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Shen Q, Wu Y, Zhou Y, Yang N, Yu J, Ouyang X, He P. A Cross-Sectional Study of Risk Factors for Coronary Heart Disease in Secondary Prevention for Patients With the Disease in China. J Clin Nurs 2024. [PMID: 39334553 DOI: 10.1111/jocn.17428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 08/23/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024]
Abstract
AIMS To explore risk factors for Coronary Heart Disease (CHD) in secondary prevention for patients with the disease in China. DESIGN Cross-sectional study. METHODS A two-stage sampling method was used (stratified sampling and systematic sampling). Patients who met WHO diagnostic criteria for CHD, had the capacity to give informed consent and volunteered to participate were recruited from five districts in Hengyang city, Hunan province, China. Six instruments were used: A general socio-demographic questionnaire, Coronary Heart Disease Self-Management Scale, International Physical Activity Questionnaires, Chinese Eight-Item Morisky Medication Adherence Scale, Zung's Self-Rating Anxiety Scale and Sexual Health Questionnaires. Participants completed the questionnaires in person or via telephone. Single-factor correlation analysis, Pearson correlation analysis and multiple linear regression analysis were carried out. RESULTS A total of 373 patients were recruited with a mean age of 66.25 years (standard deviation = 9.98). The mean score was 57.00 (14.23) for self-management, 5.41 (1.82) for medication adherence, 53.61 (9.26) for anxiety, 8.66 (3.18) for sexual knowledge and 22.20 (9.68) for the need for sexual health education. The median was 1563.90 MET-min/day for total energy consumption of physical activity. Self-management, physical activity, medication adherence, anxiety and sexual health were significantly correlated with a range of demographic variables (age, gender, marital status, occupation, education levels, types of medical insurance, personal monthly income, living arrangements) and illness-related variables (illness duration, number of hospital admissions, type of therapy, number of other chronic diseases, cardiac function grading and BMI). CONCLUSION This research has showed the risk factors related to self-management skills, medication adherence, anxiety, physical activity, sexual knowledge and the need for sexual health education in secondary prevention for patients with CHD. Health professionals play an important role in helping patients reduce risk factors for CHD to minimise its reoccurrence and mortality. RELEVANCE TO CLINICAL PRACTICE Both hospital-based and community-based health professionals, especially nurses, have an important role to play in developing and implementing health promotion interventions to help patients with CHD reduce risk factors for the disease and thus reduce mortality. PATIENT OR PUBLIC CONTRIBUTION No patient contribution. Community nursing staff contributed to the design of the general socio-demographic questionnaire for this study. REPORTING METHOD The STROBE checklist was used to ensure comprehensive reporting (Appendix S1).
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Affiliation(s)
- Qianqian Shen
- Medical College, Hunan Normal University, Changsha, China
- The Second Affiliated Hospital of Jiaxing University, The Second Hospital of Jiaxing, Jiaxing, Zhejiang, China
- School of Nursing, University of South China, Hengyang, Hunan, China
| | - Yiyuan Wu
- Medical College, Hunan Normal University, Changsha, China
| | - Ying Zhou
- Medical College, Hunan Normal University, Changsha, China
| | - Na Yang
- Medical College, Hunan Normal University, Changsha, China
| | - Juping Yu
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, Mid Glamorgan, UK
| | - Xinping Ouyang
- Medical College, Hunan Normal University, Changsha, China
| | - Pingping He
- Medical College, Hunan Normal University, Changsha, China
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Hyde EK, Martin DE, Rieger KL, Malone R. "Just think of it as sexercise" - healthcare providers' perceptions about sexual health education in cardiac rehabilitation programs. Disabil Rehabil 2022; 44:7854-7860. [PMID: 34779688 DOI: 10.1080/09638288.2021.2001052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Sexual health education (SHE) is an important rehabilitation component for acute coronary syndrome (ACS) survivors but is not routinely provided. This study's purpose was to explore healthcare providers' experiences of providing SHE to ACS survivors in cardiac rehabilitation programs to identify best practices. METHODS This qualitative study used convenience sampling and an interpretive descriptive design. Inclusion criteria were a healthcare provider employed within a cardiac rehabilitation program in a Western Canadian province. Eight cardiac rehabilitation healthcare providers volunteered to participate. The first author conducted semi-structured, digitally recorded interviews that were transcribed verbatim. The interviews were guided by a semi-structured interview guide anchored in the strengths-based, sex positive guiding frameworks. A reflective journal and socio-demographic forms served as additional data sources. Data were analyzed using open, axial, and selective coding as well as constant comparative analysis. Credibility was ensured through peer-reviewed evaluation criteria. RESULTS Eight healthcare providers participated in the study. Participants equated sexuality and sexual health with physical activity and physical health. Findings identified philosophical perspectives and several barriers and facilitators that impact SHE provision. Participants offered strategies that may be used in practice and their recommendations provide a beginning foundation to improve cardiac rehabilitation programs and the health of ACS survivors. CONCLUSION Healthcare providers in cardiac rehabilitation programs described their SHE experiences as "just think of it as sexercise." Facilitation of SHE is important as previous studies found that SHE may reduce fear, depression, and anxiety and increase the return to sexual activity among ACS survivors.IMPLICATIONS FOR REHABILITATIONSexual health doesn't need to be a taboo topic.Approach sexual health conversations by thinking of it as "sexercise".Don't let silos stop sexual health education - talk to your coworkers and patients about sexual health.Knowledge about sexual health, timing of sexual health education, and communication between care providers and patients are important factors in delivery of sexual health education.
