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Behn M, Kielhofner J, Panicker JN, Kaplan TB. Sexual dysfunction and commonly used drugs in neurology. Pract Neurol 2024; 24:207-214. [PMID: 38212111 DOI: 10.1136/pn-2023-003760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/13/2024]
Abstract
Sexual dysfunction is common in men and women with neurological diseases. Medications used in neurology can cause sexual dysfunction independently of the disease process and this may adversely affect patients' quality of life. This review focuses on medications commonly prescribed to neurological patients that may contribute to altered sexual function, and discusses how they may differ in men and women.
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Affiliation(s)
- Maya Behn
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Tamara B Kaplan
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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2
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Tayim N, Barbosa P, Panicker J. Hypersexuality in neurological disorders: A systematic review. BMJ MENTAL HEALTH 2024; 27:e300998. [PMID: 38777563 PMCID: PMC11116864 DOI: 10.1136/bmjment-2024-300998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Hypersexuality (HS) accompanying neurological conditions remains poorly characterized despite profound psychosocial impacts. Objective We aimed to systematically review the literature on HS in patients with neurological disorders. Study selection and analysis We conducted a systematic review to identify studies that reported HS in neurological disorders. HS was defined as a condition characterized by excessive and persistent preoccupation with sexual thoughts, urges, and behaviors that cause significant distress or impairment in personal, social, or occupational functioning. Data on demographics, assessment techniques, associated elements, phenotypic manifestations, and management strategies were also extracted. Findings The final analysis included 79 studies on HS, encompassing 32 662 patients across 81 cohorts with neurological disorders. Parkinson's disease was the most frequently studied condition (55.6%), followed by various types of dementia (12.7%). Questionnaires were the most common assessment approach for evaluating HS, although the techniques varied substantially. Alterations in the dopaminergic pathways have emerged as contributing mechanisms based on the effects of medication cessation. However, standardized treatment protocols still need to be improved, with significant heterogeneity in documented approaches. Critical deficiencies include risks of selection bias in participant sampling, uncontrolled residual confounding factors, and lack of blinded evaluations of reported outcomes. Conclusions and clinical implications Despite growth in the last decade, research on HS remains limited across neurological conditions, with lingering quality and methodological standardization deficits. Key priorities include advancing assessment tools, elucidating the underlying neurobiology, and formulating management guidelines. PROSPERO REGISTRATION NUMBER CRD42017036478.
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Affiliation(s)
- Natalie Tayim
- Department of Psychology, Doha Institute for Graduate Studies, Doha, Qatar
| | - Pedro Barbosa
- Movement Disorders Group, Department of Neurology, University of Sao Paulo, Sao Paulo, Brazil
| | - Jalesh Panicker
- Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, London, UK
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3
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Turner D, Gregório Hertz P, Biedermann L, Barra S, Retz W. Paraphilic fantasies and behavior in attention deficit/hyperactivity disorder and their association with hypersexuality. Int J Impot Res 2024:10.1038/s41443-024-00891-w. [PMID: 38637719 DOI: 10.1038/s41443-024-00891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
Previous research has found some peculiarities in sexual functioning of adults with attention deficit/hyperactivity disorder (ADHD). Using a set of questionnaires that had to be answered online, we assessed the prevalence of paraphilic fantasies and behaviors in a sample of 160 adults with ADHD in comparison to 75 adults without ADHD and evaluated the association between paraphilias and hypersexuality in the ADHD group. Both groups reported high rates of paraphilic fantasies and behaviors. ADHD individuals were more likely to report about very sexually arousing paraphilic fantasies (ADHD: 58.2% vs. non-ADHD: 40.5%; χ2 = 6.323, p = 0.01) and behaviors (ADHD: 44.9% vs. non-ADHD: 28.4%; χ2 = 5.774, p = 0.02). Furthermore, ADHD individuals reported on average about more very sexually arousing paraphilic behaviors compared to non-ADHD individuals (ADHD: M = 1.28, SD = 0.10 vs. non-ADHD: M = 0.81, SD = 0.09; T = 2.68, p < 0.01). Furthermore, in ADHD individuals both very sexually arousing paraphilic interests in masturbation fantasies (r(158) = 0.17, p = 0.03) and in sexual behaviors (r(158) =0.19, p = 0.02) showed a significant correlation with hypersexuality. In non-ADHD individuals no such significant correlation could be found. Altogether, it can be concluded that individuals with ADHD seem to be more prone to develop and act out paraphilic sexuality than those without ADHD, however, found differences were rather small. The results of the present study add to the current trend to depathologize paraphilic sexuality in the general as well as in clinical populations.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
