anesthetic. If the unusual sexual dysfunction was suspected to be secondary to SSNR radiculopathy, lumbar endoscopic spine surgery (LESS) was performed. Results 5 patients (mean age at presentation 26, range 17 – 38 years) meeting the criteria had the following symptoms: persistent genital arousal (3/5), distressing penile pain with arousal (3/5), spontaneous ejaculation/orgasm (2/5), and/or severe ejaculatory pain (2/5). Significant psychological distress was noted including suicidal ideation in 3/5 of patients. Neurogenital testing was abnormal in all. Mean perception of finger/glans vibration, cold and heat were 4/11 volts; 21.2/15.8° and 31 /37° respectively. Mean perception of finger/buttock vibration, posterior thighs and posterior calf were 4/14.3 volts. Mean value of bulbocavernosus reflex latency testing was 93 msec (normal 30-50 msec). Regional dorsal and pudendal nerve diagnostic anesthesia tests failed to temporarily resolve unusual sexual dysfunction symptoms in 100%. MRI findings showed annular tears in 5/5: L5-S1 (2/5), L4-L5 (4/5). Diagnostic TFESI resulted in clinically significant symptom reduction in 5/5. Based on these results, sexual dysfunctions were highly suspected to be secondary to SSNR radiculopathy. All patients underwent LESS, were discharged the same day, and had no surgical complications. All reported improvement on Patient Global Impression of Improvement of very much better (2/5) or much better (3/5). Mean follow-up was 21.6 months post-LESS treatment. Conclusions Unusual sexual dysfunctions can be a management challenge to urologists. Although persistent genital arousal, spontaneous ejaculation/orgasm, penile pain with arousal, and severe ejaculatory pain are perceived to be in the genitals, in this patient population these unusual sexual dysfunctions were actually caused by an upstream mechanical/inflammatory SSNR radiculopathy from lumbosacral annular tears. Symptom alleviation was achieved by LESS in all patients. Disclosure Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Elliquence, Lumenis).

Experiential avoidance as a mediator between anticipatory anxiety and the severity of erectile dysfunction

ABSTRACT Introduction While anticipatory anxiety is a psychological factor of erectile dysfunction (ED), the problem of experiential avoidance, which is an attempt to avoid heightened anxiety and tension associated with anticipatory anxiety, has recently been highlighted (Stephenson, 2019). Experiential avoidance becomes a problem when one worsens his or her own anxiety and tension through it (Hayes et al., 2006). It can be deduced that experiential avoidance, rather than anticipatory anxiety itself, is the problem that exacerbates ED symptoms. Objective This study aimed to examine whether experiential avoidance mediates the relationship between anticipatory anxiety and the severity of ED using mediation analysis. Methods An online survey targeting the general adult male population (age: 20–50 years) was conducted by a private research company. Participants with organic diseases were excluded from this study through a screening survey process. Eventually, valid responses from 389 participants (mean age of the participants: 36.39 years, standard deviation: 7.39 years) were obtained. Of these 389 participants, 149 participants had no ED, 72 had mild ED, 99 had mild-to-moderate ED, and 69 had moderate-to-severe ED. 1) IIEF-5 (IIEF-5 Kimoto et al., 2009): This questionnaire measured erectile functioning. ED severity can be classified based on a cutoff point. Higher the score obtained in this questionnaire, more is the severity of ED. 2) Anticipatory anxiety about ED: This questionnaire measured anticipatory anxiety regarding ED. It consisted of four items based on descriptions in ED-related books (e.g., “Time feels longer than usual until the moment you plan to have intercourse.”). Higher the score obtained in this questionnaire, more is the anticipatory anxiety regarding ED. 3) Avoidance and Fusion Questionnaire-Erectile Dysfunction (AFQ-ED; Saito et al., 2021): This questionnaire measured experiential avoidance regarding ED (e.g., “I keep telling myself ‘I cannot fail this time’.”). Higher the score obtained in this questionnaire, more is the experiential avoidance regarding ED. Results A mediation analysis was conducted with anticipatory anxiety about ED as an independent variable, experiential avoidance regarding ED as a mediating variable, and ED severity as a dependent variable (Figure 1). The results of an indirect effect test carried out using the bootstrap method (10,000 re-samplings) showed that the association between anticipatory anxiety about ED and ED severity was significantly mediated by experiential avoidance regarding ED. Conclusions The results of this study showed that experiential avoidance regarding ED serves as a partial mediator. This suggests that the hypothesis that “experiential avoidance, rather than anticipatory anxiety itself, is the problem that exacerbates ED symptoms” is valid. The effectiveness of psychological interventions (mainly cognitive behavioral sex therapy) provided to patients with ED targeting experiential avoidance should be studied in future. Disclosure Work supported by industry: yes, by BioMimetics Sympathies, Inc.. A consultant, employee (part time or full time) or shareholder is among the authors (BioMimetics Sympathies, Inc.).

Management of descemetocele: Our experience and a simplified treatment algorithm.

