Sexual Attempts Research Articles

THE EFFICACY OF LEKHANIYA GANA SIDDHA ANUVASANA BASTI ON PCOS

Infertility is the failure of a person /couple to conceive after one year of regular sexual attempts without contra-ception. Ayurveda says fertility factors are Ritu, kshetra, ambu and beeja. Any ailments in any of these four fac-tors are causes of infertility. Polycystic ovarian syndrome (PCOS) is the most common cause of chronic anovula-tion associated with hyperandrogenism. PCOS is responsible for more than half of infertility in women. An obese woman suffers mental stress due to obesity, and if she suffers from PCOS, it leads to infertility. At pre-sent, PCOS is treated by hormonal therapy, anti–diabetic, symptomatic treatment and surgical drilling. They may lead to obesity. Herbal medicines, according to Ayurveda, followed by Shodhana karma like ANUVASANA-BASTI, can be a great benefit in PCOS. In Charak Samhita, lekhaniyadashemani, which is a group of 10 drugs, acts by scraping, scratching, or by removal of the excess Doshas. In this regard, the Lekhana drug could be ef-fective in reducing obesity. Considering this view, Lekhaniyagana savasana basti has been selected for treating PCOS. This study focuses on the effect of LEKHANIYAGANA SIDDHA TAILAANUVASANABASTI on PCOS. We have compared the effects of Kuberakshavati and Lekhaniyagana siddha Anuvasana basti on 30 patients for three months. By comparing both the drugs given for PCOS, we have concluded that Shodhanachikitsa, followed by Shamana chikitsa, helps in treating PCOS.

STATUS OF WOMEN IN ANCIENT, MEDIEVAL AND MODERN PERIOD OF INDIA

India is a land of values, morals, heritage culture and traditions. As the word said by Mahatma Gandhi, “We call our nation as mother India and earth as mother earth because the genesis of all rituals, holiness existed in the compassion of a women”. So, in our early Vedic culture there was matriarchal system where the women were the head of the family. So, at that time there was a scope for existence of peace, harmony, happiness and prosperity. But the status of women declined from the later Vedic period where the tradition of kinship only vested to the male heir and prince of that kingdom. Then the same type of typical culture flourished in all regimes of kingdom. So, it led to a patriarchal system, where the family head will be the male but not the women. So, from that time a theory developed that said women were very weak, feared, threatened and mentally sensitive from their birth. Later by the entry of Persian and Muslim ruler from central Asia the women were treated as the people created by the God to fulfill their sexual feelings. Then they destroyed the holy pilgrim temples, monuments, stupas by examining the term there is only God in this world but not goddesses. From that women were habituated to live in the darkness of rajmahals, forts, kitchens, etc., They were caged with the POLYGAMY, PURDHA SYSTEM, ZENANA, JAUHAR, SATI, DOWRY Systems which turns them as a playing doll in the society. But today women were the largest working force in the Nation. They turned to be a productive force for the inclusive and sustainable development of the nation. Today from school to space in each and every field the leading personalities are woman. Today in our nation there are women Politicians, Professionals, Social Workers, Scientists, Soldiers, Teachers and CEO’s. So the modern world is targeted to the women progress and empowerment. In spite of these advances there are some cases regarding women Harassment, Violence, Sexual Attempts, Discrimination, Inequalities in each and every corner of the society. It’s time to create the equal status to the women in our hearts, home, society, livelihood and representation.

The role of social media during COVID–19 pandemic situation and Domestic violence: Its impacts on Pakistan Society

Technology based tools and methods have greater impact on society, cultural, physiological,and psychological impacts on human life. The role of electronic and print media is not part of human life. The news, videos, pictures on regular basis is on the highest peak of media weapon which effects human mind with several harsh, stern, violent and many negative impacts. However,technology has also positive impact on society which is based on user-basedskills. Domestic Violence implies to the study of mental, physical,and sexual assault to living being at home. This can be torture, punishment, injury, robbery, forced sexual attempt and any other forcefully act which harms the honor, respect and self-esteem of any body. Violence against women has been consider major issue in world. This is very serious matter of human rights. The world became global village and stepped very fast source of information sharing. The digital world made easy to share and make rapid information sharing to the law agencies to act as fast responsive to the common people. The women violence was not considered before two or three decades in account. However last decade is considered as important for women violence and victims. This becomesas an international concern due to large reports from different regions of the world related to the women violence. Many organizations are developed to protect women rights and consideron international level. This study focusseson impact of Domestic violence in Sindh province.

