Stable Heterosexual Relationship Research Articles

Sexual Function in Women with Polycystic Ovary Syndrome Living in Stable Heterosexual Relationships: A Cross-Sectional Study.

Background/Objective: The prevalence and character of female sexual dysfunction (FSD) in polycystic ovary syndrome (PCOS) have not been precisely determined. The aim of this study was to assess FSD using the Changes in Sexual Functioning Questionnaire (CSFQ-14) in women with PCOS and their partners compared to a control group, as well as correlations between five subscales, the total score of the CSFQ, and seven questions of the Visual Analogue Scale (VAS). Methods: The study sample (N = 160) comprised two groups: (1) women with PCOS and their partners (n = 91) and (2) women without PCOS and their partners (control group; n = 69). Results: The total scores of the CSFQ did not reveal FSD in either group of women. Regarding all subscales and the total score, the analysis showed a statistically significant difference between women and their partners (in all cases: p < 0.001). The discrepancy in arousal between women and men in the PCOS group was large (the mean difference was -2.32; t = -11.29, p < 0.001, Cohen's d = -1.26). The importance (VAS1), the level (VAS7) of sexual satisfaction, and the intensity of sexual thoughts (VAS2) correlated with almost all domains of the CSFQ. Conclusions: In conclusion, normal sexual function in PCOS does not mean proper sexual functioning in a sexual relationship.

Is there a relationship between mean platelet volume and response to treatment with daily tadalafil in patients with erectile dysfunction?

Mean platelet volume (MPV) has been related to erectile dysfunction (ED). However, its value in predicting therapeutic response to phosphodiesterase-5 inhibitors is not evaluated. This study aimed to investigate the value of MPV as a marker for the prediction of the response of the tadalafil treatment of ED. A retrospective analysis of patients who were admitted to the andrology outpatient clinic between 2020-2022 were performed. The inclusion criteria were, ≥40 years old male, International Index of Erectile Function-Erectile Function domain score < 26, not received any ED treatment before, have a stable heterosexual relationship, and prescribed 5mg daily tadalafil for primary treatment of ED. A total of 116 patients were included in the study. The mean age of the patients was 53.7 ± 8.7 years. The response rate to 5mg tadalafil treatment was 52.6% (Group-1; N=61). An MPV value 3 10.05 fL was associated with 66% sensitivity and 75,4% specificity for no response to 5mg daily tadalafil treatment (Area under curve=76.9% [95% CI 68.2%-85.6%; p < 0.001]). Initial IIEF-EF score, fasting blood glucose, and MPV level was independently associated with the response to the tadalafil treatment. This is the only study to evaluate the value of MPV level on the therapeutic response of ED to tadalafil. Strict inclusion criteria were applied to the cohort. However, the diagnose of vascular ED has been made by clinical evaluation and retrospective design of the study were the limitations of the study. The results of our study suggest that MPV might be used to predict the result of 5mg daily tadalafil treatment in selected ED patients as a fast and cost-effective test.

A Modified Procedure to Diagnose Erectile Dysfunction Using the International Index of Erectile Function (IIEF-6) Combined With the Premature Ejaculation Diagnosis Tool (PEDT) via an Internet Survey.

BackgroundThe reliability of the International Index of Erectile Function (IIEF-5) in diagnosing erectile dysfunction (ED) is significantly decreased for the population with premature ejaculation (PE).AimWe aimed to illustrate a better way of diagnosing ED among the general population through a web survey study.MethodsWe collected online surveys from 2,746 men between the ages of 18 and 65. Two methods were used to determine the prevalence of ED, and these 2 methods were compared. Additionally, we divided our sample into 2 equally sized groups by median age and repeated the analyses for each group. In Method Ⅰ (M Ⅰ), men with an IIEF-5 score ≤ 21 were diagnosed with ED. In Method Ⅱ (M Ⅱ), PE was defined as a PEDT score ≥ 9, and no-PE was defined as a PEDT score ≤ 8. We used an IIEF-6 score cutoff of ≤ 24 among the PE population and a cutoff of ≤ 25 among the no-PE population to diagnose ED.Main outcome measuresWe examined the results from the IIEF-5, PEDT, and IIEF-6.ResultsOf the 2,746 men, 1,540 were in a stable heterosexual relationship, and the prevalence of ED among these men was determined. The prevalence of ED, as measured by Method Ⅰ, was significantly higher than that measured by Method Ⅱ. The kappa coefficients between the 2 methods were 0.595, 0.704, and 0.430 for the overall, no-PE, and PE populations, respectively. The internal consistency of the IIEF-5 for the PE population increased if Question 5 (intercourse satisfaction) was removed. Similar trends were observed for the groups, and there were no substantial differences.Clinical implicationsOur research suggests that before using the erectile function assessment scale to evaluate erectile function, ejaculatory function should be assessed with the PEDT.Strengths and limitationsThis was the first study to highlight the importance of evaluating ejaculatory function using the PEDT before diagnosing ED via an internet survey. There may have been recruitment bias because our study was an internet survey.ConclusionEstablishing the prevalence of ED by using a combination of the IIEF-6 and PEDT was more reliable than using the IIEF-5 alone. Further validation of the modified procedure, especially regarding the effects of age on the results, in future studies is required.Wang C, Zhang H, Liu Z, et al. A Modified Procedure to Diagnose Erectile Dysfunction Using the International Index of Erectile Function (IIEF-6) Combined With the Premature Ejaculation Diagnosis Tool (PEDT) via an Internet Survey. Sex Med 2022;10:100506.