Purpose:To formulate a treatment algorithm for the management of descemetocele.Methods:This was a prospective interventional study that was conducted at a tertiary eye-care center. All consecutive cases of descemetocele during the study period (April 1, 2017–March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated.Results:The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow-up duration was 6.79 ± 3.97 months (3–12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non-perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non-functional fellow eye.Conclusion:PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

Infants and Newborns with Atypical Teratoid Rhabdoid Tumors (ATRT) and Extracranial Malignant Rhabdoid Tumors (eMRT) in the EU-RHAB Registry: A Unique and Challenging Population.

Simple SummaryMalignant rhabdoid tumors (MRT) are deadly tumors that predominantly affect infants and young children. Even when considering the generally young age of these patients, the treatment of infants below the age of six months represents a particular challenge due to the vulnerability of this patient population. The aim of our retrospective study was to assess the available information on prognostic factors, genetics, toxicity of treatment and long-term outcomes of MRT. We confirmed that, in a cohort of homogenously treated infants with MRT, significant predictors of outcome were female sex, localized stage, absence of a GLM and maintenance therapy, and these significantly favorably influence prognosis. Stratification-based biomarker-driven tailored trials may be a key option to improve survival rates.Introduction: Malignant rhabdoid tumors (MRT) predominantly affect infants and young children. Patients below six months of age represent a particularly therapeutically challenging group. Toxicity to developing organ sites limits intensity of treatment. Information on prognostic factors, genetics, toxicity of treatment and long-term outcomes is sparse. Methods: Clinical, genetic, and treatment data of 100 patients (aged below 6 months at diagnosis) from 13 European countries were analyzed (2005–2020). Tumors and matching blood samples were examined for SMARCB1 mutations using FISH, MLPA and Sanger sequencing. DNA methylation subgroups (ATRT-TYR, ATRT-SHH, and ATRT-MYC) were determined using 450 k / 850 k-profiling. Results: A total of 45 patients presented with ATRT, 29 with extracranial, extrarenal (eMRT) and 9 with renal rhabdoid tumors (RTK). Seventeen patients demonstrated synchronous tumors (SYN). Metastases (M+) were present in 27% (26/97) at diagnosis. A germline mutation (GLM) was detected in 55% (47/86). DNA methylation subgrouping was available in 50% (31 / 62) with ATRT or SYN; for eMRT, methylation-based subgrouping was not performed. The 5-year overall (OS) and event free survival (EFS) rates were 23.5 ± 4.6% and 19 ± 4.1%, respectively. Male sex (11 ± 5% vs. 35.8 ± 7.4%), M+ stage (6.1 ± 5.4% vs. 36.2 ± 7.4%), presence of SYN (7.1 ± 6.9% vs. 26.6 ± 5.3%) and GLM (7.7 ± 4.2% vs. 45.7 ± 8.6%) were significant prognostic factors for 5-year OS. Molecular subgrouping and survival analyses confirm a previously described survival advantage for ATRT-TYR. In an adjusted multivariate model, clinical factors that favorably influence the prognosis were female sex, localized stage, absence of a GLM and maintenance therapy. Conclusions: In this cohort of homogenously treated infants with MRT, significant predictors of outcome were sex, M-stage, GLM and maintenance therapy. We confirm the need to stratify which patient groups benefit from multimodal treatment, and which need novel therapeutic strategies. Biomarker-driven tailored trials may be a key option.

The Effect of Macrolides on Mortality in Bacteremic Pneumococcal Pneumonia: A Retrospective, Nationwide Cohort Study, Israel, 2009-2017.

Previous cohort studies of pneumonia patients reported lower mortality with advanced macrolides. Our aim was to characterize antibiotic treatment patterns and assess the role of quinolones or macrolides in empirical therapy. An historical cohort, 1 July 2009 to 30 June 2017, included, through active surveillance, all culture-confirmed bacteremic pneumococcal pneumonia (BPP) among adults in Israel. Cases without information on antibiotic treatment were excluded. Logistic regression analysis was used to assess independent predictors of in-hospital mortality. A total of 2016 patients with BPP were identified. The median age was 67.2 years (interquartile range [IQR] 53.2-80.6); 55.1% were men. Lobar pneumonia was present in 1440 (71.4%), multi-lobar in 576 (28.6%). Median length of stay was 6 days (IQR 4-11). A total of 1921 cases (95.3%) received empiric antibiotics with anti-pneumococcal coverage: ceftriaxone, in 1267 (62.8%). Coverage for atypical bacteria was given to 1159 (57.5%), 64% of these, with macrolides. A total of 372 (18.5%) required mechanical ventilation, and 397 (19.7%) died. Independent predictors of mortality were age (odds ratio [OR] 1.051, 95% confidence interval [CI] 1.039, 1.063), being at high-risk for pneumococcal disease (OR 2.040, 95% CI 1.351, 3.083), multi-lobar pneumonia (OR 2.356, 95% CI 1.741, 3.189). Female sex and macrolide therapy were predictors of survival: (OR 0.702, 95% CI .516, .955; and OR 0.554, 95% CI .394, .779, respectively). Either azithromycin or roxithromycin treatment for as short as two days was predictor of survival. Quinolone therapy had no effect. Empirical therapy with macrolides reduced odds for mortality by 45%. This effect was evident with azithromycin and with roxithromycin. The effect did not require a full course of therapy.