The Age of Attraction: Age, Gender and the History of Modern Male Homosexuality.

In 1902, founder of the Berlin Institute for Sexual Science, Magnus Hirschfeld, developed a ‘psychobiological questionnaire’ to investigate human sexuality.1 The section labelled ‘sexual instinct’ [Geschlechtstrieb] asked: ‘What approximately are the highest and lowest limits in age of the people to whom you feel drawn, or is age of no importance to you?’2 Hirschfeld's interest in age as a driver of sexual attraction reflects broader sexual scientific attempts to map an erotics of age.3 This article explores how and why the relative age of sexual subjects was theorised by British and German sexual scientists in the late nineteenth and early twentieth centuries. It demonstrates that questions around age preoccupied sexual science and argues, more specifically, that constructions of male homosexuality were driven by anxieties about interactions between children or adolescents and older men.4 In so doing, the article reveals the interrelationship between sexological debates about homosexuality and scientific explorations of childhood sexuality and adolescent development. It shows that age needs to be acknowledged as a crucial category shaping sexual scientific debate and structuring understandings of modern homosexuality.5 As is well known, the erotic charge provided by age difference was central to many culturally prominent eighteenth‐ and nineteenth‐century understandings of same‐sex desire.6 European and American elites interpreted classical (predominately Ancient Greek) cultures as providing affirmative models of youthful male beauty and intimate attachment between older and younger men or boys.7 While precise differences in age were rarely specified, partners were separated on the basis of maturity into active (the erastes) and passive roles (the eromenos). Moreover, attraction to younger same‐sex partners was not seen to exclude opposite‐sex relationships: men who desired male youths could also be married to women. The influence of this material on individual identities can be found, for example, in sexological case studies or letters received by prominent Hellenic writers.8 At the same time, this idealisation of age‐differentiated erotics reinforced existing associations between same‐sex activity and the sexual misuse of younger people by older men.9 In response, some sexual scientists sought to tease apart age‐structured and same‐sex relationships. These authors defined the male homosexual through his exclusive inborn attraction to other consenting adults. This article shows that this influential construction of the modern homosexual as a discrete congenital type emerged in direct response to considerations around age.10 It also demonstrates that, notwithstanding the emergence of this model, questions about the impact of sexual encounters with older men on a younger person's sexual development continued to be debated within sexual science, creating dialogue between theorisations of homosexuality and concurrent studies of childhood sexuality.11 As such, investigations of male homosexuality continued to revolve around urgent questions about how and when same‐sex desire emerged and what impact sexual experiences in youth had on later desires. These debates remained at the centre of early twentieth‐century sexual science in Britain and Germany, complicating the inborn model and securing the centrality of age as a key category in modern articulations of sexuality.

Chinese Sexual Minority Male Adolescents' Suicidality and Body Mass Index.

Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57–1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09–4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01–1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43–2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image.

