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Marchon RG, Gregório BM, Costa WS, Pereira-Sampaio MA, Sampaio FJ, De Souza DB. Effects of comfort food diet on the penile morphology of stressed rats. Heliyon 2023; 9:e17013. [PMID: 37484244 PMCID: PMC10361093 DOI: 10.1016/j.heliyon.2023.e17013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/29/2023] [Accepted: 06/04/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose To investigate the effects of chronic stress, associated or not with comfort food, on the morphology of the penis. Materials & methods Thirty-two adult Wistar rats were divided into four experimental groups: Control group (C), receiving standard rat chow, and under normal conditions; Stressed group (S), receiving standard chow, and submitted to stressful situations; Control + comfort food group (C + CF), receiving standard chow and comfort food, and under normal conditions; and Stressed + comfort food group (S + CF), receiving standard chow and comfort food, and submitted to stressful situations. At 10 weeks of age, food supply and stress were initiated. All groups had ad libitum access to standard chow and water, and groups receiving comfort food also had access to Froot Loops®. Chronic stress was induced by restriction, animals were contained daily in polypropylene tubes for 2 h, for eight weeks. After eight weeks all animals were killed; penises were removed for histomorphometric analysis. Results Body mass was similar among the groups. Food intake in S + CF group was lower than in other groups. Concerning food preference, groups C + CF and S + CF preferred comfort food over the standard chow, with this preference being higher in S + CF than in C + CF. The area of the corpora cavernosa without tunica albuginea was lower in group S + CF than in group C. Most interestingly, the surface density of connective tissue in the corpora cavernosa was higher in groups S and S + CF compared to group C. In contrast, smooth muscle surface density was markedly lower in S + CF compared to groups C and C + CF, while group S also had reduced smooth muscle in comparison to group C. Conclusion Chronic stress caused a morphological alteration on penile histomorphometry. Also, stress increased the preference for comfort foods which caused more deleterious effects in some parameters.
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Affiliation(s)
- Roger G. Marchon
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Bianca M. Gregório
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Waldemar S. Costa
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marco Aurélio Pereira-Sampaio
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Morphology, Federal Fluminense University, Niterói, RJ, Brazil
| | - Francisco J. Sampaio
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diogo B. De Souza
- Urogenital Research Unit, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Yıldırım Ç, Salman MY, Yavuz A, Bayar G. Comparison of three different tadalafil regimens for erectile dysfunction treatment in patients with diabetes mellitus microvascular complications. Andrologia 2022; 54:e14536. [DOI: 10.1111/and.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/22/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Mehmet Yılmaz Salman
- Urology Department Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital Istanbul Turkey
| | | | - Göksel Bayar
- Urology Department Gelisim Private Hospital İskenderun Turkey
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Kohut AO, Chaban OS, Dolynskyi RG, Sandal OS, Bursa AI, Bobryk MI, Vertel AV. THE FEATURES OF POSTTRAUMATIC STRESS DISORDER DEVELOPMENT IN PATIENTS WITH DIABETES MELLITUS 2 TYPE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1903-1907. [PMID: 36089877 DOI: 10.36740/wlek202208115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: The revealing of the development of stress-related disorders in patients with type 2 diabetes mellitus (DM 2) to: identify the prevalence of stress-related disorders, particularly, posttraumatic stress disorder (PTSD); study the influence of psychosocial factors on the occurrence and course of stress-related disorders and increase the effectiveness of treatment in DM 2. PATIENTS AND METHODS Materials and methods: Research papers have been found by searching the PubMed database using the keywords ``ptsd and diabetes 2 type" with the result of 74 studies. Totally 25 of selected publications were analysed based on our criteria about the mechanisms through which the influence of psychosocial factors, permanent stressful or traumatic events on the probable risk of PTSD development and their analysis and relationships for the improvement of treatment effectiveness in DM 2 patients who have not been the veterans. CONCLUSION Conclusions: Given the complex neurophysiological relationships between the long-term stress and pathophysiological mechanisms of DM 2 - this group of patients has the higher risk of developing stress-related disorders, including PTSD.