Greater Adherence to Dietary Guidelines Associated with Reduced Risk of Cardiovascular Diseases in Chinese Patients with Type 2 Diabetes.

The evidence regarding the impact of the scores on healthy eating indices on the risk of cardiovascular events among patients with type 2 diabetes (T2D) is limited. As such, in this study, we examined the associations of adherence to the Chinese and American dietary guidelines and the risk of cardiovascular disease (CVD) among Chinese individuals with T2D. We conducted a 1:1 age- and sex-matched case–control study based on a Chinese population. We used a structured questionnaire and a validated 79-item food-frequency questionnaire to collect general information and dietary intake information, and calculated the Chinese Healthy Eating Index (CHEI) and the Healthy Eating Index-2015 (HEI-2015). As participants, we enrolled a total of 419 pairs of hospital-based CVD cases and controls, all of whom had T2D. We found a significant inverse association between diet quality scores on the CHEI and HEI-2015 and the risk of CVD. The adjusted odds ratios (95% confidence interval) per five-score increment were 0.68 (0.61, 0.76) in the CHEI and 0.60 (0.52, 0.70) in the HEI-2015. In stratified analyses, the protective associations remained significant in the subgroups of sex, BMI, smoking status, tea-drinking, hypertension state, dyslipidemia state, T2D duration, and medical nutrition therapy knowledge (all p < 0.05). These findings suggest that a higher CHEI or HEI-2015 score, representing a higher-quality diet relative to the most recent Chinese or American dietary guidelines, was associated with a decreased risk of CVD among Chinese patients with T2D.

Predictors of mortality in chronic obstructive pulmonary disease: a systematic review and meta-analysis

BackgroundBetter insight in patients’ prognosis can help physicians to timely initiate advance care planning (ACP) discussions with patients with chronic obstructive pulmonary disease (COPD). We aimed to identify predictors of mortality.MethodsWe systematically searched databases Embase, PubMed, MEDLINE, Web of Science, and Cochrane Central in April 2020. Papers reporting on predictors or prognostic models for mortality at 3 months and up to 24 months were assessed on risk-of-bias. We performed a meta-analysis with a fixed or random-effects model, and evaluated the discriminative ability of multivariable prognostic models.ResultsWe included 42 studies (49–418,251 patients); 18 studies were included in the meta-analysis. Significant predictors of mortality within 3–24 months in the random-effects model were: previous hospitalization for acute exacerbation (hazard ratio [HR] 1.97; 95% confidence interval [CI] 1.32–2.95), hospital readmission within 30 days (HR 5.01; 95% CI 2.16–11.63), cardiovascular comorbidity (HR 1.89; 95% CI 1.25–2.87), age (HR 1.48; 95% CI 1.38–1.59), male sex (HR 1.68; 95% CI 1.38–1.59), and long-term oxygen therapy (HR 1.74; 95% CI 1.10–2.73). Nineteen previously developed multicomponent prognostic models, as examined in 11 studies, mostly had moderate discriminate ability.ConclusionIdentified predictors of mortality may aid physicians in selecting COPD patients who may benefit from ACP. However, better discriminative ability of prognostic models or development of a new prognostic model is needed for further large-scale implementation.Registration: PROSPERO (CRD42016038494), https://www.crd.york.ac.uk/prospero/.

Men with Unusual Sexual Dysfunctions: A Novel Management Algorithm and Long-Term Treatment Outcome