Población escolarizada de estudiantes con intento de suicidio

La depresión constituye hoy la principal causa de morbilidad y discapacidad entre adolescentes, y el suicidio, la tercera causa de defunción en el mundo. Se propuso describir características de una población adolescente escolarizada con antecedentes de intento de suicidio. Estudio transversal, descriptivo y retrospectivo. Se empleó una base de datos de adolescentes de 56 colegios públicos y privados. Muestreo probabilístico; cuestionario auto-administrado, estructurado y anónimo. La información fue cargada en planilla electrónica de Excel, analizada con SPSS 15.0-IBM. Del total de la población (661), 16,6%(110) manifestó que intentó quitarse la vida, 46,4% (51) era de sexo masculino y 53,6% (59) femenino. El 20,2% (22) tenía de 12 a 14 años, 61,7% (68) de 15 a 17 y 17,2% (19) 18 años y más. Cursaba la Educación Escolar Básica el 49,1% (54) y 50% (55) el Bachillerato. Pertenecía a colegios públicos el 61,8% (68) y 30,9%(34) a privados. Vivía con los padres el 67,3% (74). De los adolescentes que intentaron suicidarse alguna vez, 53,6% (59) pertenecen al sexo femenino y 46,4% (51) al masculino. Un 39,1% (43) tenía familiar con intento de suicidio. Respondió en primera consulta que sufrió abuso sexual el 11,8% (13) y 38,2% (42) cuando se reiteró la pregunta. Consultó alguna vez por problemas emocionales el 19,1% (21). Se encontró una correlación significativa entre haber sufrido abuso sexual e intento de suicidio (p=0,000). Se evidenciaron situaciones graves de trastornos de salud mental sin ser detectadas institucionalmente como oportunidad para intervenir y evitar muertes adolescentes.

Sexual Coercion and Associated Factors among Female Private University Students in Bishoftu Town, East Shewa Ethiopia

Background: Sexual coercion refers to any sexual act or attempt to obtain a sexual act, unwanted sexual comments or advance. Women from all age group are vulnerable. Especially, it is a widely recognized public health problem affecting students from higher educational institution. This study aimed to identify the prevalence of sexual coercion and its predictors among female private university students in Bishoftu town, East Shewa, Ethiopia. Methods: A cross-sectional study design was employed in Adama and Rift valley Universities branches found in Bishoftu town from May 26 to June 12, 2016.A total of 395 students were involved in the study. Simple random sampling method was employed to select the study participants. Bivariate and multivariable logistic regression was conducted. To identify the predictor variables a P-value less than 0.05 were taken as significant association by considering 95% confidence interval. Results: The study revealed that 171(43.3%) of the respondents experienced sexual coercion. Being a social science student (AOR=2.167; 95%CI=1.139,4.122), respondents fathers’ educational status (AOR=0.406; 95% CI=0.200,0.820), Mothers’ educational status (AOR=0.377; 95% CI=0.191,0.744), respondents source of support (AOR=2.511; 95% CI=1.225, 5.147) and drinking alcohol (AOR=0.358; 95% CI=0.177, 0.723) were found to be the predictors of the sexual coercion among the students. Conclusion: More than half of the respondents had experienced sexual coercion. The main experience was unwelcomed touch. Faculty in which the students enrolled, fathers’ educational status, mothers’ educational status, source of support for the students and alcohol drinking habit associated significantly with the sexual coercion experience.

The Voices of Young Sexual Offenders in Norway: A Qualitative Study

Adolescents commit around 20 - 30 percent of all sexual offences and attempts have been made in the literature to distinguish between types of young sexual offenders. This study describes the understanding of nine Norwegian young male sexual offenders regarding sexual offences committed by them during adolescence, their childhood experiences and their suggestions on how to prevent juvenile sexual offending. The participants were interviewed with individual, semi-structured interviews and the rich data were analyzed with systematic text condensation. The young offenders’ understanding of mutuality in the relationship with their minor victim contributed to the sexual offence. Moreover, moral immaturity, learning difficulties or being a refugee, exposure to child pornography, impulsivity and high sexual arousal were described as having impacted on their offending. Findings suggest the need for further studies to understand the risk factors for juvenile sexual offending. Better knowledge about the legal framework of a sexual relationship and consequences of sexual abuse for both offenders and victims were highlighted to be the most important measure to prevent sexual abuse by juveniles in general.