“Exfoliation, Cheese Courses, Emotional Honesty, and Paxil”

This article applies a conjunctural analysis to four US “hangout sitcoms”—Friends, How I Met Your Mother, The Big Bang Theory, and New Girl—to examine the tensions faced by masculinities in a neoliberal era. After establishing the “hangout sitcom” subgenre, I use critical discourse analysis to unpack three male subject positions. The postfeminist male singleton reacts neurotically to a perceived loss of power with a desperate search for true love. The douchebag responds with excessive performances of both masculinity and neoliberal subjectivity, while the househusband’s stable job and long-term heterosexual relationship reflect neoliberalism’s relationships with intimacy and the family. I argue that the hangout sitcom, and specifically its representation of masculinities, offers an under-explored opportunity to examine the politics of masculinities, postfeminism, and neoliberalism.

Genitopelvic pain: retrospective evaluation of a multimodal treatment efficacy.

Genitopelvic and sexual pain penetration disorder (GPPD) recognizes a multifaceted etiology. As with syndromes of chronic pain, it responds poorly to medications and its management is difficult. Clinicians consequently favor a multimodal comprehensive approach to tackle the different aspects of the disorder. To treat GPPD women, we chose a multimodal regimen including topical and systemic medications associated with physical interventions and behavioral couple therapy. Our aim was to evaluate the regimen efficacy and the influence that demographic, clinical, and pain characteristics may have on the outcome. Sixty self -referred women requesting medical care for GPPD, who were free of debilitating illness, in stable heterosexual relationships and with healthy and sexually functional partners, were treated according with the multimodal regimen we tailored on the specific needs of these women. As said, it associated topical and systemic medications combined with physical exercises used in behavioral sex therapy, and behavioral couple therapy. Past sexual history, characteristics of pain, vestibular hyperreactivity, pelvic floor hypertonicity, general health, and couple harmony were evaluated and statistically analyzed to determine which characteristics were associated with therapy outcome. The statistical analysis of an association between demographic, reproductive, pain and medical conditions on one hand and therapy outcome on the other did not find any significance. The lack of association between the investigated characteristics and treatment outcome is disappointing; on the other hand, the statistically significant impact of couple harmony (evaluated as partner presence and participation) on the treatment results may be the answer to our search for factors predicting outcome.

Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study.