ABSTRACT Introduction The most commonly treated sexual dysfunctions in men are erectile dysfunction, Peyronie's disease, premature and delayed ejaculation, and decreased sexual desire. While urologists have expertise treating these sexual dysfunctions, there are unusual sexual health concerns in men that can prove a management quandary to many clinicians. These include persistent genital arousal, spontaneous ejaculation/orgasm, penile pain with arousal, and severe ejaculatory pain, which may be secondary to a radiculopathy of the sacral spinal nerve roots (SSNR). Men with these unusual problems often experience despair, emotional lability, catastrophization, and/or suicidality. Objective The objective was to examine the management of men presenting to our multidisciplinary sexual medicine clinic with unusual sexual dysfunctions including persistent genital arousal, spontaneous ejaculation/orgasm, penile pain with arousal and severe ejaculatory pain, using a novel diagnostic and treatment algorithm. Methods We performed a retrospective chart review of men who presented to our clinic from 2015 through 2020 with a history of an unusual sexual dysfunction lasting for more than 3 months and had, at minimum, a follow-up of one year post treatment. All were managed using the novel algorithm, which included a sex therapy evaluation, neurogenital sensory testing of both the pudendal and sciatic nerves, measurement of the bulbocavernosus reflex latency, regional dorsal and pudendal nerve diagnostic anesthesia testing, lumbosacral MRI, and diagnostic transforaminal epidural spinal injection (TFESI) with an anesthetic. If the unusual sexual dysfunction was suspected to be secondary to SSNR radiculopathy, lumbar endoscopic spine surgery (LESS) was performed. Results Five patients (mean age at presentation 26, range 17 – 38 years) meeting the criteria had the following symptoms: persistent genital arousal (3/5), distressing penile pain with arousal (3/5), spontaneous ejaculation/orgasm (2/5), and/or severe ejaculatory pain (2/5). Significant psychological distress was noted including suicidal ideation in 3/5 of patients. Neurogenital testing was abnormal in all. Mean perception of finger/glans vibration, cold and heat were 4/11 volts; 21.2/15.8° and 31 /37° respectively. Mean perception of finger/buttock vibration, posterior thighs and posterior calf were 4/14.3 volts. Mean value of bulbocavernosus reflex latency testing was 93 msec (normal 30-50 msec). Regional dorsal and pudendal nerve diagnostic anesthesia tests failed to temporarily resolve unusual sexual dysfunction symptoms in 100%. MRI findings showed annular tears in 5/5: L5-S1 (2/5), L4-L5 (4/5). Diagnostic TFESI resulted in clinically significant symptom reduction in 5/5. Based on these results, sexual dysfunctions were highly suspected to be secondary to SSNR radiculopathy. All patients underwent LESS, were discharged the same day, and had no surgical complications. All reported improvement on Patient Global Impression of Improvement of very much better (2/5) or much better (3/5). Mean follow-up was 21.6 months post-LESS treatment. Conclusions Unusual sexual dysfunctions can be a management challenge to urologists. Although persistent genital arousal, spontaneous ejaculation/orgasm, penile pain with arousal, and severe ejaculatory pain are perceived to be in the genitals, in this patient population these unusual sexual dysfunctions were actually caused by an upstream mechanical/inflammatory SSNR radiculopathy from lumbosacral annular tears. Symptom alleviation was achieved by LESS in all patients. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Elliquence, Lumenis

Development and Validation of the Chinese Version of The Masturbation Beliefs Scale.

BackgroundNegative experiences of and beliefs regarding masturbation frequently affect people's psychological well-being and health behaviors, but there is currently no specific assessment tool to measure Chinese people's beliefs about masturbation.AimThe goal of the present study was to develop a brief scale (the Masturbation Beliefs Scale, BMS) for Chinese university students.MethodsThe BMS was developed and administered online to 2 different samples, with a total sample of 3,231 respondents (1,527 males and 1,704 females). The items were formulated based on previous qualitative research data. Exploratory and confirmatory factor analyses were performed.OutcomesThe BMS scale contains 3 dimensions with good internal consistency and construct validity, which can well measure Chinese people's belief about masturbation.ResultsThe results of the two samples showed that the 17-item culturally based BMS demonstrated good internal consistency and construct validity. Three factors capturing university students’ beliefs regarding masturbation emerged. The 3 factors were labeled beliefs about male masturbation (BAMM), beliefs about female masturbation (BAFM), and negative affect toward masturbation (NATM). The participants’ culturally based masturbation beliefs were negatively related to independent self-construal and sexual compulsivity. In addition, their culturally based masturbation beliefs consistently predicted their likelihood of premarital sexual behavior.Clinical TranslationClinicians and researchers could utilize this culturally sensitive instrument to evaluate individuals’ experiences of masturbation, which could help clinicians deliver efficacious sex therapy and sexual education to individuals who have misconceptions or phobias regarding masturbation.Strengths and limitationsThe scale is an innovative tool that measures culturally relevant beliefs regarding masturbation among Chinese students. A limitation of this study is that several constructs were measured by single questions. This may attenuate the estimated correlation since single items are less reliable than multiple-item scales.ConclusionThe present research demonstrates that a culturally sensitive scale is necessary to understand the culturally based values that influence university students’ beliefs regarding masturbation and sexual behavior.Ren Z, Liu Y, Deng J. Development and Validation of the Chinese Version of The Masturbation Beliefs Scale. Sex Med 2022;10:100501.

Catheter-associated urinary tract infections in adult intensive care units at a selected tertiary hospital, Addis Ababa, Ethiopia.