Prevalence and Associated Factors of Sexual Violence among High School Female Students in Dilla Town, Gedeo Zone SNNPR, Ethiopia

Background: Violence against girls takes many forms including rape, sexual harassment, intimidation, teasing and threats. It affects all girls, regardless of age, race, class, caste or location. Poverty, war and long journeys to school put girls at additional risk. The causes are rooted in male-dominated cultures which belittle or condone violence against girls and women. Therefore; this study aimed to assess the prevalence and associated factors of sexual violence against women among high school students in Dilla town. Methodology: Institutional based Cross-sectional study was conducted high school female students at Dilla town, Gedeo zone. Also total sample size of this study was 280 participants. The data was collected by using selfadministered questionnaires. Data was coded and entered in to EPi data software and was exported to SPSS version 20. Crude and adjusted OR were analyzed using logistic regression and the level of significance of association was determined at P- value<0.05. Results: The Findings of this study indicated that the prevalence of sexual violence was 13.2%. The minimum age of the study subject was 14 years and the maximum age was 21 years. From the respondents who encountered sexual violence, majority of the respondents are victimized by unknown person and much older than their age. Using chat, alcohol drinking and using drugs or substances was the main associated factors of sexual violence. Conclusion: The study indicates that female high school students in Dilla town are at high risk of sexual violence. Unwelcome touching of body part, facing sexual attempt, having boyfriend, and a habit of taking alcohol and chat are associated with life time experience of sexual violence.

Management of erectile dysfunction in patients with preexisting cardiovascular disease

Erectile dysfunction (ED) is common among patients with cardiovascular diseases (CVD). Sexual problems usually precede the onset of CVD and should, therefore, be considered as a risk factor for cardiac events. Similarly, patients with preexisting CVD are at increased risk of experiencing ED. Therefore, ED and CVD might be considered as two different clinical manifestations of the same systemic disease. Moreover, these conditions share many common pathophysiological mechanisms. Patients with preexisting CVD and ED should be stratified according to their cardiovascular risk. Sexual activity is safe in patients at low risk of CVD and these individuals might be treated with pro-erectile medications. On the other hand, men at high risk of CVD should be reassessed and the cardiac condition should be stabilized before they might have sexual attempts. Recent evidence suggests that lifestyle changes, administration of phosphodiesterase type-5 inhibitors, and testosterone supplementation might improve sexual function and reduce the risk of experiencing CVD during follow-up.

The office management of ejaculatory disorders.

Premature ejaculation (PE), delayed ejaculation (DE), anejaculation (AE) and retrograde ejaculation (RE) are four main ejaculatory disorders (EjDs) observed in clinical practice. Despite their high prevalence, EjDs remain underdiagnosed and undertreated. Primary care physicians should incorporate the discussion of sexual health topics into routine visits to facilitate EjD diagnosis and treatment. Because the causes of EjDs are multifactorial, the management of EjDs is etiology-specific and may require a holistic approach. Dapoxetine, a selective serotonin reuptake inhibitor, is the only drug approved for on-demand treatment of lifelong and acquired PE. In clinical practice, scheduled follow-up visits, risk factor treatment, appropriate dose escalation, adequate sexual attempts, patient education, and partner involvement are critical factors responsible for optimal overall management of PE and dapoxetine treatment outcomes.

Towards Bi-Inclusive Policies: Suggestions Based on Research on Dutch Same-Sex Attracted Young People

Dutch national LGBT policies are not bi-inclusive and this study provides suggestions for improvement, based on empirical research. Attention for bisexuality in policy appears simply to pay lip service and to endorse the construction of sexual orientation as a hetero/homo binary. The outcomes of our survey (n = 1449) and in-depth interviews (n = 38) of Dutch same-sex attracted young people suggest that special attention for bisexual people is warranted. Compared to exclusively same-sex attracted participants, the equally both-sex attracted participants scored worse on openness about their sexual attraction, visibility discomfort, perceived acceptance, and suicide attempts. Unique issues for bisexual-identified young people were identified as follows: marginalization of bisexuality; difficulty expressing bisexuality, particularly in relationships; and a lack of bisexual or bi-inclusive communities. These issues were all related to the hetero/homo binary and mononormativity. Suggested implications for more bi-inclusive policies focus on awareness of marginalization and invisibility of bisexuality, biphobia, community and capacity building, and comprehensive sexuality and gender education. Furthermore, rather than policies focusing on sameness, a comprehensive diversity perspective on sexuality and gender offers more space for bisexuality. This may be particularly relevant for young people who are exploring their sexuality and developing a sense of their sexual self.