| | | | - Laura Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Steffen Barra
- Institute for Forensic Psychology and Psychiatry, University Medical Center Homburg, Homburg, Germany
| | - Wolfgang Retz
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- Institute for Forensic Psychology and Psychiatry, University Medical Center Homburg, Homburg, Germany
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4
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Young S, Cocallis K. A Systematic Review of the Relationship Between Neurodiversity and Psychosexual Functioning in Individuals with Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD). Neuropsychiatr Dis Treat 2023; 19:1379-1395. [PMID: 37287894 PMCID: PMC10243356 DOI: 10.2147/ndt.s319980] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
The scientific literature on psychosexual functioning shows a range of outcomes for individuals with neurodiversity. The aim of this article was to synthesize and critically evaluate evidence regarding psychosexual selfhood (orientation), behaviors and experiences in individuals with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) to prioritize further research and identify interventions to reduce risk. A systematic review of the literature that compared sexual orientation, behavior and experiences of individuals with ASD or ADHD with those of neurotypical peers was performed in AMED, CINAHL, MEDLINE, PsycARTICLES and PsycINFO, Psychology and Behavioural Sciences Collection, Child Development and Adolescent Studies databases (supplemented by hand-searching of reference lists). Seventeen ASD and nineteen ADHD studies met inclusion criteria. Overall, the studies reviewed suggest poorer psychosexual functioning for individuals with ASD or ADHD compared to neurotypical peers, including a lack of satisfaction in their sexual relationships, sexual dysfunction, risky sexual behaviors, and victimization. This appears to be more marked for females. Individuals with ASD were more likely to identify with a non-heterosexual orientation compared with neurotypical peers. The study identifies gaps in our knowledge relating to risky sexual behaviors (in particular, those relating to sexual health and vulnerability to sexual victimization and perpetration). The public health implications of the findings are discussed. Future research is needed to clarify the mechanisms by which individuals with neurodevelopmental disorders may be at increased risk of adverse psychosexual outcomes and identify interventions that may mediate outcomes.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, UK
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Kelly Cocallis
- Health Psychology, Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
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5
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Young S, Klassen LJ, Reitmeier SD, Matheson JD, Gudjonsson GH. Let's Talk about Sex… and ADHD: Findings from an Anonymous Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2037. [PMID: 36767401 PMCID: PMC9915044 DOI: 10.3390/ijerph20032037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and impulsivity. A dearth of studies have investigated psychosexuality in this population, often with few (predominantly male) participants. We recruited individuals with and without ADHD via an anonymous online survey distributed electronically by ADHD support organizations and social media. We investigated sexual history; interests and practices; and relationships. Of 1392 respondents, we classified an 'ADHD' group (n = 541; 30.5% male) and compared them to individuals of similar ages without ADHD, ('Other' group; n = 851; 37.6% male). The ADHD group (both males and females) had a significantly higher preference for same-sex or either-sex partners; and higher rates of electronic sexual exchanges, masturbation, and sexually transmitted diseases. They were more adventurous in sexual interests and practices and substantially less satisfied with their partners, both sexually and generally. Within the ADHD group, significant sex differences emerged: females had younger onset of sexual activities, used contraception less frequently, had more sexual partners and practiced more infidelity. Sexual interests differed between the sexes, but females more commonly acted on them, whereas males did not. Findings suggest both sexes engage in risky sexual behaviors, perhaps driven by impulsivity, but risk is substantially greater for females with ADHD.