BackgroundCatheter-associated urinary tract infection is the leading cause of hospital-acquired infections. They remain the second most common healthcare-associated infection in critically sick patients.ObjectiveTo determine the prevalence of catheter-associated urinary tract infection, the spectrum of etiological agents, antibiotic sensitivity profile of bacterial pathogens among adult patients admitted to intensive care units.Materials and methodsPatients admitted to the intensive care unit of hospitals in Addis Ababa who were on urethral indwelling catheters for >48 hours from October 2020 to September 2021 were included in the study. Urine specimens were aseptically collected and processed as per standard protocols. Microorganisms were isolated, identified, and subjected to antibiotic susceptibility testing.ResultsIn all 220 pateints included in the study development of significant bacteriuria/candiduria was not affected by sex, age, and prior antibiotic therapy. However, the length of stay in the intensive care unit was significantly associated with bacteriuria /candiduria (P-value < 0.001). The overall prevalence of bacteriuria/candiduria was 51.4% among which 21.0%, 19.1%, and 11.4% were bacteriuria, candiduria, and polymicrobial infections, respectively. About 138 organisms were recovered of which 79 (57.25%) were bacteria and 59 (42.75%) were yeast isolates. Acinetobacter species, Pseudomonas species, Klebsiella species E. coli, and Enterococcus species were the dominant bacterial isolates. Candida. albicans, Candida. krusei and Candida. tropicalis were the commonest yeasts. Many gram-negative bacterial isolates were resistant to ceftriaxone 36(94.7%), ampicillin 21(91.3%) followed by cefotaxime34(89.5%), amikacin (16.0%), nitrofurantoin (17.4%), meropenem (20.0%) and imipenem (20.0%). Out of 79 bacterial pathogens, 52(65.8%) were multiple antibiotic resistant of which 37(71.0%) were Gram-negative bacteria and 15(29%%) were Gram-positive bacteria. About 13(86.7%) isolates of Acinetobacter, all isolates of Klebsiella species (100%) and E. coli (100%) were multiple antibiotic-resistant. Out Of 18,10(55.56%), isolates of Enterococcus were multiple antibiotic-resistant.ConclusionsA very high prevalence of bacteriuria/ candiduria was demonstrated in this study. This warrants the establishment of multidimensional infection control approach on catheter associated urinary tract infection in ICU. In addition to high prevalence of candiduria, recovery of non-albicans candida species almost in equal proportion with candida albicans in the present study was an important finding as non-albicans candida species distinct to C. albicans are intrinsically resistant to the commonly used azole antifungal drugs in Ethiopia. The prevalence of rate MDR bacteria in our ICU particularly of E. coli, Klebsiella spp, Pseudomonas and Acetobacter spp was very high. In order to combat this problem, proper antibiotic policies should be formulated.

Asexuality: a content analysis of sex therapy journals

ABSTRACT Despite recent progress in society’s understanding of sexuality as a nuanced, highly individualised concept, asexuality is a continually under-researched and misunderstood sexual identity and community. Via content analysis, the authors examined 41 publications in nine leading journals in the sex therapy field to assess how asexuality has been represented in literature over the past decade. The purpose of the review was to determine if this literature acknowledges the spectrum of asexual identities, whether asexuality and aromanticism are conflated terms, and whether asexuality is pathologized. The review determined that 41.5% of publications did not note the heterogeneity of identities under the asexuality umbrella, 12.2% conflated the terms asexuality and aromanticism, and 0% pathologized asexuality. Implications are discussed.

Curiosity and other attitudes towards sex robots: Results of an online survey

As artificial intelligence and technology advance, mobile robots capable of human intimacy are an inevitable consequence of this progress. Such a profound shift in sexual technology will herald both advantages and disadvantages for human intimate relationships, yet a paucity of research exists on the study of human-robot sexual relationships. We believe a greater understanding of attitudes toward sex robots will be of value as this emerging technology progresses from its currently incipient stage. We conducted an online survey exploring potential gender differences in attitudes and opinions about sex robots. Survey responses were analyzed by gender, age, relationship status, relationship satisfaction and sexual satisfaction. Results confirm our hypothesis, that men report more positive reactions to sex with robots than women. Indeed, on no question did women report more enthusiasm or optimism about the arrival of sex robots than did men. This conclusion begs the question, what will sex robots mean to the future of gender relations, and in particular, sexual relationships? Engaging one another in a dialogue about the increasing impact technology will have on human intimacy can only strengthen our efforts to mold its effect into a primarily positive one. In addition, it is our expectation that dialogue about these gender differences can assist psychologists, sex therapists, anthropologists, roboticists and couples in navigating technological advancements as they increasingly impact human intimacy. Indeed, this dialogue may be increasingly urgent as the sudden and severe impact of COVID-19 raises increasing safety concerns for human/human sexual relationships.

The Sex Therapists' Approach to the Evaluation and Management of Low Sex Drive in Men

Desire represents the most complex and fascinating among sexual response phases. It is often defined as "the subjective psychological status for initiating and maintaining human sexual behavior, triggered by internal (erotic fantasies, emotions) and/or external (attraction, pornography) stimuli." 1 Mark K Herbenick D Fortenberry D et al. The object of sexual desire: Examining the “what” in “what do you desire?. J Sex Med. 2014; 11: 2709-2719 Google Scholar In other words, desire refers to feelings and thoughts that motivate individuals to approach or be receptive to sexual stimulation. 2 Spector IP Carey MP Steinberg L. The sexual desire inventory: development, factor structure, and evidence of reliability. J Sex Marital Ther. 1996; 22: 175-190 Google Scholar Over time, researchers and clinicians seemed to agree that sexual desire is a complex construct, moving away from simplistic unidimensional definitions toward multidimensional models. For example, Levine 3 Levine SB. Reexploring the concept of sexual desire. J Sex Marital Ther. 2002; 28: 39-51 Google Scholar described desire under a biopsychosocial model (BPS) that highlights 3 components: drive (biological substratum such as anatomy and neuroendocrine system physiology), motivation (psychological components such as mental states, relationships, and social influences), and wish (cultural ideals, values, and scripts concerning sexual expression). This subdivision could be very useful in emphasizing the central role of the biological, psychological, and sociocultural components that are present in every sexual expression. On the one hand, it is important to recognize the specific role of these 3 components, for example, by exploring them in detail during the assessment phase in the evaluation of a desire problem. But on the other hand, focusing only on one component in spite of the others would imply a great loss of information, a theoretical and practical reductionism which does not help clinicians and researchers to understand desire function and related problems or to find effective treatments. In our perspective, it is fundamental to always keep an eye on the overall experience of sexual desire as reported by individuals and couples in order to be able to navigate desire.

