Attention-deficit hyperactivity disorder in patients with premature ejaculation: a pilot study

Distressing Problems with Sexual Function and Symptoms of Attention-Deficit/Hyperactivity Disorder

Cognitive models of sexual dysfunction situate distraction as a core mechanism underlying difficulties with sexual function. It follows that individuals who have difficulties with inattention and distractibility (e.g., attention-deficit/hyperactivity disorder; ADHD) may be at increased risk of problems with their sexual function, though previous research is mixed, and no research has examined links with sexual distress despite distress being a necessary criterion for sexual dysfunction. The goals of the current study were to: (1) examine associations between ADHD symptoms, sexual function, and sexual distress; (2) examine group differences in sexual function and sexual distress as a function of presumptive ADHD diagnosis; and (3) establish whether individuals with presumptive ADHD are at greater risk of distressing problems with sexual function relative to controls. In a large mixed-gender community sample (N = 943: controls n = 837, presumptive ADHD n = 106), we found that ADHD symptoms were positively correlated with worse overall sexual function, as well as orgasm difficulties and greater sexual distress. Relative to controls, individuals with presumptive ADHD reported worse sexual function and greater sexual distress, controlling for age, biological sex, and sexual orientation. Individuals with presumptive ADHD were significantly more likely (OR = 2.16) to have distressing problems with sexual function than controls. Core difficulties related to ADHD, including inattention, distractibility, and emotion dysregulation, may make individuals more vulnerable to experiencing problems with sexual function and sexual distress, putting them at risk for developing sexual dysfunction. Taken together, these data support associations between ADHD and distressing sexual function problems, including possible mechanisms explaining these links such as difficulties with emotion regulation.

A study on sexual functioning in adults with attention-deficit/hyperactivity disorder

PURPOSE

Sexual dysfunction has been ignored in adults with attention-deficit hyperactivity disorder (A-ADHD). This study examined sexual function in adults with ADHD compared to a healthy control group.

DESIGN AND METHODS

The experimental group (N = 63, mean age = 31.11 ± 4.29, females = 31) were recruited among referrals with ADHD to an outpatient A-ADHD clinic. The DIVA-2 (Diagnostic Interview for ADHD in adults) and the schedule for affective disorders and schizophrenia (SADS) were used to assess for A-ADHD and comorbid psychiatric disorders, respectively. The healthy groups (N = 66, mean age = 31.37 ± 4.30, females = 31) were demographically matched and had no psychiatric disorders based on the Conners' Adult ADHD Rating Scales-Self Report, Short Version and SADS. Sexual functions were evaluated using the Female Sexual Function Index (FSFI) for females and International Index of Erectile Function (IIEF) for males.

FINDINGS

Females with ADHD compared to the control group showed significantly (P < .001) poorer scores in all FSFI domains (desire, arousal, orgasm, satisfaction, pain, and lubrication). The IIEF mean scores in the males with A-ADHD were lower (P = .00) than their counterparts for all the subscales including orgasm, erectile function, intercourse satisfaction, and overall satisfaction, except for the desire (P = .75). The orgasmic function had a significant negative correlation with Conners Adult ADHD Rating Scale-Self Report: Short total scores in males (r = -.48) and females (r = -.40).

PRACTICE IMPLICATIONS

This study provides preliminary information on greater difficulties with sexual function in adults with ADHD. Assessment of sexual function in referrals with A-ADHD is suggested.

Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review

BACKGROUND

The scientific literature on sexuality among mentally ill patients clearly shows a higher prevalence of sexual disorders for many mental disorders, but little is known about sexuality in individuals suffering from ADHD. Clinicians will often assume that specific difficulties of ADHD are bound to affect sexual functioning.

AIM

The aim of this study was to provide a review of the literature to gain better knowledge about sexuality in subjects with ADHD and to discuss screening and management of their potential sexual problems.

METHODS

A systematic review of the literature was performed in Pubmed, PsychInfo, and Embase databases.

MAIN OUTCOME MEASURES

The main outcome measures were sexual function and sexual dysfunctions.

RESULTS

The studies indicated that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population.

CLINICAL IMPLICATIONS

Clinicians working with subjects with ADHD should explore the quality of their sexual life.

STRENGTHS & LIMITATIONS

This is the first systematic review of the sexuality of individuals with ADHD. However, the results are limited by the small number of studies, by the small sample size of many studies, and the potential for bias.

CONCLUSIONS

ADHD is a mental disorder affecting sexual health. Further studies are warranted to learn more about sexuality in subjects with ADHD. Soldati L, Bianchi-Demicheli F, Schockaert P, et al. Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review. J Sex Med 2020;17:1653-1664.