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Affiliation(s)
- Susan Young
- Psychology Services Ltd., London CR9 7AE, UK
- Department of Psychology, University of Reykjavik, 110 Reykjavik, Iceland
| | - Larry J. Klassen
- Eden Mental Health Centre, 1500 Pembina Avenue, Winkler, MB R6W 1T4, Canada
| | - Shayne D. Reitmeier
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R33 0W2, Canada
| | | | - Gisli H. Gudjonsson
- Department of Psychology, University of Reykjavik, 110 Reykjavik, Iceland
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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7
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Limoncin E, Ciocca G, Castellini G, Sansone A, Cavalieri F, Cavallo F, Cocchiaro T, Ricca V, di Lorenzo G, Rossi A, Fisher AD, Rochira V, Corona G, Jannini EA. Hypersexuality as a tip of the iceberg of a primary psychopathology: a joined position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) and of the Italian Society of Psychopathology (SOPSI). J Endocrinol Invest 2022; 45:1787-1799. [PMID: 35527295 DOI: 10.1007/s40618-022-01798-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
In the last years, hypersexual behavior has been broadly scientifically studied. The interest in this topic, belonging to psycho-sexology and sexual medicine, has been due to its still unclear aetiology, nature, and its manifestation in relationship with several organic and psychopathological conditions. So, the specialist (the psychologist, psychiatrist, endocrinologist, neurologist) may encounter some difficulties in diagnosing and managing this symptom. The first main objective of this position statement, which has been developed in collaboration between the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Psychopathology (SOPSI) is to give to the reader evidence about the necessity to consider hypersexuality as a symptom related to another underlying condition. Following this consideration, the second main objective is to give specific statements, for the biopsychosocial assessment and the diagnosis of hypersexual behavior, developed on the basis of the most recent literature evidence. To develop a psycho-pharmacological treatment tailored on patients' needs, our suggestion is to assess the presence of specific comorbid psychopathological and organic conditions, and the impact of pharmacological treatments on the presence of an excess of sexual behavior. Finally, a suggestion of a standardized psychometric evaluation of hypersexuality will be given.
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Affiliation(s)
- E Limoncin
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy
- Department of Dynamic, Clinical Psychology and Health, University Sapienza, Rome, Italy
| | - G Ciocca
- Department of Dynamic, Clinical Psychology and Health, University Sapienza, Rome, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A Sansone
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy
| | - F Cavalieri
- Department of Medicine, Unit of Andrology and Reproduction Medicine, University of Padova, Padua, Italy
| | - F Cavallo
- Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - T Cocchiaro
- Department of Gender, Parenting, Child and Adolescent Medicine, Unit of Reproductive Pathophysiology and Andrology, "Sandro Pertini" Hospital, Rome, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - G di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Psychiatry and Clinical Psychology Unit, Section of Psychiatry, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - A Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A D Fisher
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - E A Jannini
- Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University Tor Vergata, E Tower South. Floor 4, Room E413, Via Montpellier 1, 00133, Rome, Italy.
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8
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Wallin K, Wallin Lundell I, Hanberger L, Alehagen S, Hultsjö S. Self-experienced sexual and reproductive health in young women with Attention Deficit Hyperactivity Disorder: A qualitative interview study. BMC Womens Health 2022; 22:289. [PMID: 35836208 PMCID: PMC9281117 DOI: 10.1186/s12905-022-01867-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background Sexual risk behaviors and struggles in romantic relationships result in higher risk of unplanned pregnancy, sexually transmitted diseases, sexual victimization and lower satisfaction in relationships for young women with Attention Deficit Hyperactivity Disorder (ADHD). There is a need to better understand sexual behaviors and the consequences of relational difficulties to help health professionals promote sexual and reproductive health. To deepen knowledge in this area, this study aimed to identify and describe self-experienced sexual and reproductive health in young women with ADHD. Methods A qualitative design was used. Data was collected with individual and focus group interviews with 15 young women, aged 15–29, with an ADHD diagnosis, and analyzed with thematic analysis. Results Data analysis identified the themes Acceptance of being different and Feeling sexually secure. The women reveal feelings of being different from others without ADHD as they break norms of sexual behavior, struggle with romantic relationships, and have difficulties concentrating during sex. There is a need to be understood and accepted, to not feel judged, and to manage romantic relationships. Self-knowledge helps them to recognize needs for support and to develop strategies that can improve sexual satisfaction. Feeling sexually secure illustrates the women’s need to feel comfortable with their own sexuality and in control in the sexual situation. Low self-esteem and a negative self-image, described as a consequence of living with ADHD, can compromise communication in sexual situations and increase fear of being rejected. Further, misjudging sexual partners and situations can contribute to sexual victimization. Conclusions This study provides knowledge of how ADHD affects emotions and sexual behaviors in young women. The results highlight the need for understanding and acceptance by peers and partners. It accentuates the value of involving the partner in counselling and the importance of self-knowledge. Feeling insecure in sexual relationships further implies the importance of early diagnosis to prevent secondary outcomes of ADHD, and the need for sexual victimization screening in professional settings.