Increased sexual desire with exogenous testosterone administration in men with obstructive sleep apnea: a randomized placebo-controlled study.

Testosterone (T) deficiency, sexual dysfunction, obesity and obstructive sleep apnea (OSA) are common and often coexist. T prescriptions have increased worldwide during the last decade, including to those with undiagnosed or untreated OSA. The effect of T administration on sexual function, neurocognitive performance and quality of life in these men is poorly defined. The aim of this study was to examine the impact of T administration on sexual function, quality of life and neurocognitive performance in obese men with OSA. We also secondarily examined whether baseline T might modify the effects of T treatment by dichotomizing on baseline T levels pre-specified at 8, 11 and 13 nmol/L. This was a randomized placebo-controlled study in which 67 obese men with OSA (mean age 49 ± 1.3 years) were randomized to receive intramuscular injections of either 1000 mg T undecanoate or placebo at baseline, week 6 and week 12. All participants were concurrently enrolled in a weight loss program. General and sleep-related quality of life, neurocognitive performance and subjective sexual function were assessed before and 6, 12 and 18 weeks after therapy. T compared to placebo increased sexual desire (p = 0.004) in all men, irrespective of baseline T levels. There were no differences in erectile function, frequency of sexual attempts, orgasmic ability, general or sleep-related quality of life or neurocognitive function (all p = NS). In those with baseline T levels below 8 nmol/L, T increased vitality (p = 0.004), and reduced reports of feeling down (p = 0.002) and nervousness (p = 0.03). Our findings show that 18 weeks of T therapy increased sexual desire in obese men with OSA independently of baseline T levels whereas improvements in quality of life were evident only in those with T levels below 8 nmol/L. These small improvements would need to be balanced against potentially more serious adverse effects of T therapy on breathing.

Prenatal Hypoxia Ischemia Increases Male Rat Sexual Behavior.

Research consistently indicates an association between prenatal hypoxia-ischemia (HI) and mortality and chronic neurological diseases in newborns. HI can cause permanent effects, including mental retardation, motor impairment, learning disabilities, epilepsy, and cerebral palsy. Moreover, little is known about the relationship between HI and sexual behavior. The aims of this study are to examine whether HI is associated with changes in sexual behavior. HI was induced by clamping the uterine arteries of pregnant rats. The arteries were clamped for 45 minutes on the 18th day of gestation (HI group). Shams received laparotomy and anesthesia only. Pups were born at term. At 90 days of age, sexual behavior was evaluated. Statistical analysis was performed using two-way analysis of variance and post hoc Bonferonni correction. The main outcome measures of sexual response were standard sexual behavior, homosexual behavior, and sexual attempt on nonreceptive females. The stimulatory effect of HI on male rat sexual behavior has been shown in various experimental models; these animals showed reduced mount, intromission and ejaculation latencies; increased copulatory efficiency; and homosexual mounting. Additionally, there was an increase in fighting in trying to mount an unreceptive female. Our results indicate that HI had a long-term effect on sexual behavior despite exhibiting motor skill impairment. Accordingly, injuries during the fetal period may cause behavioral problems in adulthood.

Efficacy of Avanafil 15 Minutes after Dosing in Men with Erectile Dysfunction: A Randomized, Double-Blind, Placebo Controlled Study