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Affiliation(s)
- Anna O Kohut
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | - Oleg S Chaban
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
| | | | - Olha S Sandal
- KOSTIUK INSTITUTE OF PSYCHOLOGY OF NATIONAL ACADEMY OF EDUCATIONAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | | | | | - Anton V Vertel
- SUMY STATE PEDAGOGICAL UNIVERSITY NAMED AFTER A.S. MAKARENKO, SUMY, UKRAINE
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Sansone A, Mollaioli D, Ciocca G, Limoncin E, Colonnello E, Jannini EA. Sexual Dysfunction in Men and Women with Diabetes: A Reflection of their Complications? Curr Diabetes Rev 2022; 18:e030821192147. [PMID: 33687898 DOI: 10.2174/1573399817666210309104740] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality. OBJECTIVE The study aimed to investigate and report current evidence with regard to the association between sexual dysfunction and diabetes. METHODS A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to the study topic. RESULTS Female and male sexual dysfunction often occurs in diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet they should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects in both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease, a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and exerting beneficial effects for cardiovascular health being reported for pro-erectile drugs. CONCLUSION Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessments are therefore needed to provide the best chances for adequate treatment.
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Affiliation(s)
- Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma,Italy
| | - Daniele Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma,Italy
| | - Giacomo Ciocca
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma,Italy
| | - Erika Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma,Italy
| | - Elena Colonnello
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma,Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma,Italy
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Amanda AR, Hidajah AC, Wahyuni CU. The Effect of Post-Traumatic Stress Disorder on Women After The Earthquake in Central Sulawesi. JURNAL BERKALA EPIDEMIOLOGI 2021. [DOI: 10.20473/jbe.v9i32021.303-309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is a psychological disorder caused by uncommon occurrences such as threats or catastrophic events. Women are particularly susceptible to developing PTSD, as they have a range of threat perceptions. Purpose: The aim of this study was to examine the effect of PTSD on women survivor of the earthquake in the Sigi Biromaru sub-district of Central Sulawesi. Methods: This was a descriptive study conducted using a cross-sectional design. The population for this study were housewives who have been displaced by the earthquake and are currently residing in temporary shelters (Huntara) in a village located in the Sigi Biromaru sub-district. The instrument used in this study was the PTSD measurement questionnaire sheet. It was conducted from March to April 2020 and included a total of 115 participants. Univariate analysis was used to determine the respondents’ characteristics, including their age, education, occupation, income, and a description of the PTSD condition. Results: The results show that the majority of respondents experienced severe PTSD (70.43%). Most of the respondents (35.65%) were between the ages of 37 and 46, were senior high school graduates (40%), were unemployed (74%), and had earnings of < 2,500,000 (85.22%). Three variables that affect PTSD are education with a p-value of 0.03 < 0.05, job/occupation with a p-value of 0.02 < 0.05, and income with a p-value of 0.03 < 0.05. Conclusion: Women who are elderly, have a low level of education, are unemployed, and have low income are more vulnerable to experiencing PTSD.
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Kopilaš V, Hasratian AM, Martinelli L, Ivkić G, Brajković L, Gajović S. Self-Perceived Mental Health Status, Digital Activity, and Physical Distancing in the Context of Lockdown Versus Not-in-Lockdown Measures in Italy and Croatia: Cross-Sectional Study in the Early Ascending Phase of the COVID-19 Pandemic in March 2020. Front Psychol 2021; 12:621633. [PMID: 33613398 PMCID: PMC7890192 DOI: 10.3389/fpsyg.2021.621633] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
The novelty of the coronavirus disease 2019 (COVID-19) pandemic is that it is occurring in a globalized society enhanced by digital capabilities. Our aim was to analyze the psychological and emotional states of participants in different pandemic-related contexts, with a focus on their digital and physical distancing behaviors. The online survey was applied during the ascending phase of the pandemic in March 2020 in two neighboring EU countries: Italy and Croatia. The study subjects involved four groups, two directly affected by epidemiological measures and two serving as controls—(1) participants from Italy who were in lockdown (Italy group), (2) participants from Croatia who were not in lockdown but who were in direct contact with an infected person and underwent epidemiological measures (CRO-contact group), (3) participants from Croatia who were in an analogous situation but not near the same infected person (CRO-no contact group), and (4) participants from Croatia who were not aware of any infected person (CRO-unrelated group). The survey consisted of validated scales of psychological and emotional states, and custom-made questionnaires on the digital (online) and physical (off-line) behavior of the participants. The Italy group in lockdown had higher self-perceived scores for depression, stress, post-traumatic intrusion, and avoidance, as well as the highest digital activity and physical distancing than the not-in-lockdown Croatian groups. The insight into the extent of online activities and off-line isolation allowed for the introduction of Digital Activity and Physical Distancing Scores. Self-perceived post-traumatic avoidance was higher in both the Italy and CRO-contact groups than the control CRO-no contact and CRO-unrelated groups, and higher avoidance correlated with higher Digital Activity and Physical Distancing Scores. Being in direct contact with the infected person, the CRO-contact group had no other alterations than unexpectedly lower post-traumatic hyperarousal when compared with the Italy group. The Italy group in lockdown demonstrated higher self-perceived psychological toll together with higher digital activity and physical distancing than Croatian groups not in lockdown, even when compared with the affected CRO-contact group. The study outcomes suggest that the general emergency measures influenced citizens in lockdown more than exposure to the virus through direct contact with an infected person.