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Affiliation(s)
- Emily K Hyde
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Canadian Nurses Foundation Scholar, Winnipeg, Canada
| | - Donna E Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Kendra L Rieger
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,School of Nursing, Trinity Western University, Langley, Canada
| | - Reece Malone
- Sexuality Consultants and Support Services Manitoba, Inc, Winnipeg, Canada
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Smith AB, Barton DL, Davis M, Jackson EA, Smith J, Wittmann D. A Preliminary Study of Short-Term Sexual Function and Satisfaction Among Men Post-Myocardial Infarction. J Holist Nurs 2022; 40:208-218. [PMID: 34382477 PMCID: PMC9393871 DOI: 10.1177/08980101211038085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexuality is an important component of holistic quality of life, and myocardial infarction (MI) negatively influences many aspects of sexuality, including sexual function. However, there is limited literature that examines sexuality beyond the most basic physical components. This pilot study aimed to describe the relationships between the physical, psychologic, and social domains of holistic sexuality at an early timepoint post-MI. Adult men post-MI were mailed self-report surveys at 2 weeks post discharge. Physical domains of sexuality were measured with the arousal, orgasm, erection, lubrication, and pain subscales of the Male Sexual Function Index (MSFI). The social domain utilized the sexual satisfaction subscale of the MSFI. The psychologic domain included the desire subscale of the MSFI and sexual fear (Multidimensional Sexuality Questionnaire). Spearman correlations were estimated to examine associations among the different measurement subscales. Twenty-four men post-MI were analyzed. Average scores on the MSFI were 9.2 (SD 7.7). Desire and satisfaction were the highest scoring subscales among men when compared with other subscales (i.e. erection, lubrication). There was minimal evidence supporting a relationship between sexual fear and function. Additional research is also needed with larger samples, and among women post-MI.
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Rao TSS, Banerjee D, Tandon A, Sawant NS, Jha A, Manohar S, Rao SS. Psychosexual Health and Sexual Medicine in Consultation-Liaison Psychiatry. Indian J Psychiatry 2022; 64:S429-S448. [PMID: 35602370 PMCID: PMC9122165 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_13_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- T S Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | | | - Abhinav Tandon
- Department of Psychiatry, United Institute of Medical Sciences, Allahabad, Uttar Pradesh, India
| | - Neena S Sawant
- Department of Psychiatry, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Shivanand Manohar
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Suman S Rao
- Department of Psychiatry, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India E-mail:
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Sexual Function, Anxiety, Depression and Coping After Myocardial Infarction: An Exploratory Study. SEXUALITY AND DISABILITY 2022; 40:77-89. [PMID: 36712231 PMCID: PMC9881546 DOI: 10.1007/s11195-021-09715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Myocardial infarction (MI) may decrease sexual function and satisfaction in men and can be influenced by anxiety, depression, and sexual fear. However, few studies have examined short-term changes in sexual function over time in a post-MI population. This study aimed to longitudinally describe changes in sexual function and satisfaction in a sample of men post-MI. Methods Eighteen patients were recruited from a Midwestern hospital. Surveys were mailed two weeks and three months post discharge. Sexual function was measured with the Male Sexual Function Index. Other variables collected included sexual fear (Multidimensional Sexuality Questionnaire), anxiety and depressive symptoms (Patient-Reported Outcomes Measurement Information System Anxiety and Depression 4a), and use of coping strategies (Coping Strategy Indicator). Results Sexual function scores increased in the entire sample from 8.9 (SD 7.3) at two weeks to 14.6 (SD 8.9) at three months (18.8% improvement, p=0.04). Men who were sexually active improved their scores by 27.3% (p=0.01), while those who were not sexually active decreased their scores by 2.3% (p=0.5). Depressive symptoms and anxiety scores were low and largely stable across timepoints, though there were some improvements among men who were sexually active compared to those who were not. Decreased utilization of avoidance coping strategies was reported in sexually active versus inactive men. Conclusion While sexual function improved within a short-time period post discharge among sexually active men post-MI, further research is needed with a larger sample to understand these changes across a longer period. Additional research is also warranted to examine any potential influence of psychosocial predictors.