IntroductionThe prevalence of polycystic ovary syndrome (PCOS) is 10–15% in women of reproductive age. Its characteristics are (i) clinical or biochemical hyperandrogenism, (ii) oligomenorrhea or amenorrhea, and (iii) polycystic ovaries on ultrasound. PCOS is associated with lower quality of life, depression, anxiety, diabetes, and cardiovascular disease. Treatment commonly entails oral contraceptive use to lower endogenous androgen levels. Androgen levels and comorbidities may affect sexual function. Previous studies have addressed a limited range of possible contributing factors. We will assess sexual function as well as genital and self-reported sexual arousal in a laboratory setting in women with PCOS compared to an age-matched healthy control group. Modulation by biopsychosocial factors mentioned will be studied.MethodsThis is a multicenter prospective case control study. The study population includes healthy women with and without PCOS, aged 18–40 years, in a stable heterosexual relationship for at least 6 months. Power is calculated at 67 participants in each group. Anticipating a drop out of 10%, 150 participants will be recruited.Main outcome measuresThe main outcomes measured are sexual function using the Female Sexual Function Index, Sexual Desire Inventory, and Female Sexual Distress Scale-Revised; genital sexual arousal measured as vaginal pulse amplitude; and self-reported sexual arousal in response to erotic stimuli in a laboratory setting. The mediators that will be investigated include testosterone, free androgen levels, oral contraceptive use, sensitivity to androgens (using CAG repeat length), body mass index, body image, mental health, and self-esteem.ConclusionStrengths of this study are the inclusion of a broad range of biopsychosocial outcome measures including DNA analysis, a healthy control group, and standardized assessment of genital and self-reported sexual arousal in a laboratory setting. With the design of this study we aim to provide an insight into which biopsychosocial factors associated with PCOS are related to sexual function, and how sexual function may be affected by treatment. These new insights may help to improve clinical management of PCOS while improving the quality of life.Pastoor H, Both S, Timman R, et al. Sexual Function in Women With Polycystic Ovary Syndrome: Design of an Observational Prospective Multicenter Case Control Study. Sex Med 2020;8:718–729.

Time to Orgasm in Women in a Monogamous Stable Heterosexual Relationship

BackgroundOrgasm in women is a complex phenomenon, and the sparse data about time to orgasm (TitOr) in women are an impediment to the research on this complex phenomenon. AimTo evaluate the stopwatch measured TitOr in women in a monogamous stable heterosexual relationship. MethodsThe study was conducted through web-based and personal interview using a questionnaire, which addressed the issues related to TitOr. Sexually active women older than 18 years and women in a monogamous stable heterosexual relationship were included in the study. Those with comorbidities such as diabetes, hypertension, asthma, psychiatric illness, sexual dysfunction and those with partners with sexual dysfunction were excluded. The participants reported stopwatch measured TitOr after adequate sexual arousal over an 8-week period. The data analysis was performed using GraphPad software (©2018 GraphPad Software, Inc, USA). OutcomesThe outcomes included stopwatch measured average TitOr in women. ResultsThe study period was from October 2017 to September 2018 with a sample size of 645. The mean age of the participants was 30.56 ± 9.36 years. The sample was drawn from 20 countries, with most participants from India, the United Kingdom, the Netherlands, and the United States of America. The mean reported TitOr was 13.41 ± 7.67 minutes (95% confidence interval: 12.76 minutes–14.06 minutes). 17% of the participants had never experienced the orgasm. Penovaginal intercourse was insufficient to reach orgasm in the majority, in whom it was facilitated by certain positions and maneuvers. Clinical ImplicationsThe knowledge of stopwatch measured TitOr in women in real-life setting helps to define, treat, and understand female sexual function/dysfunction better and it also helps to plan treatment of male ejaculatory dysfunction, as reported ejaculatory latency in healthy men is much less than the reported TitOr here. Strengths & limitationsUse of stopwatch to measure TitOr and a large multinational sample are the strength of the study. The absence of a crosscheck mechanism to check the accuracy of the stopwatch measurement is the limitation of the study. ConclusionStopwatch measured average TitOr in the sample of women in our study, who were in a monogamous stable heterosexual relationship, is 13.41 minutes (95% confidence interval: 12.76 minutes–14.06 minutes) and certain maneuvers as well as positions during penovaginal intercourse help achieving orgasm, more often than not.Bhat GS, Shastry A. Time to Orgasm in Women in a Monogamous Stable Heterosexual Relationship. J Sex Med 2020;17:749–760.

Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression

IntroductionThe findings regarding the association between body mass index (BMI) and sexuality outcomes are mixed. Subjective body image has been found to be more salient in predicting sexual function than actual body size. Previous studies have demonstrated appearance anxiety to be particularly significant. AimTo evaluate the association between appearance anxiety and female sexual functions. Specific aims included the evaluation of body morphologic measurements with indicators other than BMI and determining the predictive role of surgical scars for appearance anxiety and female sexual function. MethodsSexually active women who had been in a stable heterosexual relationship for ≥6 months participated in this study. Demographic features, anthropometric measurements including BMI, skin-fold thickness (SFT) measurements from 3 regions of the body (triceps, scapula, and abdomen) and waist circumference (WC) were assessed. Finally, participants were asked to complete the Appearance Anxiety Inventory, Female Sexual Function Index, and Beck Depression Inventory. Multivariate path analyses and hierarchical multiple regression analyses were performed. Main Outcome MeasuresThe correlations of age, BMI, presence of surgical scars, and measurements of BMI, WC, and SFT as independent variables with Beck Depression Inventory, Appearance Anxiety Inventory, and Female Sexual Function Index scores were the main outcomes of the study. ResultsThe data of 329 women were analyzed. The median age of the participants was 33 (19–52) years. The mean BMI was 24.5 (SD 3.5) kg/m2. The prevalence of female sexual dysfunction was 22.8%. Multivariate analyses revealed that increased appearance anxiety (−0.45), presence of surgical scars (−0.28), accompanying depression (−0.15), SFT abdomen measurement (−0.16), and age (−0.13) were significantly associated with sexual function. Appearance anxiety was found to be associated with accompanying depression (0.56), presence of surgical scar (0.38), and measurements of the WC (0.22), BMI (0.14), SFT-abdomen (0.12), and SFT-triceps (−0.31). Clinical ImplicationsClinicians should take the strong relationship between appearance anxiety and female sexual function into consideration. Body morphologic evaluation should not be limited to BMI; surgical scars and WC and SFT measurements may play a considerable role. Strengths & LimitationsA major limitation of this study was the lack of personal distress evaluation in the participants. ConclusionSexual complaints in middle-aged women revealed the strongest correlation with appearance anxiety. Further longitudinal studies are needed to reveal its underlying factors and implications for sexuality.Cihan A, Cihan E. Interrelation Between Appearance Anxiety and Sexual Functions in Women: The Role of Surgical Scars, Morphologic Features, and Accompanying Depression. J Sex Med 2019;16:1769–1778.

012 Average Time to Orgasm (TitOr) in Females during Heterosexual Penovaginal Intercourse

Orgasm in females is a controversial topic with respect to its occurrence, timing, types as well as associated ejaculation. Orgasm in females depends on many factors; hence the question about time to reach orgasm in females largely remains unanswered. To evaluate the average time to reach orgasm in females following adequate sexual arousal, during heterosexual penovaginal intercourse. After obtaining Institutional Review Board approval, the study was initiated. The study was conducted using an internet based questionnaire as well as web based interview. Sexually active females in stable heterosexual relationship were included in the study. Females with co morbid conditions such as diabetes, hypertension, asthma, malignancy, psychiatric disorders were excluded from the study. Females who had undergone pelvic surgeries, radiation to the pelvis and associated genitourinary abnormalities were excluded from the study. Data regarding participants’ place of residence, educational status, age, marital status/relationship status, and length of relationship were collected. Information regarding orgasm, its occurrence as well as time to reach orgasm following adequate sexual arousal was recorded. Participants were asked to record the time to orgasm using stopwatch. For the purpose of this study, Time to orgasm in females (TitOr) was defined as the time taken to reach orgasm (in seconds or minutes) following sexual arousal. For the purpose of this study, sexual arousal was defined as an intense desire for sex in the presence of erotic stimuli, which were provided by the partner, audiovisual methods or both. The data was analyzed using GraphPad software (©2018 GraphPad Software, Inc. USA).

PO-02-021 Appearance anxiety can be an independent risk factor for female sexual dysfunction

Investigation of the relationship between the levels of appearance anxiety and female sexual function index parameters in women was aimed at the current epidemiologic survey. Sexual active women who have a stable heterosexual relationship at least six months were the subjects of the study. Following informed consent demographic features, medical history, anthropometric measurements including body mass index (BMI), skinfold thickness (SFT) measurements from three different regions of the body (Triceps, Scapula, Abdomen) and waist circumference (WC) were obtained and recorded by the researchers. Finally, subjects were asked to fill Appearance Anxiety Inventory (AAI) to measure the severity of appearance anxiety, Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI). Among participants, Female sexual dysfunction (FSD) was termed who have below 26.50 points in FSFI total score as previously accepted. Nonparametric Spearman’s correlation test and Hosmer –Lemeshow test for multivariate logistic regression analyses were used with SPSS 21.0.