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Affiliation(s)
- Vanja Kopilaš
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Croatian Studies, University of Zagreb, Zagreb, Croatia
| | - Anni M Hasratian
- Department of Psychology, Southern Methodist University, Dallas, TX, United States
| | | | - Goran Ivkić
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Srećko Gajović
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
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Sansone A, Mollaioli D, Ciocca G, Limoncin E, Colonnello E, Vena W, Jannini EA. Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. J Endocrinol Invest 2021; 44:223-231. [PMID: 32661947 PMCID: PMC7355084 DOI: 10.1007/s40618-020-01350-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a "cytokine storm", which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients. METHODS A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed. RESULTS Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED. CONCLUSION COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.
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Affiliation(s)
- A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - D Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - G Ciocca
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - E Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - E Colonnello
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - W Vena
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
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Li N, Song M, Wang L, Zhao XC, Wang R, Gao YY, Yu LL, An CX, Wang XY. Experiencing earthquake in the first trimester of the fetal life increases subsequent diabetes risk in the adulthood: a cross-sectional study. Reprod Biol Endocrinol 2020; 18:109. [PMID: 33167992 PMCID: PMC7654152 DOI: 10.1186/s12958-020-00664-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the long-term effect of prenatal exposure to earthquake stress on diabetes risk in the adulthood. METHODS This study included employees of Tangshan Kailuan Mining Group between July 29, 1976 and April 28, 1977. The exposure group included subjects who experienced the Tangshan Earthquake during their prenatal period and who had lived in Tangshan since birth. The non-exposure group included subjects who were born 1-1.9 years after the earthquake and who had lived in Tangshan since birth. A questionnaire was designed that included sociodemographic information, conditions during pregnancy, and earthquake experience. Anthropometric measurements including height and weight, body mass index (BMI), waist circumference were made. Fasting plasma glucose (FPG) and lipid profiles were also determined. RESULTS Totally 947 subjects were included with 397 subjects in the exposed group and 550 subjects in the non-exposed group. The diabetes rate is significant different in these four groups(χ2 =8.045, P = 0.045). Moreover, 11.8, 7.5 and 8.0% of the subjects who were exposed to earthquake in the 1st, 2nd, and 3rd trimester of pregnancy had diabetes. 5.1% of the subjects had diabetes in non-exposure group. Our multivariate analysis showed that 1st trimester (OR 2.481, 95%CI 1.02, 6.034; P = 0.045) and loss of family members during earthquake (OR 2.452, 95%CI 1.293, 4.653; P = 0.006) were associated with significantly increased risk of diabetes. CONCLUSIONS Exposure to earthquake during the first trimester of pregnancy and experience of family member loss in the earthquake significantly increased the subsequent risk of diabetes in the middle age (36-39 years of age). Our data suggest that earthquake experience in the early pregnancy has a longer-term effect on diabetes risk during adulthood.