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Smith AB, Barton DL, Jackson EA, Wittmann D, Smith J, Davis M. Predictors of sexual function among men after myocardial infarction: a pilot study. BRITISH JOURNAL OF CARDIAC NURSING 2021; 16:10.12968/bjca.2021.0056. [PMID: 35993011 PMCID: PMC9386732 DOI: 10.12968/bjca.2021.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Sexual dysfunction often persists among men post-myocardial infarction (MI). While some cross-sectional and longitudinal research has been conducted, there are still no known modifiable targets for intervention. This pilot study aimed to model hypothesized predictive factors of higher sexual function in a cohort of men post-MI. Methods In a longitudinal study design, sexual function (Male Sexual Function Index), sexual fear (Multidimensional Sexuality Questionnaire), anxiety and depressive symptoms (Patient-Reported Outcomes Measurement Information System), and utilization of coping strategies (Coping Strategy Indicator) data were collected at two weeks and three months post discharge for MI. Spearman correlations were estimated to examine associations among MSFI scores with the selected predictors at two weeks and three months. Linear regression models were conducted for sexual function while controlling for age. Results Fourteen men post-MI were analyzed. The average age of the sample was 59.79 years, 78.6% were married, and all were self-reported White race. Sexual fear and utilization of problem-solving and support-seeking coping strategies were moderately correlated with MSFI scores at three months. Increased use of problem-solving and support-seeking coping strategies were associated with increased sexual function at three months (support-seeking coping 1.47, p<0.01; problem-solving coping 0.95, p=0.02). Conclusions Based on these preliminary findings, utilization of coping strategies may predict increased function score over three months. However, additional studies are needed to further examine these hypothesized relationships with a larger more diverse sample. Additional studies are needed of predictors of sexual function among women post-MI.
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Affiliation(s)
| | | | - Elizabeth A. Jackson
- Department of Medicine, Division of Cardiology, University of Alabama at Birmingham
| | | | - Jacqui Smith
- Department of Psychology and Institute for Social Research, University of Michigan
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Gregory A, Paylo MJ. Assessing a sexual history during intake: a preliminary study with licensed professional counselors. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1715933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adam Gregory
- Counseling Center, Georgia Southern University, Statesboro, GA, USA
| | - Matthew J. Paylo
- Department of Counseling, School Psychology, & Educational Leadership, Youngstown State University, Youngstown, OH, USA
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Cohen G, Nevo D, Hasin T, Benyamini Y, Goldbourt U, Gerber Y. Resumption of sexual activity after acute myocardial infarction and long-term survival. Eur J Prev Cardiol 2020; 29:304-311. [PMID: 33624045 DOI: 10.1093/eurjpc/zwaa011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/14/2022]
Abstract
AIMS Sexual activity is an important factor in the overall quality of life. We examined whether resumption of sexual activity frequency within the first few months after myocardial infarction (MI) is associated with long-term survival. METHODS AND RESULTS Sexually active patients aged ≤65 years (n = 495; median age, 53 years), drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, were interviewed during the index hospitalization (1992-93) and after 3-6 months. Resumption of sexual activity was defined as abstaining/decreasing or maintaining/increasing according to self-reported frequency post- vs. pre-MI. Patients were followed for all-cause and cause-specific mortality through national registries. A propensity score for sexual activity resumption was calculated, based on which inverse probability weighted Cox models were constructed to examine associations. Patients who maintained/increased frequency [n = 263 (53%)] were more likely to be of higher socioeconomic status and to express lower levels of depression than their abstained/decreased counterparts. In the propensity score-weighted synthetic sample, the distribution of measured baseline covariates was similar across exposure categories. During a median follow-up of 22 years, 211 (43%) patients died. Maintaining/increasing sexual activity frequency was inversely associated with all-cause mortality [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.48-0.88], compared with abstaining/reducing. The inverse association was more robust for non-cardiovascular mortality (HR 0.56, 95% CI 0.36-0.85) than cardiovascular mortality (HR 0.90, 95% CI 0.53-1.51). CONCLUSIONS Resumption of sexual activity frequency within the first months after MI was strongly associated with improved long-term survival, highlighting the need for sexual counselling shortly after MI.