Content Validity of the Premature Ejaculation Profile, Original and Per-Event Formats, in Men with Lifelong Premature Ejaculation

BackgroundThe Premature Ejaculation Profile (PEP) is a patient-reported outcome (PRO) measure that is widely used in clinical research in men with premature ejaculation (PE) but has not been fully validated for men meeting the current International Society for Sexual Medicine (ISSM) definition of lifelong PE. AimTo explore the content validity of the PEP (original 1-month recall version and new event-driven version) in men meeting current definitions of lifelong PE and to understand the relevance of the concept of ejaculation control. MethodsIn-depth individual interviews were conducted with 24 men in a stable heterosexual relationship, including 15 with lifelong PE, 4 with acquired PE (with intravaginal ejaculation latency time values confirmed during a 4-week period of no treatment), and 5 with no sexual dysfunction. Initial concept elicitation explored individual experiences of having PE (in those with PE), experiences of control, and impact on sexual life. This was followed by a cognitive debriefing of the PEP versions. Main Outcome MeasureThematic analysis was used to identify key concepts of PE, understand the experience of control in men with and without PE, and confirm understanding and relevance of questions from original and event-driven versions of the PEP. ResultsThe interviews confirmed substantial negative consequences for men with lifelong PE. Men with and without PE could describe ejaculation control (or lack of it). The PEP was shown to cover the key concepts in PE, and the questions were easily understood in both the original or event-driven versions. The items were comprehensive, and the concept of ejaculation control was confirmed. A 1- or 2-category change in each item of the PEP was considered clinically meaningful. Clinical ImplicationsThe PEP (original and per-event) has strong content validity for use in clinical research studies of men meeting the ISSM definition of lifelong PE. Strengths & LimitationsThis study addressed gaps in previously published research on the development and validation of the PEP and also confirmed that a new event-driven version is also suitable for use in research. However, the study was limited mainly to men meeting a strict definition of lifelong PE; in addition, homosexual men and those not in stable long-term relationships were not studied. ConclusionBoth the original and per-event PEP versions were shown to have strong content validity and be acceptable for use in men with lifelong PE.Burbridge C, Symonds T, Osterloh IH, et al. Content Validity of the Premature Ejaculation Profile, Original and Per-Event Formats, in Men with Lifelong Premature Ejaculation. J Sex Med 2019;16:569–576.

Morphometric and Vascular Modifications of the Clitoris During Pregnancy: A Longitudinal, Pilot Study.

During pregnancy, women go through a series of physical and emotional changes that may have an impact on their sexuality. The aim of the study was to examine modifications in sexual function during pregnancy by means of translabial ultrasonography and administration of questionnaires on sexual activity. Eighteen healthy and adult (25-35years) pregnant women without sexual dysfunction and with a stable heterosexual relationship were examined at 10-12, 18-20, and 30-32weeks of gestation. Patients underwent ultrasonographic translabial clitoral volume and labia minora thickness measurements and color Doppler assessment of the dorsal clitoral and posterior labial arteries. On the same day, each patient completed the two-factor Italian McCoy Female Questionnaire (MFSQ) and the Female Sexual Function Index (FSFI). The mean clitoral body volume progressively increased during pregnancy, and color Doppler analysis of the dorsal clitoral artery showed a significant decrease in the pulsatility index from the first to the third trimester. Similarly, the labia minora thickness increased and the posterior labial artery pulsatility index progressively decreased throughout gestation. The MFSQ score for sexuality and partnership and the number of intercourses/week did not significantly change during the study period. However, the MFSQ score for partnership reached the lowest value in the third trimester of pregnancy. Analysis of the FSFI data showed no significant differences throughout pregnancy for the majority of the domains (sexual desire, arousal, orgasm, lubrication, and pain), with the exception of the satisfaction item, which decreased during the third trimester. A significant proportion of women are concerned that changes in their body during pregnancy may have a detrimental effect on sexuality. Despite significant changes in genital morphology and vascularity throughout gestation, these modifications do not seem to have an impact on sexual function in pregnancy.

Hypertension and obesity comorbidities increases coronary risk, affects domains of sexual function and sexual quality of life.