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Hertz PG, Turner D, Barra S, Biedermann L, Retz-Junginger P, Schöttle D, Retz W. Sexuality in Adults With ADHD: Results of an Online Survey. Front Psychiatry 2022; 13:868278. [PMID: 35651826 PMCID: PMC9148957 DOI: 10.3389/fpsyt.2022.868278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.
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Affiliation(s)
- Priscilla Gregório Hertz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Steffen Barra
- Institute for Forensic Psychology and Psychiatry, University Hospital, Homburg, Germany
| | - Laura Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Petra Retz-Junginger
- Institute for Forensic Psychology and Psychiatry, University Hospital, Homburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Wolfgang Retz
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute for Forensic Psychology and Psychiatry, University Hospital, Homburg, Germany
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Abdel-Hamid M, Basilowski M, Schönfeld B, Bartels C, Anderson-Schmidt H, Hessmann P, Kownatka M, Dehghan-Vratonjic S, Krieger S, Scherbaum N, Wiltfang J, Kis B, Signerski-Krieger J. Sexual dysfunction in patients with adult attention deficit hyperactivity disorder: A pilot study. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2021. [DOI: 10.3138/cjhs.2020-0036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) symptomatology, comorbid diseases, and pharmacological treatment with antidepressants can have a negative impact on sexual function, which in turn increases the likelihood of sexual dysfunction in people with ADHD. The objective of this pilot study was to differentiate and delineate possible sexual dysfunction in adults with ADHD. Adult ADHD patients (n = 32, cisgender / heterosexual) and healthy controls (n = 32, cisgender / heterosexual) filled out the DÄS-Zuf questionnaire with 59 items (Krieger, 2013). This questionnaire is divided into the scales “general contentment with life,” “anxiety/depression,” “sexual dysfunction” and “sexual satisfaction.” Patients with ADHD had significantly higher scores on single items measuring various aspects of sexual dysfunction as well as higher scores on the “anxiety/depression” scale and lower scores on the “general contentment with life” scale. Following repeated measures analyses of covariance in which the scale “anxiety/depression” was controlled as covariate, none of the previously differences for single items between ADHD patients and controls remained significant. ADHD patients with methylphenidate showed stronger physical sexual arousal compared to those without methylphenidate. The results of this pilot study suggest several explanations for sexual dysfunction among adults with ADHD and offer tentative routes for practical treatment approaches.