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Affiliation(s)
- Gali Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Nevo
- Department of Statistics and Operations Research, School of Mathematical Sciences, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.,Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Tel Aviv, Israel
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9
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Farhan R, Yousuf R, Hussain SNF, Khan M, Bilal Z, Khan M, Yousuf Z, Khatri B, Siddiqua A, Khan SA. Sexual Knowledge in Post-Myocardial Infarction Patients: A Cross-Sectional Study. Cureus 2020; 12:e8480. [PMID: 32642384 PMCID: PMC7336652 DOI: 10.7759/cureus.8480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Adequate sexual knowledge is a key component of cardiac rehabilitation. Sexual knowledge in post-myocardial infarction (MI) patients is unknown. Thus, we conducted this study to investigate the sexual knowledge of post-myocardial infarction patients and their accessibility to sexual counseling. Methodology Between July and September 2018, a cross-sectional survey was carried out in 6six major hospitals in Karachi. The non-probability convenient sampling technique was used to include all patients meeting the inclusion criteria. To reduce biases, face-to-face interviews were conducted by investigators who were trained prior to the start of data collection. Knowledge was assessed using the Swedish version of the "Sex after MI Knowledge Test" questionnaire, where a higher score meant higher knowledge. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY) The t-test was applied to compare the knowledge score between males and females. Results There was a total of 278 MI patients with a mean age of 54 years, of which 60% were men. The "Sex After MI Knowledge Test" scores varied between 37 and 67 (mean score 51 ± 5). None of the participants obtained the maximum possible test score of 75. The most frequently occurring score was 49 (16%). Around half of the participants (48%) incorrectly believed that sex cannot be safely resumed within a few weeks after the heart attack. Limited knowledge was found in questions pertaining to alcohol, viagra, and late evening being the best time to have sex. Medical knowledge was provided to only 27% (n=76) of the participants, of whom 77% (n=58) received it from the hospital staff itself. A significant difference existed in scores obtained by males and females, with males having a higher score and the mean difference in scores being 1.7 (p=0.015). Conclusion Lack of sexual knowledge in MI patients due to the inadequacy of healthcare providers and the social stigma surrounding the topic causes marital strain leading to low quality of life.
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Affiliation(s)
- Rida Farhan
- Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Rabail Yousuf
- Cardiology, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK
| | | | - Maaz Khan
- Cardiology, United Medical and Dental College, Karachi, PAK
| | - Zara Bilal
- Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Maryam Khan
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | - Burhan Khatri
- Medicine, Bahria University Medical and Dental College, Karachi, PAK
| | - Ayesha Siddiqua
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | - Shenel A Khan
- Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
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Hyde EK, Martin DE, Rieger KL. Factors shaping the provision of sexual health education for adults with acute coronary syndrome: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:877-887. [PMID: 31767244 DOI: 10.1016/j.pec.2019.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Each year, 63,000 Canadians are diagnosed with acute coronary syndrome (ACS) and 73 % survive. Sexual health education for ACS survivors is recommended but is not routinely provided. A scoping review was performed to inform health care providers about factors shaping sexual health education for ACS survivors. METHODS Three databases were searched, 208 studies were screened, and 24 were included in this scoping review. Significant points from the selected studies were charted and synthesized. RESULTS This review confirmed absent to limited provision of sexual health education to individuals with ACS. Key factors influencing lack of provision of sexual health were categorized according to macro, meso, and micro levels. At the macro level, societal and cultural factors were noted. The meso level included healthcare environment and limited healthcare provider knowledge. At the micro level, healthcare professional-healthcare consumer relationships and role clarity were noted. CONCLUSION A sex positive approach may facilitate provision of sexual health education. PRACTICE IMPLICATIONS This scoping review points to the need to use a sex positive lens to identify and remove barriers to facilitate the provision of sexual health education. Providing this education may result in reduced fear, depression, and anxiety in ACS survivors.
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Affiliation(s)
- Emily K Hyde
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2 Canada.
| | - Donna E Martin
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2 Canada.
| | - Kendra L Rieger
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, 89 Curry Place, University of Manitoba, Winnipeg, MB R3T 2N2 Canada.