About 25% of the world's adult population suffers from arterial hypertension with about 1.5 billion estimated to develop hypertension by 2025. Hypertensive patients have been reported to have a higher risk of developing diabetes and sexual dysfunction. Hypertension have been linked with lubricative and orgasmic difficulties in females, as wel as ED and vascular disease in men. Obesity has also been linked to ED in diabetic males as well as several aspects of female sexuality. Hypertension and obesity are closely related, each occurring in greater frequency with the other, it is only logical to think that comorbidities of obesity and hypertension could increase the risk of cardiovascular disease and SD. This research looks at the relationship between hypertension and obesity comorbidities and its association with sexual function in type II diabetics. Diabetic patients who were at least 18 years old and were engaged in a stable heterosexual relationships for at least 1 year were recruited for this study. Participants were categorized into the -HYP/-OB, +HYP/-OB and the +HYP/+OB groups. Sexual function was assessed using the GRISS-M and GRIS-F for the diabetic males and females respectively. Early morning fasting blood samples was used in lipid profile as well as FBG assay. The Coronary risk was estimated as Total/HDL Cholesterol. Triglyceride levels and coronary risk were highest in the +HYP/+OBES group, followed by the +HYP/-OBES group, with the -HYP/-OBES group recording the lowest levels. PE and infrequency recorded the highest score among the +HYP/+OBES group with the +HYP/-OBES group recording the lowest scores. SQoL was highest amongst the -HYP/-OBES group, with the +HYP/+OBES group recording the lowest scores. Anorgasmia and avoidance increased along the shades of HYP/OBES groups. Comorbidities of hypertension and obesity increases the risk of coronary disease, affects some domains of sexual function and decreases the SQoL of diabetics.

Role of depression, anxiety, testosterone and luteinizing hormone levels in disorders of sexual function

Background: Hypogonadism as well as deficiency of testosterone can lead to disorder of sexual function in males. The initial clinical manifestations of this are mostly erectile dysfunction (ED) and hypoactive sexual desire disorder (HSSD). This not only causes the sexual dysfunction but can also lead to many health problems. To study the role of depression, anxiety, testosterone and luteinizing hormone levels in disorders of sexual functionMethods: A hospital based cross sectional study was conducted at department of General Medicine, Kamineni Academy of Medical Sciences, Hyderabad for a period of one year among 60 eligible study subjects to study the role of depression, anxiety, testosterone and luteinizing hormone levels in disorders of sexual function. All male patients aged between 21-60 years, who had stable heterosexual relationship, were included. Patients with severe diseases, users of alcohol and smoking, having marital disharmony were excluded. Informed consent was obtained from all the patients.Results: Testosterone and LH levels are significantly lower in subjects with SD, suggesting that a state of hypogonadotropic hypogonadism prevails in male diabetics with SD. Depression and anxiety are significant factors associated with SD. Premature Ejaculation is significantly associated with Anxiety.Conclusions: Testosterone and LH levels are significantly lower in subjects with SD. Depression and anxiety is significant factors associated with SD. Premature Ejaculation is significantly associated with anxiety.

Efficacy and Safety of Sildenafil in Men With Sexual Dysfunction and Spinal Cord Injury.

Spinal cord injury (SCI) is estimated to affect approximately 276,000 individuals in the United States. Since 2010, the mean age of individuals at the time of the SCI has been 42 years, with nearly 80% of cases involving men. This means that individuals with SCI generally are young men who typically place a great deal of importance on normal sexual and reproductive function. To assess the effect of sildenafil treatment on erectile function and the frequency of ejaculation in men with SCI. This study was a post hoc analysis of pooled data from two randomized, double-blinded, placebo-controlled, flexible-dose, crossover sildenafil trials conducted in Europe, Australia, and Turkey. Two hundred forty-eight men at least 18 years old with traumatic SCI of at least 6 months' duration, with erectile dysfunction solely attributed to SCI, and in a stable heterosexual relationship were treated sequentially with sildenafil and placebo. Exclusion criteria included taking nitrate therapy, severe cardiac failure, and recent stroke or myocardial infarction. The starting sildenafil dose was 50 mg, taken approximately 1 hour before sexual activity, with subsequent dose adjustment to 100 or 25 mg based on efficacy and safety during treatment. There was a 2-week washout between 6-week treatments. Change from baseline in International Index of Erectile Function question 3 (frequency of penetration), question 4 (maintaining erection after penetration), question 9 (frequency of ejaculation), and erectile function domain scores; intercourse success; and treatment preference. All International Index of Erectile Function outcomes, including achieving and maintaining erections and ejaculation frequency, were statistically significantly greater with sildenafil vs placebo, including the subgroup with complete SCI (P < .01 for all comparisons). The percentage of successful intercourse attempts with sildenafil (53% vs 12%) and preference for sildenafil (96% vs 4%) vs placebo were significant (P < .001), including the subgroup with complete SCI. The most common all-cause adverse events with sildenafil were headache (16.1%) and urinary tract infection (11.6%). Sildenafil significantly improves erections, intercourse success, and ejaculation frequency vs placebo, including in men with complete SCI. Sildenafil is an effective and well-tolerated treatment for sexual dysfunction in men with SCI. The increase in frequency of ejaculation could allow the possibility of having children without medical intervention in this patient population. Ohl DA, Carlsson M, Stecher VJ, Rippon GA. Efficacy and Safety of Sildenafil in Men With Sexual Dysfunction and Spinal Cord Injury. Sex Med Rev 2017;5:521-528.

