Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015

The relationship between female sexual function index domains and premature ejaculation

PURPOSE

The aim of this prospective, observational study was to investigate the relationship between premature ejaculation (PE) and female sexual response cycle, using the female sexual function index (FSFI). The FSFI evaluates female sexual function in six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

METHODS

All men were considered to have PE if they fulfilled the criteria of the second Ad Hoc International Society for Sexual Medicine (ISSM) Committee. All men were also assessed by the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculatory latency time (IELT) using stopwatch which was held by the partner. All women completed the FSFI.

RESULTS

A total of 181 couples who had regular sexual intercourse with one partner for the past 6 months were enrolled the study. By the definition of ISSM Committee, there were 117 men with PE and 64 men without PE. Partners of men with PE had significantly lower total FSFI scores than did partners of men without PE (21.8 ± 3.5 for PE and 26.4 ± 3.1 for non-PE, p < 0.001). Moreover, all the domains of the FSFI scoring system were separately associated with PE. According to the mean FSFI scores, the 48.43% of women had sexual dysfunction in the non-PE group, and all women had sexual dysfunction in PE group.

CONCLUSION

PE is associated with female sexual dysfunction and all of the female sexual dysfunction domains, as determined by FSFI scores.

Premenstrual Syndrome Is Associated With a Higher Frequency of Female Sexual Difficulty and Sexual Distress

Few prospective studies have evaluated the impact of premenstrual symptoms (PMS) on female sexual function and sexuality-related distress. The purpose of the present study was therefore to find out risk factors of PMS for  female sexual function and sexuality-related personal distress. This prospective cohort study was conducted at the Süleymaniye Women and Children's Health Training and Research Hospital in Istanbul, Turkey, between February 2014 and March 2016. The study group consisted of women admitted to the general gynecology outpatient clinic aged 18 to 40 years who met the inclusion criteria. The American College of Obstetricians and Gynecologists criteria were used for the initial diagnosis of PMS and the participants were allocated to PMS(+) and PMS(-) groups (healthy subjects). All participants completed the Beck Depression Inventory to exclude those at risk for depression. The patients with an initial diagnosis of PMS then completed the PMS Daily Record of Severity of Problems form prospectively for two consecutive menstrual cycles to confirm PMS diagnosis. Lastly, both sexual function and sexual distress of eligible PMS(+) (n = 143) and PMS(-) (n = 143) participants were assessed with both the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R). According to the FSFI cutoff value, 77.6% of patients in the PMS(+) group and 27.3% of patients in the PMS(-) group had sexual concerns (p < 0.05). The sexuality-related personal distress rate was 51.7% in the PMS(+) group and 24.5% in the PMS(-) group (p < 0.05). Overall, 51.7% of the PMS(+) and 24.5% of the PMS(-) group were recognized as having sexual difficulties based on the presence of sexual distress and the low FSFI scores (p < 0.05). We concluded that women with PMS are likely to have sexual difficulties and a higher level of sexual distress, emphasizing the importance of the sexual aspects of PMS in clinical practice.

Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review

BACKGROUND

Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-adherence is often related to severity of AEs. Frequently, patients do not spontaneously report, and clinicians do not specifically query, critical AEs that lead to non-adherence, including sexual dysfunction. Sexual dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced sexual dysfunction leading to periodic non-adherence.

AIMS

To report lamotrigine-induced sexual dysfunction leading to periodic lamotrigine non-adherence in the context of multiple comorbidities and concurrent antidepressant and antihypertensive pharmacotherapy.

METHOD

Case analysis with PubMed literature review.

RESULTS

A 56-year-old male patient with major depression, panic disorder without agoraphobia and post-traumatic stress disorder was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux disease and hydrocephalus with patent ventriculoperitoneal shunt that were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual functioning, he developed auras. Family confirmed patient's consistent monthly non-adherence for 2-3 days during the past year.

CONCLUSIONS

Sexual dysfunction is a key AE leading to AED non-adherence. This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure adherence.