We examined the therapeutic effects of avanafil 15 minutes after dosing in men with mild to severe erectile dysfunction. This randomized, double-blind, placebo controlled, 12-week study (4-week run-in and 8-week treatment) randomized 145 men to placebo, 147 to avanafil 100 mg and 148 to avanafil 200 mg on demand. The primary efficacy variable was the per subject proportion of sexual attempts during the treatment period in which subjects achieved erection sufficient for vaginal penetration within approximately 15 minutes after dosing as measured by a stopwatch. The attempt had to enable successful completion of sexual intercourse according to SEP question 3. Significantly greater mean per subject percentages of successful intercourse attempts within approximately 15 minutes after dosing were observed for avanafil 100 mg (mean 25.9%, LS mean ± SE 24.7% ± 2.9%) and 200 mg (mean 29.1%, LS mean 28.2% ± 2.9%) vs placebo (mean 14.9%, LS mean 13.8% ± 2.9%, p = 0.001 and <0.001, respectively). After treatment we noted a statistically significant difference between avanafil and placebo in the average per subject proportion of successful intercourse attempts according to SEP question 3 as early as 10 minutes in the 200 mg group and 12 minutes in the 100 mg group. Treatment emergent adverse events included headache, upper respiratory tract infection and nasal congestion, and most such events were mild or moderate in severity. Avanafil was efficacious within approximately 15 minutes of dosing compared to placebo. A statistically significant treatment difference in the percentage of successful sexual attempts was demonstrated as early as 10 minutes after treatment.

MP19-07 THE STUDY ON CORRELATION BETWEEN SEXUAL ACTIVITY, BENIGN PROSTATIC HYPERPLASIA AND AND LOWER URINARY TRACT SYMPTOMS IN SOUTH CHINA POPULATION

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Basic Research1 Apr 2014MP19-07 THE STUDY ON CORRELATION BETWEEN SEXUAL ACTIVITY, BENIGN PROSTATIC HYPERPLASIA AND AND LOWER URINARY TRACT SYMPTOMS IN SOUTH CHINA POPULATION Gong Cheng Gong ChengGong Cheng More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.708AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Benign prostatic hyperplasia (BPH) is highly prevalent in older men and causes sub-stantial adverse effects on health. The pathogenesis of this disease is not totally clear. Although age, genetics, and sex steroid hormones play prominent roles in the cause of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), recent reports have suggested a possible relationship between sexual activity, BPH and LUTS. METHODS A total of 184 men aged 37 to 92 years presenting at the urological clinic were enrolled in this study. First age of intercourse, sexual activity frequency before and after 40years, Last age of intercourse, each sexual intercourse time and the International Prostatic Symptom Score (IPSS) were recorded. The prostate volumes in the patients with BPH were detected by type-B ultrasound. The questionnaires were completed by face-to-face interview. Logistic regression model was used for multivariate analysis of the factors of sexual activity, BPH and IPSS. RESULTS Of the patients, Frequency of sexual attempts before 40 years was related to LUTS severity and prostatic volume (P < .001). Advanced age was positively associated with LUTS severity (r = 0.534, P < .001). Sexual dysfunction, defined as IIEF score of 20 and less, was present in 68.2% of the patients. All IIEF domain scores and the overall score were correlated with age (P < .001) and the IPSS ( P < .001). In a multivariate analysis, age, diabetes mellitus, and the IPSS were strong independent predictors of the overall IIEF score. The sexual function in the patients with BPH were more powerful than those age cohorts without BPH. CONCLUSIONS The hyperplastic degree of prostate gland are direct related to patients' sexual function especially from postadolescence to senectitude. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e191 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gong Cheng More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Sexology of elderly man with secondary infertility.