Human leucocyte antigen (HLA)-DQB1*03:02 and HLA-A*02:01 have opposite patterns in their effects on susceptibility to HIV infection.

The objective of this study was to seek correlates of immune protection in HIV infection. We sought to elucidate the association between the presence of human leucocyte antigen (HLA) alleles, as well as killer immunoglobulin receptor (KIR) genotypes, and the susceptibility to HIV infection in a Spanish cohort of HIV-exposed seronegative (HESN) individuals. A total of 152 individuals were evaluated: 29 HESN individuals in stable heterosexual relationships with an HIV-infected partner admitting high-risk sexual intercourse for at least 12 months prior to inclusion in the study, 61 HIV-infected patients and 62 healthy controls. HLA class I and II alleles and KIR genotypes were assessed in genomic DNA from all individuals in the study by polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) using bead array technology. HESN individuals showed a higher prevalence of HLA-A3 (62%) and HLA-B44 (83%) supertypes compared with HIV-infected individuals (42% and 66%, respectively). Regarding specific HLA alleles, HESN individuals had a higher prevalence of HLA-A*33:01, DRB1*04 and DQB1*03:02 alleles (14%, 34% and 31%, respectively) and a lower prevalence of the HLA-A*02:01 allele (27%) than HIV-infected patients (3%, 15%, 11% and 52%, respectively; P < 0.05). Interestingly, in a multivariate analysis, only the presence of DQB1*03:02 and the absence of A*02:01 alleles were independently associated with HESN status [odds ratio (OR) 3.4 (95% confidence interval (CI) 1.1-10.5) and 0.4 (95% CI: 0.1-0.9), respectively; P < 0.05]. No KIR genotype was associated with susceptibility to HIV infection. Our data showed that the presence of the HLA class II allele DQB1*03:02 was a correlate of immune protection against HIV infection, while the presence of the HLA class I allele A*02:01 was associated with being infected with HIV.

The Metabolic Syndrome and Sexual Dysfunction in a State of Inflammation

Background: Diabetes is amongst the most researched diseases worldwide due to its debilitating effects on patients. Diabetics have a higher risk of developing erectile dysfunction. Evidence has linked erectile dysfunction severity to increased age, duration of diabetes, the metabolic syndrome and hypogonadism. However, the role of inflammatory markers in the pathogenesis of SD is still unclear. The contributions of hormonal parameters and adipokines to both macro and micro vascular complications are still poorly understood. This study was conducted to provide some evidence of an association between SD, the metabolic syndrome and inflammatory hormones. Method: A total of 130 diabetic males participated in this study. All participants were at least 18 years and were actively engaged in a stable heterosexual relationship for a minimum of two years before they were recruited for this study. The Diabetic men were evaluated using the Golombok Rust Inventory of Sexual Satisfaction for males (GRISS-M). The NCEP-ATP III, IDF and WHO criteria were used to assess the metabolic syndrome. Blood samples were taken for biochemical and hormonal assays. Results: Participants with raised Triglyceride levels showed significantly higher leptin levels for NCEP-ATP III and IDF criteria. Participants with impotence showed significantly lower leptin/adiponectin ratio (p = 0.0184) whilst participant with non-sensuality showed significantly higher values of leptin/adiponectin ratio (p = 0.0103). A significantly higher levels of insulin (p = 0.0265) was recorded in participants with Dissatisfaction problems. Participants with Non communication problems showed significantly higher levels of insulin (p = 0.0419) and lower levels of adiponectin (p = 0.0438) whilst participants with infrequency showed significantly lower levels of adiponectin (p = 0.0042). Conclusion: The relative balance between pro inflammatory and anti-inflammatory mediators of endothelial dysfunction could possibly be essential for the progression of diabetes to SD and the MetS thus a longitudinal study which measures a range of both pro and anti-inflammatory hormones and adipokines as risk factors for SD and the MetS could potentially aid in improvements in assessing the risk of developing these conditions among diabetics.