Laparoscopic Versus Open Surgery for Rectal Gastrointestinal Stromal Tumor: A Multicenter Propensity Score-Matched Analysis.

The safety and feasibility of laparoscopic surgery for the management of rectal gastrointestinal stromal tumors are unknown. This study aimed to compare the surgical and oncologic results of laparoscopic versus open surgery for the treatment of rectal gastrointestinal stromal tumors. This was a retrospective multicenter propensity score-matched study to minimize heterogeneity between groups and focus on the difference between surgery strategies. Eleven Chinese tertiary hospitals participated in this study. A total of 364 patients with pathologically confirmed rectal gastrointestinal stromal tumors were retrospectively analyzed. Relapse-free survival, postoperative hospital stay length, and 30-day postoperative complication rate were the main outcome measures. We enrolled 214 patients who underwent surgical operation for primary localized rectal gastrointestinal stromal tumors. After propensity score matching, 134 cases involved in the comparison (67 laparoscopic vs 67 open surgery) were randomly matched (1:1) by sex, age, tumor size, tumor site, and neoadjuvant therapy. The laparoscopic surgery group had superior relapse-free survival (χ2 = 4.46, p = 0.04), and fewer complications (6.0% vs 25.4%, p = 0.002). No significant difference was found in the length of postoperative hospital stay between the laparoscopic surgery and open surgery groups (9.66 ± 5.42 vs. 10.64 ± 4.93, p = 0.28). Subgroup analysis showed that the laparoscopic surgery group had superior relapse-free survival (χ2 = 4.14, p = 0.04) and fewer complications after surgery (2.9% vs 24.4%, p = 0.01) in the rectal gastrointestinal stromal tumors ≤5 cm subgroup. This study was limited by the nature of retrospective reviews and relatively short follow-up period. Laparoscopic surgery offers a safe and feasible option for the radical resection of primary localized rectal gastrointestinal stromal tumors, especially for patients with rectal gastrointestinal stromal tumors ≤5 cm. See Video Abstract at http://links.lww.com/DCR/B764. ANTECEDENTES:Se desconoce la seguridad y factibilidad de la cirugía laparoscópica para el tratamiento de los tumores del estroma gastrointestinal de recto.OBJETIVO:Comparar los resultados quirúrgicos y oncológicos de la cirugía laparoscópica versus cirugía abierta para el tratamiento de los tumores del estroma gastrointestinal de recto.DISEÑO:Estudio retrospectivo multicéntrico emparejado por puntuación de propensión para minimizar la heterogeneidad entre los grupos y centrarse en las diferencias entre las estrategias quirúrgicas.AJUSTES:Once hospitales terciarios de la China participaron en este estudio.PACIENTES:Se analizaron retrospectivamente un total de 364 pacientes con tumores del estroma gastrointestinal de recto confirmados patológicamente.PRINCIPALES MEDIDAS DE VALORACION:Supervivencia sin recidiva, duración de la estancia hospitalaria postquirúrgica y tasa de complicaciones postquirúrgicas a los 30 días.RESULTADOS:Inscribimos a 214 pacientes que fueron sometidos a cirugía por tumores primariamente localizados del estroma gastrointestinal de recto. Después del emparejamiento por puntaje de propensión, 134 casos involucrados en la comparación (67 laparoscópicos versus 67 cirugía abierta) fueron emparejados aleatoriamente (1: 1) por sexo, edad, tamaño del tumor, sitio del tumor y terapia neoadyuvante. El grupo de cirugía laparoscópica tuvo una supervivencia sin recidiva superior (χ2 = 4,46, p = 0,04) y menos complicaciones (6,0% frente a 25,4%, p = 0,002). No se encontraron diferencias significativas en la duración de la estancia hospitalaria postquirúrgica entre los grupos de cirugía laparoscópica y cirugía abierta (9,66 ± 5,42 frente a 10,64 ± 4,93, p = 0,28). El análisis de subgrupos mostró que el grupo de cirugía laparoscópica tuvo una supervivencia sin recidiva superior (χ2 = 4,14, p = 0,04) y menos complicaciones después de la cirugía (2,9% frente a 24,4%, p = 0,01) en el subgrupo de tumores del estroma gastrointestinal de recto ≤ 5 cm.LIMITACIONES:La naturaleza de la revisión retrospectiva y el período de seguimiento relativamente corto son limitaciones de este estudio.CONCLUSIONES:La cirugía laparoscópica ofrece una opción segura y factible para la resección radical de tumores primariamente localizados del estroma gastrointestinal de recto, especialmente para pacientes con tumores ≤5 cm. Consulte Video Resumen en http://links.lww.com/DCR/B764.