Atif A. Katib et al. touched a very sensitive field of everyday andrological work–up. The manuscript gives an overview to almost all possible causes of secondary infertility [1]. Compared to primary infertility, patients are rather young, usually healthy, slim, without chronic diseases and with normal libido, erectile and ejaculation function. The semen quality diminishes with age. In elderly men, healthy lifestyle recommendations are more often insufficient because comorbidities are so advanced. In this case, only pharmacological or surgical treatment is a way of choice. However, pharmacology and surgery carry other side effects, such as influencing semen, sexual drive, sexual function and fertility potential. Unfortunately, in many cases, the only way is assisted reproduction technology (ART). Varicocelectomy improves the semen quality but statistically does not improve the rate of pregnancy. Microsurgical techniques give the highest rate of success without serious complications [2]. However, when performing varicocelectomy in elderly men, one must always keep in mind that the time of existing varicoceles is much longer than in younger patients, so expected positive effect in improving semen quality could be worse. Sexological aspects in these patients are issues which cannot be just solved in one or two questions. It is not enough to ask “Do you have sexual intercourse?” After a few failures resulting from erectile dysfunction, many elderly males do not initiate or respond to sexual attempts from their partners, even when they want to have a child. The definitions of infertility enclose a time frame (1–5 years) but there are no details concerning “regular unprotected sexual intercourse” or “being sexually active” [3]. The frequency of intercourse in young men could be a few per day; in elderly men it could be a few per month or even a few per year, even if sexual activity is perceived as a marker of “good health” [4]. In these conditions, with poor semen quality, it is very difficult to conceive. Information regarding how many sexual intercourses occurred within the last 4 weeks which were finalized with semen deposition in the vagina is crucial to initially define how high the probability of becoming pregnant is. Sexological consultation should be seriously considered in every patient with secondary infertility. The impact on sexual behaviour is not only determined by the level of testosterone, obesity or heart insufficiency, but also by frailty, lack of trust, intimacy, sexual desire or arousal [5]. During an interview with a couple who appears in the office due to secondary infertility, never assume that they have normal, regular active sexual life without any disturbances. Do not focus on semen analysis and treating low testosterone level. Appropriate counseling and treatment of erectile and/or ejaculation dysfunction [6] combined with effective treatment of metabolic, hormonal [7] and cardiovascular diseases could reach success and avoid ART. It is worth to underline that treatment of secondary infertility in aging males cannot be reduced only to a urologist or an andrologist. The broad team of specialists mentioned by the authors, including a sexologist or sexological psychotherapist, is required for the proper care of these unique patients. The most important message to take home from the article is that elderly men who suffer from secondary infertility have much more multifactoral and extensive histories of diseases, traumas, surgeries, sexological problems and many more years of bad lifestyle habits (smoking, alcohol, drugs, etc.) than younger men. This makes diagnosis and treatment more difficult compared to patients with primary infertility. The future challenge for reproductive medicine is to help them, especially if we take into account elongating time of life and the increasing problem of infertility.

Frequency of sexual activity and cardiovascular risk in subjects with erectile dysfunction: cross-sectional and longitudinal analyses

Erectile dysfunction (ED) is risk factor for cardiovascular (CV) events. The relationship between sexual activity and incident major adverse cardiovascular events (MACE) in subjects at high CV risk is conflicting and never investigated in ED subjects. The aim of this study was to investigate relationships between frequency of sexual attempts and incident MACE and to retrospectively explore its main determinants in subjects with sexual dysfunction. A consecutive series of 2187 subjects (mean age 49.9±11.6years old) attending the Outpatient Clinic for sexual dysfunction was retrospectively studied. A subset of the previous sample (N=1687) was enrolled in a longitudinal study. Frequency of sexual intercourse (coital and non-coital) was assessed using a standard question ('During the last 3months how many sexual attempts per month did you have?'). In the whole sample, sexual attempts were an age- and testosterone-dependent phenomenon, while no association between frequency of sexual intercourse and ED or premature and delayed ejaculation, was observed. However, when the same analysis was performed according to age tertiles (I=17-46, II=47-59, III=60-88years old), ED was significantly associated with a higher risk of reduced sexual intercourse in younger (hazard ratio=1.857 [1.066-3.234]; p=0.029), but not in middle-aged or older individuals. The marital component, as assessed by SIEDY Scale 2, played a major role in regulating sexual frequency in all age bands. Depressive symptoms represent another independent risk factor for reduced sexual activity (adj r=-0.139; p<0.0001), in an age-dependent manner. When longitudinal data were analysed, a higher frequency of sexual intercourse significantly reduced the risk of MACE even after adjusting for known CV risk factors for this cohort. Identifying among mild-to-moderate ED subjects those with lower frequency of sexual activity might provide an opportunity to modify their behaviour and to discover subthreshold comorbidities, possibly preventing forthcoming CV events.