Safety Profile of Finasteride: Distribution of Adverse Effects According to Structural and Informational Dichotomies of the Mind/Brain

Finasteride is currently used extensively for male androgenic alopecia and benign prostatic hyperplasia; however, some adverse effects are severe and even persistent after treatment cessation, the so-called 'post-finasteride syndrome'. The following most severe adverse effects-sexual dysfunction and depression-often occur together and may potentiate one other, a fact that could explain (at least in part) the magnitude and persistence of finasteride adverse effects. This paper presents the pharmacological action of finasteride and the corresponding adverse effects, the biological base explaining the occurrence, persistence and distribution of these adverse effects, and a possible therapeutic solution for post-finasteride syndrome. The distribution of finasteride adverse effects is presented within a comprehensive and modern neuro-endocrine perspective related to structural and informational dichotomies of the brain. Understanding the variation of finasteride side effects among different populations would be necessary not only to delineate the safety profile of finasteride for different subgroups of men (a subject may or may not be affected by a certain anti-hormonal compound dependent on the individual neuro-endocrine profile), but also as a possible premise for a therapeutic approach of finasteride adverse effects. Such therapeutic approach should include administration of exogenous hormones, which are deficient in men with post-finasteride syndrome, namely dihydrotestosterone (in right-handed men) or progesterone/dihydroprogesterone (in left-handed subjects).

Cognitive Attentional Syndrome and Metacognitive Beliefs in Male Sexual Dysfunction: An Exploratory Study

Erectile dysfunction (ED) and premature ejaculation (PE) are two forms of male sexual disorder with both psychological and physical features. While their cognitive, attentional, and affective components have been investigated separately, there is a lack of knowledge about the role played by cognitive attentional syndrome in their onset and maintenance. The aim of the present study was to investigate the possible contribution of perseverative thinking styles and thought control strategies to the development and maintenance of ED and PE. The authors hypothesized that such modes of processing might constitute a cognitive attentional syndrome specific to these disorders and sustained by particular metacognitive beliefs. A semistructured interview was administered to 11 participants with ED and 10 with PE in order to assess their metacognitive beliefs and cognitive attentional processes. The results suggest that individuals with ED and PE adopt a range of cognitive attentional strategies aimed at improving their sexual performance, and endorse both positive and negative metacognitive beliefs about these thinking responses. Overall, their cognitive and attentional patterns worsened negative internal states, reduced sexual excitement, detached them from their bodily sensations, and hindered sexual functioning. These preliminary findings suggest that perseverative thinking, thought control strategies, and metacognitive beliefs may play a key role in the onset and maintenance of male sexual dysfunction.

The ventral-hypothalamic input route: a common neural network for abstract cognition and sexuality

Classically, external receptors of the body transmit information from the environment to the cerebral cortex via the thalamus. This review explains and argues that only concrete external information is transmitted from peripheral receptors to the cortex via a thalamic route, while abstract and sexual external information are actually transmitted from peripheral receptors to the cortex through a cognitive hypothalamic route. Sexual function typically implies participation of two distinct partners, ensuring reproduction in many species including humans. Human sexual response involves participation of multiple (environmental, biological, psychological) kinds of stimuli and processing, so the understanding of sexual control and response supposes integration between the classical physiological mechanisms with the more complex processes of our 'mind'. Cognition and sexuality are two relational functions, which are dependent on concrete (colours, sounds, etc.) and/or abstract (gestures, facial expression, how you move, the way you say something seemingly trivial, etc.) environmental cues. Abstract cues are encoded independent of the specific object features of the stimuli, suggesting that such cues should be transmitted and interpreted within the brain through a system different than the classical thalamo-cortical network that operates on concrete (material) information. Indeed, data show that the cerebral cortex is capable of interpreting two distinct (concrete and abstract) formats of information via distinct and non-compatible brain areas. We expand upon this abstract-concrete dichotomy of the brain, positing that the two distinct cortical networks should be uploaded with distinct information from the environment via two distinct informational input routes. These two routes would be represented by the two distinct routes of the ascending reticular activating system (ARAS), namely the classical/dorsal thalamic input route for concrete information and the ventral hypothalamic input route for abstract cognition and sexuality. Physiologically, the hypothalamic (dual-autonomic) route of the ARAS that processes abstract and sexual information is incompatible with the thalamic (somatic) route of the ARAS that processes concrete information, such that the two distinct routes would be needed to support the mind processes (awareness, consciousness, sexuality) through their own informational inputs from the environment. Informationally, the concrete external data are differentiated from abstract and sexual external data, so that they should be transmitted to cortex through distinct input routes. Pathologically, the hardware and/or software impairments of the hypothalamic default-mode network generate disturbed messages within the brain (related to information transmitted on this route), laying at the basis of mental and sexual disorders. The novel conceptualisations presented in the present paper help address issues surrounding the mind-brain dichotomy and, in doing so, suggest new possible avenues for exploration in the treatment and interventions for cognitive and sexual problems.