DECLARATION OF INTEREST

No financial interests. K.R.K. is Editor of BJPsych Open; he took no part in the peer-review of this work.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Sexual dysfunction among diabetics and its impact on the SQoL of their partners

Sexual dysfunction (SD) has long been known to affect a significant number of people worldwide with serious implications and limitations on sexual expression and fulfillment. This may affect the sexual quality of life (SQoL) of individuals and their partners. A cross-sectional study was conducted among diabetic patients and their partners who visited the Tema General Hospital. A total of 130 and 116 diabetic males and females and their partners were interviewed. Male and female diabetic participants and partners were evaluated using the Golombuk Rust Inventory for Sexual Satisfaction-Male (GRISS-M)/SQoL-M and GRISS-Female/SQoL-F, respectively. For the diabetic males, the mean age and duration of diabetes (DOD) was 63.04±10.85 and 8.38±6.53 years, respectively, and that of the diabetic females was 56.98±9.42 and 6.11±5.31 years, respectively. Diabetic male participants with SD were significantly older and had a longer duration of diabetes. The mean SQoL and SQoL-Partner (SQoL-P) recorded for the diabetic males and their partners was 42.29±30.88 and 52.86±15.26, respectively. The mean SQoL and SQoL-P recorded for the diabetic females and their partners was 57.73±14.91 and 64.97±19.68, respectively. Diabetic males who had impotence had female partners with significantly lower SQoL-P scores, and similar results were recorded for those who had premature ejaculation, nonsensuality, avoidance and dissatisfaction problems. Female diabetics who had nonsensuality, avoidance and infrequency had male partners who recorded significantly lower SQoL-P scores. Female diabetics with higher perceptions of what an adequate intravaginal ejaculatory latency time (IELT) should be had male partners with significantly lower SQoL-P scores. Ageing and DOD are more likely to affect the sexual functioning of diabetic males than females. SD in diabetics with problems of impotence/vaginismus, premature ejaculation/anorgasmia, nonsensuality and avoidance has an adverse effect on the SQoL-P of their partners. Male partners of diabetic females who have a higher perception of IELT had a reduced SQoL. Ageing and longer DOD in diabetics are associated with a reduced SQoL-P of their partners.

CO2-laser for the genitourinary syndrome of menopause. How many laser sessions?

OBJECTIVES

The aim of this prospective study was to assess the efficacy of 3, 4 or 5 CO₂-laser sessions for the management of the genitourinary syndrome of menopause (GSM).

METHODS

Postmenopausal women with moderate to severe symptoms of dyspareunia, wanting to resume/retain sexual activity, were treated with 3-5 laser sessions depending on symptom severity/presence, sexual function, clinical findings and women's preference following the third laser application.

MAIN OUTCOMES

Severity of dyspareunia, dryness, sexual function, sexual satisfaction and frequency of sexual intercourse defined the primary outcomes. Vaginal Maturation Value (VMV) and Vaginal Health Index Score (VHIS) defined the secondary ones.

RESULTS

Fifty-five women received three sessions, 53 an extra fourth and 22 an extra fifth. Following the third, fourth and fifth laser sessions, respectively: dyspareunia completely regressed in 15/55 (27%), 32/55 (58%) and 38/47 (81%) of participants; dryness completely regressed in 20/55 (36%), 36/55 (66%) and 44/51 (86%); normal sexual function resumed in 23/55 (41%), 37/54 (69%) and 41/49 (84%); VMV regained non-atrophic values in 29/55 (53%), 38/55 (69%) and 42/50 (84%); and VHIS regained non-atrophic values in 44/55 (80%), 53/55 (96%) and 55/55 (100%) of participants.

CONCLUSION

Results of this study indicate that CO₂-laser therapy may contribute to complete regression of dyspareunia and dryness and reestablishment of normal sexual function in postmenopausal women, in a dose-response manner. An extra fourth or fifth session may further increase the GSM symptom-free rate.

Sexual Assault Severity and Depressive Symptoms as Longitudinal Predictors of the Quality of Women's Sexual Experiences

Depressive symptoms are one consequence of adult/adolescent sexual victimization (ASV) and are linked to sexual health. Female nonproblem drinkers (N = 419) with an ASV history participated in a one-year longitudinal study. Participants completed measures of lifetime ASV severity and four quarterly assessments of depressive symptoms, ASV severity, and sexual experience quality. Multilevel models revealed that depressive symptoms interacted with ASV severity: Women with low-lifetime ASV severity reported higher ratings of sexual pain as depressive symptoms increased. ASV reported during assessment months predicted sexual experience quality. Interventions to improve survivors' sexual experiences should consider incorporating treatment for depressive symptoms.