Containing Attachment Concerns: Does Trait Mindfulness Buffer the Links between Attachment Insecurity and Maladaptive Sexual Motivations?

ABSTRACT Individuals reporting greater insecure attachment are more likely to report maladaptive sexual motivations, such as sex to avoid negative relational and personal outcomes (e.g., conflict). Despite the costs of such sexual motivations, research is less clear regarding what might buffer the extent to which attachment insecurities manifest in such motives. The current study examined whether trait mindfulness moderates the links between attachment insecurity and maladaptive sexual motives. Participants (N = 194) completed measures of trait mindfulness, general sexual motivations, and attachment. As predicted, the links between attachment anxiety and having sex to cope and affirm the self were eliminated among individuals reporting higher levels of the acting with awareness facet of trait mindfulness. No such buffering effects were seen for attachment avoidance. Instead, acting with awareness mindfulness appeared to increase the extent to which more avoidantly attached individuals reported coping and self-affirmation-based sexual motives. These findings contribute to knowledge regarding the potential utility and limits of mindfulness in relational and sexual contexts, perhaps suggesting that mindfulness may help anxiously attached individuals manage the extent to which attachment concerns manifest in maladaptive sexual motivations. Findings of the study may inform both theory regarding mindfulness in interpersonal functioning and how mindfulness interventions might be deployed in sex therapy contexts.

Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration.

Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. https://doi.org/10.23641/asha.19178459.

Annual hospital volume and colorectal cancer survival in a population-based nationwide cohort study in Finland

PurposeTo examine the annual hospital volume of surgery in relation to survival in colorectal cancer. Previous studies on hospital volume and survival following colorectal cancer surgery are conflicting. MethodsAll 49 032 patients who underwent resection for colorectal cancer in 1987–2016 in Finland were included, with complete follow-up until December 31, 2019. Primary outcome was 5-year mortality. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) for quartiles of annual hospital volume for colorectal surgery, adjusted for calendar period, age, sex, comorbidity, stage, tumor location and oncological therapy. Additionally, colon and rectal cancer surgery were assessed separately. Sensitivity analysis of patients with confirmed curative intent was conducted. ResultsCompared to highest quartile (≥108 resections annually), lowest hospital volume (≤37 resections annually) was associated with slightly increased 5-year all-cause mortality (adjusted HR 1.07, 95% CI 1.02–1.12). A pre-planned subgroup-analysis suggested a slightly improved 5-year survival in high-volume institutions for rectal cancer, but not colon cancer surgery. Sensitivity analysis including only those operated with confirmed curative intent suggested no differences between hospital volume groups in colorectal, colon or rectal cancer for 5-year all-cause mortality. ConclusionHigher hospital volume is associated with slightly improved all-cause 5-year mortality in colorectal cancer surgery, but this effect may be limited to rectal cancer surgery only. Volume-outcome relationship in rectal cancer surgery should be investigated further using large datasets. These results do not support centralization of colon cancer surgery based on hospital volume only.

An integrated approach for very high cardiovascular risk patients. Intermediate results

The main objective of secondary prevention measures is to modify key risk factors such as hypertension (HTN) and dyslipidemia in patients with established cardiovascular diseases. Its proper implementation improves both short- and long-term outcomes. Telehealth technologies contributes to faster achievement of target levels and better control of key risk factors.Aim. To establish a comprehensive personalized follow-up framework for patients recovered from an acute coronary syndrome (ACS) that integrates telehealth software and to test its clinical and patient-centered efficacy.Material and methods. The three-month follow-up data of 50 patients (50% of planned enrollees; median age, 57 years [53; 61]; males, 84%) who suffered ACS with myocardial revascularization and low-density lipoprotein cholesterol (LDL-C) at least 2,5 mmol/L at admission. We introduced the simple and save telehealth software for home BP monitoring and lipid profiling. The basic demographic, clinical and laboratory characteristics of patients were described, as well as the changes lipid profile, office and home BP over this period was analyzed. The primary endpoint was a change in LDL-C after 3 months. In addition, we also focused on pharmacological therapy and its dynamics, as well as on remote counseling and patient’ experience with the mobile application.Results. Three months after inclusion, we have noted significant decrease of total cholesterol (-1,67 mmol/L, p&lt;0,0001) and triglycerides (-0,48 mmol/L, p&lt;0,0001). LDL-C changes were also significant (-1,49 mmol/L, adjusted for age, sex and lipid-lowering therapy; p&lt;0,0001) and was associated only with the baseline LDL-C levels (R2=-0,521, p&lt;0,0001). Thirty-nine (78%) patients achieved at least 1 mmol/L drop of LDL-C. Nine of them reached target LDL-C &lt;1,4 mmol/L (and/or a decrease of 50% from baseline). Both high-density lipoprotein cholesterol (-0,48 mmol/l, p=0,348), office and home BP remained mostly unchanged. The proportion of patients with target office BP levels was almost the same (χ2=3,06, p=0,08). Patients who were recommended combined lipid-lowering therapy with cholesterol absorption inhibitor (ezetimibe) were more likely to achieve target LDL-C (χ2=10,95; p=0,003) than those with single agent (67% versus 17%, p=0,003). No differences were found in subgroups of patients in LDL-C reduction. In each patient an average of 15 remote consultations have been performed (from 1 to 54 per patient per 3 moths). Investigators have had to send reminders to 22 patients regarding the need for regular home BP monitoring. The majority of patients treated telehealth software as easy-to-use and user-friendly.Conclusion. According to the 3-month follow-up of patients after ACS who used the framework integrated with telemonitoring and remote counseling, a positive trend in reducing atherogenic lipid levels was demonstrated, but not in office BP. Only a fifth of patients reached the target LDL-C, but the vast majority had target BP. Despite the fact that the program is convenient to use, almost half of participants require additional reminders from physician on self-monitoring.