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Affiliation(s)
- Mona Abdel-Hamid
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Miriam Basilowski
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- WIR Center for Sexual Health and Medicine, St. Elisabeth-Hospital Bochum, Catholic Hospitals Bochum, Bochum, Germany
| | | | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Heike Anderson-Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Philipp Hessmann
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Melanie Kownatka
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Sonja Dehghan-Vratonjic
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Simone Krieger
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Norbert Scherbaum
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Bernhard Kis
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
- LVR Hospital Essen, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth-Hospital Niederwenigern, Contilia Group, Hattingen, Germany
| | - Jörg Signerski-Krieger
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen (UMG), Göttingen, Germany
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Abstract
Subjects with ADHD suffer from inattention, hyperactivity, and impulsivity. Clinicians often assume that specific symptoms of ADHD are bound to affect sexual desire by increasing the frequency of hypersexuality. There is a lack of knowledge about the comorbidity between ADHD, hypersexuality, and paraphilias. The aim of this article was to provide a review of the literature on the association of ADHD and hypersexuality and paraphilias and to discuss the screening and the management of these syndromes when associated with ADHD. A systematic review of the literature was performed in PubMed, PsychInfo, and Embase databases. The studies reviewed show that some individuals who suffer from ADHD report hypersexuality and paraphilias, but no clear data emerged supporting the idea that hypersexuality and paraphilias are more frequent in an ADHD population. On the other hand, some studies showed a high prevalence of ADHD in hypersexual and paraphilic subjects. This is the first systematic review of hypersexuality and paraphilias in individuals with ADHD. However, the results are limited by differences in the methodology and measurement instruments for hypersexuality and paraphilias as well as by the small number of studies and the small sample sizes of many studies.
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12
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Amani Jabalkandi S, Raisi F, Shahrivar Z, Mohammadi A, Meysamie A, Firoozikhojastefar R, Irani F. A study on sexual functioning in adults with attention-deficit/hyperactivity disorder. Perspect Psychiatr Care 2020; 56:642-648. [PMID: 32043624 DOI: 10.1111/ppc.12480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/04/2020] [Accepted: 01/17/2020] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Samaneh Amani Jabalkandi
- Department of Clinical Psychology, School of Medicine, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shahrivar
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Cognitive and Behavioral Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mohammadi
- Department of Clinical Psychology, School of Medicine, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alipasha Meysamie
- Department of Community and Preventive Medicine, School of Medicine, Tehran University of Medical Sciences/University of Tehran, Tehran, Iran
| | | | - Fatemeh Irani
- Department of Psychology, Center for Interdisciplinary Brain Research (CIBR), University of Jyväskylä, JYU, Jyväskylä, Finland
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Soldati L, Bianchi-Demicheli F, Schockaert P, Köhl J, Bolmont M, Hasler R, Perroud N. Sexual Function, Sexual Dysfunctions, and ADHD: A Systematic Literature Review. J Sex Med 2020; 17:1653-1664. [PMID: 32402814 DOI: 10.1016/j.jsxm.2020.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Lorenzo Soldati
- Sexual Medicine and Sexology unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland.
| | - Francesco Bianchi-Demicheli
- Sexual Medicine and Sexology unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pauline Schockaert
- Sexual Medicine and Sexology unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - John Köhl
- Sexual Medicine and Sexology unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Mylène Bolmont
- Sexual Medicine and Sexology unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland; TRE Unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland; TRE Unit, Division of Psychiatric Specialties, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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14
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Levi G, Cohen C, Kaliche S, Sharaabi S, Cohen K, Tzur-Bitan D, Weinstein A. Sexual addiction, compulsivity, and impulsivity among a predominantly female sample of adults who use the internet for sex. J Behav Addict 2020; 9:83-92. [PMID: 32359233 PMCID: PMC8935197 DOI: 10.1556/2006.2020.00007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior is characterized by extensive sexual behavior and unsuccessful efforts to control excessive sexual behavior. The aim of the studies was to investigate compulsivity, anxiety and depression and impulsivity and problematic online sexual activities among adult males and females who use the Internet for finding sexual partners and using online pornography. METHODS Study 1- 177 participants including 143 women M = 32.79 years (SD = 9.52), and 32 men M = 30.18 years (SD = 10.79). The Sexual Addiction Screening Test (SAST), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Spielberger Trait-State Anxiety Inventory (STAI-T STAI-S) and Beck Depression Inventory (BDI). Study 2- 139 participants including 98 women M = 24 years (SD = 5) and 41 men M = 25 years (SD = 4). The impulsivity questionnaire (BIS/BAS), Problematic online sexual activities (s-IAT-sex) and Sexual Addiction Screening Test (SAST). RESULTS Study 1- Multiple regression analysis has indicated that a model which included BDI, Y-BOCS, and STAI scores contributed to the variance of sexual addiction rates, and explained 33.3% of the variance. Study 2- Multiple regression analysis indicated that BIS/BAS and s-IAT scores contributed to the variance of sexual addiction rates, and explained 33% of the variance. DISCUSSION AND CONCLUSIONS Obsessive-compulsive symptoms contributed to sexual addiction among individuals who use the Internet for finding sexual partners. Impulsivity and problematic online sexual activity contributed to ratings of sex addiction. These studies support the argument that sex addiction lies on the impulsive-compulsive scale and could be classified as a behavioral addiction.