Sexual functioning and experiences in young people affected by mental health disorders

The majority of mental disorders have their onset in late adolescence and early adulthood and this coincides with important stages of sexual development. Although sexual dysfunction is highly prevalent among people with mental health disorders, little is known about this topic among youth. This study aimed to evaluate the sexual functioning and subjective experience of sex in young people aged between 15 and 26 years attending a youth mental health service. One hundred and three participants were assessed with the Sexual Health Questionnaire, Sexual Functioning Questionnaire, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Medication Adherence Rating Scale. There were 43 males, 52 females, and 8 transgender and gender diverse participants with a range of mental health disorders. Eighty (77.7%) had experienced consensual sexual intercourse. Ninety-nine (95.8%) endorsed at least one item of sexual dysfunction and clinical sexual dysfunction was present in 37 (38.9%) cases. Sexual dysfunction was associated with greater severity of general psychopathology, negative symptoms, antipsychotic use, lower antipsychotic medication adherence, and negative subjective experiences around sex. Addressing this sexual dysfunction in young people could lead to both an improvement in subjective experiences of sexual relationships and potentially improvement in adherence to treatment.

The prevalence and correlates of low sexual functioning in women on hemodialysis: A multinational, cross-sectional study

Sexual dysfunction may affect 80% of women in hemodialysis. However the specific patterns and clinical correlates of sexual functioning remain poorly described. The aim of this study was to assess prevalence and correlates of the individual domains of sexual functioning in women treated with hemodialysis. We recruited, into this multinational cross-sectional study, women treated with long-term hemodialysis (Collaborative Working Group on Depression and Sexual dysfunction in Hemodialysis study). Self-reported domains of sexual functioning were assessed by the Female Sexual Function Index, which is routinely administered within the network of dialysis patients followed by the working group. Lower scores represented lower sexual functioning. Socio-demographic and clinical correlates of each domain of sexual functioning were identified by stepwise multivariable linear regression. Sensitivity analyses were restricted to women who reported being sexually active. We found that of 1309 enrolled women, 659 (50.3%) provided complete responses to FSFI survey questions and 232 (35%) reported being sexually active. Overall, most respondents reported either no sexual activity or low sexual functioning in all measured domains (orgasm 75.1%; arousal 64.0%; lubrication 63.3%; pain 60.7%; satisfaction 60.1%; sexual desire 58.0%). Respondents who were waitlisted for a kidney transplant reported scores with higher sexual functioning, while older respondents reported scores with lower functioning. The presence of depression was associated with worse lubrication and pain scores [mean difference for depressed versus non-depressed women (95% CI) -0.42 (-0.73 to -0.11), -0.53 (-0.89 to -0.16), respectively] while women who had experienced a previous cardiovascular event reported higher pain scores [-0.77 (-1.40- to -0.13)]. In conclusion, women in hemodialysis reported scores consistent with marked low sexual functioning across a range of domains; the low functioning appeared to be associated with comorbidity.

Drugs in preclinical to phase II clinical development for the treatment of erectile dysfunction

INTRODUCTION

Erectile function is an important aspect in the quality of life of many men. For men with erectile dysfunction (ED), a spectrum of treatment options exists. Novel therapies for ED are currently being developed in order to delay surgical placement of a penile prosthesis - the final step in the management of treatment-refractory ED. Areas covered: This review examines innovative treatments such as alternative vasoactive agents, trophic factors and bio-compounds as well as gene and stem cell therapy. All therapies are currently in some phase of development for the management of ED. Using the MedLine and FDA Clinical Trials Registry, recent developments in treatment of ED were queried. Expert opinion: Recent studies have demonstrated the potential for multiple, novel therapies in the treatment of ED. Much of the work requires further experimentation in large-scale, blinded, placebo-controlled studies. This will require a concerted effort to bring these products to market.