An open-label, long-term evaluation of the safety, efficacy and tolerability of avanafil in male patients with mild to severe erectile dysfunction

Determine the long-term efficacy, safety and tolerability of avanafil, a highly specific, rapidly absorbed phosphodiesterase type 5 inhibitor in male patients with mild to severe erectile dysfunction (ED), with or without diabetes. This was a 52-week, open-label extension of two 12-week, randomised, placebo-controlled, phase 3 trials. Patients were assigned to avanafil 100 mg, but could request 200 mg (for increased efficacy; '100/200-mg' group) or 50 mg (for improved tolerability). Primary end points included percentage of sexual attempts ending in successful vaginal penetration [Sexual Encounter Profile 2 (SEP2)] and intercourse (SEP3) and erectile function domain score per the International Index of Erectile Function (IIEF-EF). Some 712 patients enrolled; 686 were included in the intent to treat population and contributed to the data. All primary end points showed sustained improvement. SEP2 and SEP3 success rates improved from 44% to 83% and from 13% to 68% (100-mg group) and from 43% to 79% and from 11% to 66% (100/200-mg group), respectively. Mean IIEF-EF domain scores improved from 13.6 to 22.2 (100-mg group) and from 11.9 to 22.7 (100/200-mg group). Avanafil was effective in some patients ≤ 15 min and > 6 h postdose. Sixty-five per cent (112/172) of 'nonresponders' to avanafil 100 mg responded to the 200-mg dose. The most common (≥ 2%) treatment-emergent adverse events were headache, flushing, nasopharyngitis and nasal congestion; < 3% of patients discontinued therapy because of adverse events. The long-term tolerability and improvement in sexual function, coupled with rapid onset, suggest that avanafil is well suited for the on-demand treatment of ED.

ANTIHYPERTENSIVE EFFICACY AND INFLUENCE ON SEXUAL FUNCTION OF VALSARTAN AND VALSARTAN AND HYDROCHLOROTHIAZIDE COMBINATION IN SMOKERS VERSUS NON-SMOKERS WITH ARTERIAL HYPERTENSION

Aim. To study antihypertensive efficacy and safety of valsartan-based therapy as well as influence of treatment on several aspects of sexual function. Material and methods. Hypertensive patients (n=650) in 53 medical institutions of Russia were enrolled to the prospective multicenter observation study, 37.5% of smokers and 62.5% non-smokers. The evaluation of therapy efficacy was based on analysis of systolic (SBP) and diastolic (DBP) blood pressure (BP) changes. Safety and compliance of treatment was also analyzed. The evaluation of sexual function was performed with 5 universal questions selected form the International Index of Erectile Function. These ques- tions could be asked in both men and women. The valsartan dose was 80–320 mg OD. A combination of the valsartan with hydrochlorothiazide (12.5–25 mg/d), amlodipine (5–10 mg/d) or any other antihypertensive was allowed. Results. Significant similar decrease of SBP and DBP was observed in smoking and non-smoking patients (37.4/17.8 and 36.7/16.5 mm Hg respectively, р&lt;0.01 vs baseline). Differences in SBP and DBP changes were not significant between groups. Target BP level (&lt;140/90 mmHg) was reached in 81.9% smokers and 76.0% non-smokers. After 20 weeks of treatment the number of patients without sexual activity and with 1–2 successful sexual attempts in the last 4 weeks significantly decreased from 44.7 to 32.8% and from 29.1% to 23.2%, respectively (р&lt;0.05). Significant increase in the number of patients with 5–6 and 7–10 successful sexual attempts was observed (from 6.1 to 13.6% and from 3.2 to 5.9% respectively, р&lt;0.05). The treatment resulted in significant increase in the number of patients, who evaluated their sexual life satisfaction as ″very satisfied″ (from 8.2 to 14.8%, &lt;0.01). Conclusion. Comparable antihypertensive efficacy and safety were demonstrated for valsartan based therapy in smoking and non-smoking patients. During the course of treatment there was a significant improvement of sexual function and general satisfaction with sexual life in patients with arterial hypertension, which could have favorable long-term consequences in increased compliance to the antihypertensive therapy.