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Affiliation(s)
- Na Li
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Mei Song
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Lan Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Xiao-Chuan Zhao
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Ran Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Yuan-Yuan Gao
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Lu-Lu Yu
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China
| | - Cui-Xia An
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China.
| | - Xue-Yi Wang
- Department of Psychiatry, the First Hospital of Hebei Medical University, Mental Health Institute of the Hebei Medical University, No.89 Donggang Road, Yuhua District, Shijiazhuang, 050031, Hebei, China.
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Ciocca G, Rossi R, Collazzoni A, Gorea F, Vallaj B, Stratta P, Longo L, Limoncin E, Mollaioli D, Gibertoni D, Santarnecchi E, Pacitti F, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis. J Affect Disord 2020; 273:384-390. [PMID: 32560933 DOI: 10.1016/j.jad.2020.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/21/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation. METHODS One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome. RESULTS Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress. CONCLUSIONS The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Fiorela Gorea
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Blerina Vallaj
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Paolo Stratta
- Department of Mental Health, ASL 01 Avezzano-Sulmona-L'Aquila, Italy
| | - Lucia Longo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Daniele Mollaioli
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Dino Gibertoni
- DIBINEM Department of Biomedical And Neuromotor Sciences, Unit of Hygiene, Public Health And Biostatistics, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emiliano Santarnecchi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy; Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
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Mollaioli D, Ciocca G, Limoncin E, Di Sante S, Gravina GL, Carosa E, Lenzi A, Jannini EAF. Lifestyles and sexuality in men and women: the gender perspective in sexual medicine. Reprod Biol Endocrinol 2020; 18:10. [PMID: 32066450 PMCID: PMC7025405 DOI: 10.1186/s12958-019-0557-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/17/2018] [Indexed: 01/13/2023] Open
Abstract
Sexual health is strictly related with general health in both genders. In presence of a sexual dysfunction, the expert in sexual medicine aims to discover the specific weight of the physical and psychological factors can cause or con-cause the sexual problem. At the same time, a sexual dysfunction can represent a marker of the future development of a Non-communicable diseases (NCDss) as cardiovascular or metabolic diseases.In the evaluation phase, the sexual health specialist must focus on these aspects, focusing especially on the risk and protective factors that could impact on both male and female sexuality.This article presents a review of researches concerning healthy and unhealthy lifestyles and their contribute in the development of sexual quality of life in a gender-dependent manner.Among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. Tobacco smoking, alcohol - substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapies.
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Affiliation(s)
- Daniele Mollaioli
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Giacomo Ciocca
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Erika Limoncin
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Stefania Di Sante
- grid.7841.aDepartment of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, Rome, 00161 Italy
| | - Giovanni Luca Gravina
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), L’Aquila, 67100 Italy
| | - Eleonora Carosa
- grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio (Coppito 2), L’Aquila, 67100 Italy
| | - Andrea Lenzi
- grid.7841.aDepartment of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, Rome, 00161 Italy
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Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease. Sex Med 2019; 7:217-226. [PMID: 30954495 PMCID: PMC6523036 DOI: 10.1016/j.esxm.2019.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/12/2019] [Accepted: 03/03/2019] [Indexed: 01/21/2023] Open
Abstract
Introduction More sexual problems are reported among people treated for diabetes; however, this situation is less explored in women than in men. Aim To analyze the presence and causal links of female sexual dysfunction (FSD) among Czech women treated for type 1 diabetes. Methods 40 women completed a national version of the Female Sexual Function Index (FSFI), Female Sexual Distress Scale-revised (FSDS-R), and Beck’s Depression Inventory–II (BDI-II). A metabolic and endocrine analysis was done using blood samples. Data were statistically analyzed using SPSS v.24 and the R environment. Main Outcome Measures Patient details (personal information, diabetes-related data, and sex history), sexual performance (the FSFI and FSDS-R scores), and level of depression (the BDI-II score) were measured. Results FSD was present in 58% of the participants (based on the FSFI score), and 38% women declared significant sexual distress (according to their FSDS-R score). Even though only 4 women fulfilled the criteria for depression, we observed a strong association between BDI-II and FSFI (for total FSFI score P = .012, ρ = −0.394) resp. FSDS-R scores (P < .001, ρ = 0.552). Although we were not able to establish a clear direct connection between FSD and metabolic control, BDI-II scores were closely correlated with glycosylated hemoglobin (P = .009, ρ = 0.407). The duration of diabetes (based on FSDS-R: P = .046) but neither age nor the presence of chronic diabetic microvascular complications was associated with a higher FSD occurrence. We also observed an association between FSD and the presence of autoimmune hypothyroidism, even when successfully treated (FSDS-R: P = .009; FSFI: P = .067). Conclusion FSD is more common in women with type 1 diabetes than in healthy women, and coexisting thyroid autoimmune disease seems to exacerbate FSD. Women suffering from type 1 diabetes, and particularly those with additional endocrinopathies, should be actively screened for FSD. Stechova K, Mastikova L, Urbaniec K, et al. Sexual Dysfunction in Women Treated for Type 1 Diabetes and the Impact of Coexisting Thyroid Disease. Sex Med 2019;7:217–226.