Analysis of the prevalence and associated factors of overactive bladder in adult Korean men

Overactive bladder (OAB) is a prevalent condition characterized by lower urinary tract symptoms (LUTS). Age, education, income, marital status, sleep, and emotional problems have been associated with OAB; however, conflicting results exist. The present study was conducted to estimate the prevalence of OAB and comprehensively analyze its associated factors in a large cross-sectional, population-based study. The data of 94,554 participants aged 19-107 were analyzed from the Korean Community Health Survey (KCHS) of 2012. Data on marital status, physical activity, education level, occupation, body mass index (BMI), income level, sleep time, and stress level were retrieved for all enrolled participants. The overactive bladder symptom score (OABSS) was used to evaluate the presence and degree of OAB. Simple and multiple logistic regression analyses with complex sampling were used for the associations between various factors and the presence of OAB. Overall, OAB was present in approximately 2.9% of the participants. The prevalence of OAB increased with age and steeply increased after 60 years of age (adjusted odds ratio [AOR] for each 10 years = 1.70, 95% confidence interval [CI] = 1.61-1.80, P<0.001). The prevalence of OAB was lower in married than unmarried subjects (AOR = 0.59, 95% CI = 0.48-0.72, P<0.001). The prevalence of OAB was significantly different according to occupation Compared to manager, expert, specialist, clerk group, the prevalence of OAB was highest in unemployed group (AOR = 1.90, 95% CI = 1.55-2.32, P < 0.001). Being underweight was correlated with OAB (AOR = 1.29, 95% CI = 1.08-1.55, P = 0.018). Inadequate sleep showed a significant association with OAB (AOR = 1.13, 95% CI = 1.02-1.25 for ≤6 hours of sleep time and AOR = 1.53, 95% CI = 1.27-1.86 for ≥9 hours of sleep, P<0.001). Stress level showed a dose-dependent positive association with OAB [AOR (95% CI) = 3.91 (3.13-4.89) > 2.16 (1.88-2.48) > 1.39 (1.23-1.57) for severe stress > moderate stress > some stress, respectively, P<0.001]. A medical history of diabetes mellitus, hyperlipidemia, and/or cerebral stroke was significantly related to OAB. Approximately 2.9% of adult Korean men experienced OAB based on the OABSS. Unmarried status; occupation; being underweight; inadequate sleep; stress; and medical history of diabetes mellitus, hyperlipidemia, or cerebral stroke were significantly correlated with OAB.

Central Haemodynamics and Prediction of Cardiovascular Events in Patients With Erectile Dysfunction

BACKGROUND

We investigated whether central hemodynamics predict major adverse cardiovascular events (MACEs) in erectile dysfunction (ED) patients beyond traditional risk factors.

METHODS

MACEs in relation to aortic pressures and augmentation index (AIx) were analyzed in 398 patients (mean age, 56 years) with ED but without established cardiovascular (CV) disease.

RESULTS

During the mean follow-up period of 6.5 years, a total of 29 (6.5%) MACEs occurred. The adjusted relative risk of MACEs was 1.062 (95% confidence interval (CI), 1.016-1.116) for a 10-mm Hg increase of aortic systolic pressure, 1.119 (95% CI, 1.036-1.155) for a 10-mm Hg increase of aortic pulse pressure (PP), and 1.191 (95% CI, 1.056-1.372) for a 10% absolute increase of AIx. While aortic pressures and AIx did not significantly improve the C-statistic models, the calibration for all indices was satisfactory. Regarding reclassification, the integrated discrimination improvement index (IDI) indicated improvement in risk discrimination of the models that included AIx and aortic PP compared to the reference model in identifying MACEs (IDI = 0.0069; P = 0.024, and IDI = 0.0060; P = 0.036, respectively). The based on categories for 10-year coronary heart disease risk and adapted at 6.5 years overall net reclassification index showed marginal and indicative risk reclassification for AIx (15.7%, P = 0.12) and aortic PP (7.2%, P = 0.20) respectively.

CONCLUSIONS

Our results show for the first time that higher central pressures and AIx are associated with increased risk for a MACE in ED patients without known CV disease. Considering the adverse prognostic role of central hemodynamics on outcomes, the present findings may explain part of the increased CV risk associated with ED.

Sexuality in menopausal women

PURPOSE OF REVIEW

Sexuality is an essential part of a healthy life. It can contribute significantly to the physical, psychological and social wellbeing of menopausal women, therefore, to their quality of life. This study is an overview of the most recent findings in the literature retrieved from searches of computerized databases. We extracted all notable information concerning definition, epidemiology, symptoms, diagnostic evaluation and management.

RECENT FINDINGS

The experience of sexuality in menopause is fundamentally shaped by the biological and psychological changes that occur on a substrate of modifications linked to the ageing process. Moreover, several additional factors, including effects of illness, medications and psychosocial stressors can contribute to sexual dysfunction. Patients should be educated about the causes of sexual dysfunction and available treatment.