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Affiliation(s)
- Gal Levi
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel
| | - Chen Cohen
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel
| | - Sigal Kaliche
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel
| | - Sagit Sharaabi
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel
| | - Koby Cohen
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel
| | - Dana Tzur-Bitan
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel
| | - Aviv Weinstein
- Department of Behavioral Science, Ariel University, Science Park, Ariel, 40700, Israel,Corresponding author. Department of Behavioral Science and Integrative Brain and Cognition Center, University of Ariel, Ariel, Israel. Tel.: 972-3-9076555; fax: 972-3-9066629. E-mail: ;
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Kaufman KR, Coluccio M, Linke M, Noonan E, Babalola R, Aziz R. Alprazolam-induced dose-dependent anorgasmia: case analysis. BJPsych Open 2018; 4:274-277. [PMID: 30083378 PMCID: PMC6066992 DOI: 10.1192/bjo.2018.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sexual dysfunctions are associated with multiple medical and psychiatric disorders, as well as pharmacotherapies used to treat these disorders. Although sexual dysfunctions negatively affect both quality of life and treatment adherence, patients infrequently volunteer these symptoms and clinicians do not pose directed questions to determine their presence or severity. This issue is especially important in psychiatric patients, for whom most common psychotropics may cause sexual dysfunctions (antidepressants, antipsychotics, anxiolytics and mood-stabilising agents). There is limited literature addressing benzodiazepines, and alprazolam in particular. AIMS To report dose-dependent alprazolam anorgasmia. METHOD Case analysis with PubMed literature review. RESULTS A 30-year-old male psychiatric patient presented with new-onset anorgasmia in the context of asymptomatic generalised anxiety disorder, social anxiety, panic disorder with agoraphobia, obsessive-compulsive disorder, major depression in remission, and attention-deficit hyperactivity disorder treated with escitalopram 10 mg q.a.m., gabapentin 1000 mg total daily dose, lisdexamfetamine dimesylate 70 mg q.a.m., nortriptyline 60 mg q.h.s. and alprazolam extended-release 2.5 mg total daily dose. All psychotropic doses had been constant for >6 months excluding alprazolam, which was titrated from 1 mg to 2.5 mg total daily dose. The patient denied any sexual dysfunction with alprazolam at 1 mg q.d. and 1 mg b.i.d. Within 1 week of increasing alprazolam to 2.5 mg total daily dose, the patient reported anorgasmia. Anorgasmia was alprazolam dose-dependent, as anorgasmia resolved with reduced weekend dosing (1 mg b.i.d. Saturday/1.5 mg total daily dose Sunday). CONCLUSIONS Sexual dysfunction is an important adverse effect negatively influencing therapeutic outcome. This case reports alprazolam-induced dose-dependent anorgasmia. Clinicians/patients should be aware of this adverse effect. Routine sexual histories are indicated. DECLARATION OF INTEREST None.
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Affiliation(s)
- Kenneth R Kaufman
- Department of Psychiatry, Department of Neurology, and Department of Anesthesiology, Rutgers Robert Wood Johnson Medical School, USA
| | - Melissa Coluccio
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Michelle Linke
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Elizabeth Noonan
- Department of Psychology, School of Arts and Sciences, Rutgers University, USA
| | - Ronke Babalola
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, USA
| | - Rehan Aziz
- Department of Psychiatry and Department of Neurology, Rutgers Robert Wood Johnson Medical School, USA
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