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Low dose daily versus on-demand high dose tadalafil in diabetic patients with erectile and ejaculatory dysfunction. Int J Impot Res 2018; 30:102-107. [PMID: 29795527 DOI: 10.1038/s41443-018-0019-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/20/2017] [Accepted: 12/24/2017] [Indexed: 02/07/2023]
Abstract
The aim was to compare the differences between daily 5 mg and on-demand 20 mg tadalafil use in diabetic patients with erectile dysfunction (ED), and the effects of two different tadalafil protocols on ejaculatory and lower urinary tract symptoms (LUTS). Of the 63 diabetic patients with ED, 31 were given 5 mg tadalafil once a day, and 32 were given 20 mg tadalafil on-demand four times a month over three months. Erectile function, erectile hardness, ejaculatory function, and LUTS were assessed at pretreatment, first- and third-month controls. Both tadalafil protocols increased International Index of Erectile Function (IIEF) scores in all patients under 65 years, whereas patients older than 65 years did not benefit. Ejaculatory function, the quality of the hardness of an erection, and LUTS improved in both groups in the study. Tadalafil improved sexual function with acceptable side effects in diabetic men with ED. Both protocols equally improved LUTS and the quality of the erection. Daily use of 5 mg of tadalafil significantly improved the quality of ejaculation and LUTS more than the on-demand use of 20 mg of tadalafil. It may be beneficial to give 5 mg tadalafil daily to patients over 65 years old who do not benefit from treatment with 20 mg of tadalafil or in patients who have LUTS over 65 years old.
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Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018; 6:508-524. [PMID: 29730315 DOI: 10.1016/j.sxmr.2018.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Erectile dysfunction is recognized as an opportunity for preventing cardiovascular (CV) events, and assessing the impairment of penile vascular flow by Doppler ultrasound is an important tool to ascertain CV risk. Conversely, the role of genital vascular impairment in the pathophysiology of female sexual dysfunction (FSD) remains contentious. AIM To focus on the current scientific support for an association between CV risk factors and female sexual health in the 1st part of a 2-part review. METHODS A thorough literature search of peer-reviewed publications on the associations between CV risk factors and FSD and their underlying mechanisms was performed using the PubMed database. MAIN OUTCOME MEASURES We present a summary of the evidence from clinical studies and discuss the possible mechanisms providing the pathophysiologic bases of vasculogenic FSD syndromes. RESULTS The peripheral sexual response in women is a vascular-dependent event, and evidence suggests that cardiometabolic-related perturbations in endothelial function can determine vascular insufficiency in female genital tissues. Although epidemiologic and observational studies demonstrate that the prevalence of FSD is higher in women with diabetes mellitus, a cause-effect relation between these clinical conditions cannot be assumed. Evidence on the effect of obesity, metabolic syndrome, and polycystic ovary syndrome on sexual function in women is controversial. Data on the associations of dyslipidemia and hypertension with FSD are limited. CONCLUSION Common cardiometabolic alterations could affect vascular function in the female genital tract. Based on limited data, there is an association between CV risk factors and female sexual health in women; however, this association appears milder than in men. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev 2018;6:508-524.