Risk factors and severity of functional impairment in long COVID: a single-center experience in Croatia

AimTo determine the frequency of common symptoms in long COVID and their effect on the quality of life, and to determine the factors contributing to a more severe long COVID.MethodsThe study enrolled 266 patients who were either referred to long-COVID outpatient clinic or were inpatients undergoing rehabilitation. The data were collected between December 2020 and May 2021. We evaluated the symptoms experienced during acute and long COVID and comorbidities. Functional status was assessed with Post Covid Functional Status (PCFS).ResultsThe final sample consisted of 261 patients. After acute COVID-19 period (>4 weeks), almost 80% of patients had impaired functional status. Only 21.5% reported no functional impairment (0 on PCFS scale). A higher PCFS score was associated with female sex (P < 0.001) and oxygen therapy requirement during acute disease (P = 0.001). However, it was not associated with having a pre-existing lung disease (P = 0.749). Disease severity did not pose a risk for developing a more severe long COVID.ConclusionWomen were at greater risk for developing greater functional impairment in long COVID, although we have no explanation why. Malignant disease and hypertension also presented a risk factor for greater functional impairment. More studies are warranted to determine if patients with certain lung disease are more susceptible to long COVID.

Comparative outcomes of minimally invasive and open gastrectomy.

271 Background: Gastric cancer(GC) is associated with significant mortality worldwide. Radical gastrectomy with lymphadenectomy is considered the only curative option for GC. Laparoscopic(LG) and more recently robotic(RG) techniques have been developed as a way to potentially decrease the peri-operative morbidity associated with gastrectomy. We sought to compare oncologic outcomes with minimally invasive and open techniques for gastrectomy. Methods: Utilizing the National Cancer Database we identified patients with gastric cancer who underwent gastrectomy. We then stratified technique, RG, LG, or OG. Mann-Whitney U and Kruskal were used to compare continuous variables and Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. Multivariate analysis (MVA) was performed to identify predictors of survival. A p &lt; 0.05 was considered significant. Results: We identified 2,530 patients RG, 10,790 in the LG and 25,810 in the OG group with median ages of 66, 66 and 67 years respectively, p &lt; 0.001. There were higher numbers of poorly differentiated tumors in the OG 60% compared to RG (49.7% and LG 49.1%, p &lt; 0.001. Additionally, there were increased numbers of signet ring GC in the OG 16.7%, compared to 13.8% in the RG and 13.8% in the LG, p &lt; 0.001. There were higher numbers of early stage GC’s in the RG and LG compared to more advanced stages (stage II and III in the OG), p &lt; 0.001. RG and LG did demonstrate higher numbers of R0 resections 92.8% and 89.9% compared to OG at 85.2%, p &lt; 0.001. Length of stay was shorter in the RG and LG at 7 (4-10) days compared to 8 days (6-12) in the OG cohort, p &lt; 0.001. Thirty and 90-day mortality rates were higher in the OG (4.3% and 8.3%) compared to 2.1% and 4% in the RG and 2.7% and 5.4% in the LG patients. Median and 5-year survival was higher in the RG (84.7mo and 61%) and LG (90.3mo and 58%) compared to the OG at 48.3mo and 46%, p = 0.001. When adjusted by stage this survival benefit persisted across all stage cohorts (stage 0-1, p = 0.001, stage 2, p = 0.001, and stage 3, p = 0.001). Multivariate analysis revealed that age, sex, Charlson/Deyo score, tumor location, histology, grade, stage, facility volume, and neoadjuvant therapy were all predictors of survival. Conclusions: Robotic and laparoscopic approaches to gastrectomy demonstrate improved median and overall survival compared to conventional open approaches. This benefit was demonstrated across all stages.