Testosterone and Its Bioactive Components Are Associated with Libido and the Metabolic Syndrome in Men

Background: Some evidence has shown that the prevalence of hypoactive sexual desire and erectile dysfunction (ED) is associated with testosterone levels whilst higher levels of testosterone have been reported to increase the frequency of intercourse. Available evidence points towards an etiologic role for hypogonadism in the causation of diabetes, metabolic syndrome (Mets) and sexual dysfunction (SD) even though the exact pathophysiological linkage is yet to be fully elucidated. This study therefore sought to evaluate the impact of testosterone as well as its bioactive components on both the MetS and SD. Method: Diabetic men engaged in a stable heterosexual relationship for at least 2 years were recruited for this study. Participants were at least 18 years and provided an informed and signed consent to partake in this study. Fasting blood samples were taken from the participants for biochemical and hormonal assay. The participants were then evaluated using the Golombok Rust Inventory of Sexual Satisfaction for males (GRISS-M). Metabolic syndrome was assessed using the NCEP-ATP III, IDF and WHO criteria. All data analyses were performed using the SPSS software, version 11.0 systat, Inc. Germany and GraphPad Prism, version 5.0, San Diego California, USA. Results: The mean total, free and bioavailable testosterone as well as SHBG recorded among the participants was 7.10 ± 1.23 ng/ml, 0.10 ± 0.01 ng/ml, 7.01 ± 1.41 ng/ml and 4.33 ± 1.12 nmol/l respectively. Subjects with the MetS showed significantly lower SHBG levels in comparison with subjects without the MetS. Participants with raised triglyceride levels showed significantly lower levels of total, free and bioavailable testosterone when compared to participant without raised triglycerides. Participants with problems of avoidance and infrequency of sexual activity showed significantly lower levels of total, free and bioavailable testosterone when compared to participants without avoidance or infrequency problems. The +SD/+MetS group recorded the lowest SHBG levels. Conclusion: Testosterone and its bioactive components are associated with male libido as well as the metabolic syndrome. Low levels of free and bioavailable testosterone are true determinants of the MetS in men.

Sexual Desire Inventory: Two or Three Dimensions?

The Sexual Desire Inventory (SDI), developed by Spector, Carey, and Steinberg in 1996, has been widely used to assess sexual desire in men and women throughout the world. This questionnaire categorizes sexual desire in two dimensions: dyadic sexual desire and solitary sexual desire. Our study addressed the factorial structure of the SDI, an aspect that until now has been largely neglected. We recruited two samples of Spanish men and women involved in stable heterosexual relationships. The first sample consisted of 3,417 subjects (1,600 males and 1,817 females), ages 18 to 84; the second sample consisted of 677 subjects (285 males and 392 females), ages 18 to 50. The results of an exploratory factor analysis (EFA) showed that instead of two dimensions the SDI should have three: (1) partner-focused dyadic sexual desire, (2) general dyadic sexual desire for an attractive person, and (3) solitary sexual desire. A confirmatory factor analysis (CFA) supported the robustness of this new three-factor structure. No gender differences were revealed, except for dyadic sexual desire for an attractive person, for which men reported higher scores. Good validity and reliability values were obtained. Moreover, standard scores for men and women by different age groups were developed.

The burden of HIV infection among women attending antenatal clinic in a semi-urban Nigerian town.

Stable heterosexual relationships are a major determinant of the HIV epidemic and seroprevalence rate of HIV amongst antenatal women is a reflection of what is happening in the larger society. This study aims to determine the HIV seroprevalence rate and to identify factors responsible for this rate among pregnant women. The study was a three-year (July 2008-June 2011) cross-sectional evaluation of cases of HIV in pregnancy. Data were collected with the aid of a closed structured self-administered questionnaire for all the positive women and randomly selected negative cases. The study was carried out at Niger Delta University Teaching Hospital in Bayelsa State, Nigeria. The seroprevalence rate during the study period was 4.9%. Parity, age at first coitus, educational status, marital status and occupation do not seem to increase the risk. However, partner being unemployed, hospital/clinic delivery, the route of last delivery, previous induced abortion and the number of lifetime partners were identified as risk for HIV seropositivity (all p-values < 0.005). Sex education on the dangers of sexual promiscuity, availability of barrier methods of contraception, delivery with strict adherence to the principles of universal precaution and routine screening of all pregnant women during the antenatal period will help to decrease the prevalence of HIV in our environment.