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Maiorino MI, Bellastella G, Castaldo F, Petrizzo M, Giugliano D, Esposito K. Sexual function in young women with type 1 diabetes: the METRO study. J Endocrinol Invest 2017; 40:169-177. [PMID: 27613610 DOI: 10.1007/s40618-016-0542-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/30/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to evaluate the prevalence and risk factors associated with female sexual dysfunction (FSD) in young women with type 1 diabetes treated with different intensive insulin regimens. METHODS Type 1 diabetic women aged 18-35 years were included in this study if they had stable couple relationship and no oral contraceptive use. All women were asked to complete the Female Sexual Function Index (FSFI) and other validated multiple-choice questionnaires assessing sexual-related distress (Female Sexual Distress Scale, FSDS), quality of life (SF-36 Health Survey), physical activity (International Physical Activity Questionnaire), depressive symptoms (Zung Self-Rating Depression Scale, SRDS) and diabetes-related problems (Diabetes Integration Scale ATT-19). FSD was diagnosed according to a FSFI score higher than 26.55 and a FSDS score lower than 15. RESULTS The overall prevalence of FSD in diabetic and control women was 20 and 15 %, respectively (P = 0.446). Compared with the continuous subcutaneous insulin infusion group and control women, diabetic women on multiple daily injections (MDI) had lower global FSFI score (P = 0.007), FSDS score (P = 0.045) and domains such as arousal (P = 0.006), lubrication and satisfaction scores (P < 0.001 for both). In the multiple regression analysis, only the mental component summary (P = 0.047) and the SRDS score (P = 0.042) were independent predictors of FSFI score in the overall diabetic women. CONCLUSION Young women with type 1 diabetes wearing an insulin pump show a prevalence of sexual dysfunction similar to that of healthy age-matched women, but sexual function was significantly impaired in diabetic women on MDI therapy. Depression and the mental health status were independent predictors for FSD in diabetic women.
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Affiliation(s)
- M I Maiorino
- Diabetes Unit, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy.
| | - G Bellastella
- Diabetes Unit, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy
| | - F Castaldo
- Diabetes Unit, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy
| | - M Petrizzo
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy
| | - D Giugliano
- Diabetes Unit, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy
| | - K Esposito
- Diabetes Unit, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy
- Diabetes Unit, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Second University of Naples, Piazza L. Miraglia no 2, 80138, Naples, Italy
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Maseroli E, Fanni E, Cipriani S, Scavello I, Pampaloni F, Battaglia C, Fambrini M, Mannucci E, Jannini EA, Maggi M, Vignozzi L. Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance. J Sex Med 2016; 13:1651-1661. [PMID: 27692844 DOI: 10.1016/j.jsxm.2016.09.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. AIM To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. METHODS Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. MAIN OUTCOME MEASURES Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). RESULTS Clitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = -0.321, P = .014) and satisfaction (β = -0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). CONCLUSION Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.
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Affiliation(s)
- Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Egidia Fanni
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Irene Scavello
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Pampaloni
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cesare Battaglia
- Department of Gynecology and Pathophysiology of Human Reproduction, University of Bologna, Bologna, Italy
| | - Massimiliano Fambrini
- Gynecology and Obstetrics Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Edoardo Mannucci
- Diabetes Section Geriatric Unit, Department of Critical Care, University of Florence, Florence, Italy
| | | | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Istituto Nazionale Biostrutture e Biosistemi, Rome, Italy.
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Lee DC, Gupta VK, Carr BG, Malik S, Ferguson B, Wall SP, Smith SW, Goldfrank LR. Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy. BMJ Open Diabetes Res Care 2016; 4:e000248. [PMID: 27547418 PMCID: PMC4964212 DOI: 10.1136/bmjdrc-2016-000248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/13/2016] [Accepted: 07/01/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. RESULTS In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Vibha K Gupta
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brendan G Carr
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Health & Human Services, Emergency Care Coordination Center, Office of the Assistant Secretary for Preparedness & Response, Washington, DC, USA
| | - Sidrah Malik
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brandy Ferguson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Lewis R Goldfrank
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
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Ciocca G, Tuziak B, Limoncin E, Mollaioli D, Capuano N, Martini A, Carosa E, Fisher AD, Maggi M, Niolu C, Siracusano A, Lenzi A, Jannini EA. Psychoticism, Immature Defense Mechanisms and a Fearful Attachment Style are Associated with a Higher Homophobic Attitude. J Sex Med 2015; 12:1953-60. [DOI: 10.1111/jsm.12975] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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