SUMMARY

In recent years, the field of research in sexual dysfunctions has made great progress in many areas of investigation, from epidemiology to pathophysiology providing a better understanding of causes and promoting better care. However, the multifactorial nature of human sexuality still makes our ability to comprehensively treat sexual dysfunction quite difficult. An integrated approach is needed to recognize different aspects involved and to identify the proper intervention strategies for early prevention and promotion of a healthy sexuality in menopause.

Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations

In the World Health Organization's forthcoming eleventh revision of the International Classification of Diseases and Related Health Problems (ICD-11), substantial changes have been proposed to the ICD-10 classification of mental and behavioural disorders related to sexuality and gender identity. These concern the following ICD-10 disorder groupings: F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation. Changes have been proposed based on advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards. This paper describes the main recommended changes, the rationale and evidence considered, and important differences from the DSM-5. An integrated classification of sexual dysfunctions has been proposed for a new chapter on Conditions Related to Sexual Health, overcoming the mind/body separation that is inherent in ICD-10. Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health. The proposed classification of Paraphilic disorders distinguishes between conditions that are relevant to public health and clinical psychopathology and those that merely reflect private behaviour. ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11.

Female sexual dysfunction (FSD): Prevalence and impact on quality of life (QoL)

Female sexual dysfunction (FSD) and quality of life (QOL) are both multidimensional and have a bidirectional relationship across the reproductive life span and beyond. Methodological difficulties exist in estimating the real prevalence of FSD because it is hard to determine the level of distress associated with sexual symptoms in a large-scale survey. Approximately 40-50% of all women report at least one sexual symptom, and some conditions associated with hormonal changes at menopause, such as vulvovaginal atrophy (VVA) and hypoactive sexual desire disorder (HSDD), have a significant impact on sexual function and QOL. Sexual distress peaks at midlife, declines with age and is strongly partner-related. Many postmenopausal women are still sexually active, especially if they are in a stable partnership. Even though sexual functioning is impaired, a variety of psychosocial factors may maintain sexual satisfaction. That being so, health care providers (HCPs) should proactively address sexual symptoms at midlife and in older women, from a balanced perspective. Adequate counselling should be offered. Women with distressing symptoms may benefit from tailored hormonal and non-hormonal therapies, whereas women without distress related to their sexual experiences should not receive any specific treatment.

Sexual Satisfaction and the Importance of Sexual Health to Quality of Life Throughout the Life Course of U.S. Adults

INTRODUCTION

Discussions about sexual health are uncommon in clinical encounters, despite the sexual dysfunction associated with many common health conditions. Understanding of the importance of sexual health and sexual satisfaction in U.S. adults is limited.

AIM

To provide epidemiologic data on the importance of sexual health for quality of life and people's satisfaction with their sex lives and to examine how each is associated with demographic and health factors.

METHODS

Data are from a cross-sectional self-report questionnaire from a sample of 3,515 English-speaking U.S. adults recruited from an online panel that uses address-based probability sampling.

MAIN OUTCOME MEASURES

We report ratings of importance of sexual health to quality of life (single item with five-point response) and the Patient-Reported Outcomes Measurement Information System Satisfaction With Sex Life score (five items, each with five-point responses, scores centered on the U.S. mean).

RESULTS

High importance of sexual health to quality of life was reported by 62.2% of men (95% CI = 59.4-65.0) and 42.8% of women (95% CI = 39.6-46.1, P < .001). Importance of sexual health varied by sex, age, sexual activity status, and general self-rated health. For the 55% of men and 45% of women who reported sexual activity in the previous 30 days, satisfaction with sex life differed by sex, age, race-ethnicity (among men only), and health. Men and women in excellent health had significantly higher satisfaction than participants in fair or poor health. Women with hypertension reported significantly lower satisfaction (especially younger women), as did men with depression or anxiety (especially younger men).

CONCLUSION

In this large study of U.S. adults' ratings of the importance of sexual health and satisfaction with sex life, sexual health was a highly important aspect of quality of life for many participants, including participants in poor health. Moreover, participants in poorer health reported lower sexual satisfaction. Accordingly, sexual health should be a routine part of clinicians' assessments of their patients. Health care systems that state a commitment to improving patients' overall health must have resources in place to address sexual concerns. These resources should be available for all patients across the lifespan.