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Simeone S, Guillari A, Pucciarelli G, Stile F, Gargiulo G, Esposito M, Alvaro R, Rea T. Sexual Health After Acute Myocardial Infarction: The Lived Experience of Women During the First-Year Post Discharge. SEXUALITY AND DISABILITY 2020. [DOI: 10.1007/s11195-020-09627-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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The Effect of Modified Cardiac Rehabilitation on Erectile Dysfunction and Coping with Stress in Men Undergoing Coronary Artery Bypass Graft (CABG): A Clinical Trial. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09578-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Wang P, Ai J, Davidson PM, Slater T, Du R, Chen C. Nurses' attitudes, beliefs and practices on sexuality for cardiovascular care: A cross-sectional study. J Clin Nurs 2018; 28:980-986. [PMID: 30338867 DOI: 10.1111/jocn.14692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/21/2018] [Accepted: 09/30/2018] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To describe nurses' attitudes, beliefs, and practices regarding sexuality care for patients with cardiovascular disease. BACKGROUND Limited sexual activity is common among patients with cardiovascular disease, yet assessment of sexuality and counselling is frequently not undertaken by nurses. DESIGN Cross-sectional study. METHODS This study recruited 268 cardiac nurses from seven tertiary hospitals in five cities of Henan province. The Sexual Attitudes and Beliefs Survey, along with investigator-developed questions regarding practices and perceived barriers, was administered to the nurses. The STROBE checklist was used to ensure quality reporting during this observational study (see Supporting Information Data S1). RESULTS The average age of nurses who participated was 31.81 years (SD = 7.41). The average score of Sexual Attitudes and Beliefs Survey was 47.72 (SD = 7.40), indicating moderate attitudinal barriers for nurses to discuss sexual activities with patients. Most nurses (91%) perceived that sexuality was too private to discuss with patients. Only 20% of nurses expressed that they would provide time to discuss sexual concerns with patients. Eighty per cent of nurses revealed that they felt uncomfortable discussing sexuality; moreover, they believed that hospitalised patients were too sick to be engaged in these types of conversations. Additionally, almost 85% of nurses conveyed that they have never conducted discussions regarding sexuality care in patients with cardiovascular disease. The most frequently reported perceived barriers preventing nurses from discussing sexual concerns included fear of offending patients (77.2%), uncertainty of how to communicate with patients (69.4%), feelings of embarrassment (67.5%), lack of safe and private environments (61.9%) and lack of knowledge (54.9%). CONCLUSION Nurses in this cross-sectional sample rarely discussed sexual concerns with their patients. There were several key barriers identified by nurses regarding providing sexuality care, including personal attitudes and beliefs, limited skills and knowledge, culture and organizational-related barriers. RELEVANCE TO CLINICAL PRACTICE Targeted training for nurses and creating a culturally safe environment is recommended to improve management of sexuality in patients with CVD.
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Affiliation(s)
- Panpan Wang
- School of Nursing, Zhengzhou University, Zhengzhou, China.,Nursing Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiansai Ai
- Nursing Department, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Patricia M Davidson
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Tammy Slater
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Ruofei Du
- Nursing Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changying Chen
- School of Nursing, Zhengzhou University, Zhengzhou, China.,Nursing Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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15
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Abstract
BACKGROUND Sexual activity after myocardial infarction (MI) is a concern for patients and often a challenge for health care professionals to address. It is widely recognized that most patients, of both sexes, report sexual problems or concerns after MI. However, there are reported differences between men and women. Women with sexual concerns may seek less help from health care providers and are more inclined to conceal them because of cultural barriers. OBJECTIVE The aim of the current study is to present a comprehensive review of the literature describing women's sexual issues after MI. METHOD A systematic search of the relevant literature was performed within international databases, including PubMed/Medline, Scopus, ScienceDirect, and ProQuest, as well as Google Scholar using relevant keywords. Also, Persian electronic databases such as Magiran, Scientific Information Databases, and Iran Medex were searched from the inception to October 2014. Articles focusing on the sexual issues after MI only in women, as well as articles on both sexes where women's results could be separated, were included in this review. RESULTS A total of 8 articles were included in the final dataset. The main themes of women's sexual concerns after MI were "loss or decrease of sexual activity," "dissatisfaction of sexual relationship," "doubt about resumption time of sexual activity," "fear of reinfarction or sudden death during sexual activity after MI," "knowledge deficit regarding sexual activity after MI," and "poor performance of health care providers in sexual counseling." DISCUSSION The results of this review demonstrate that women's post-MI sexual activity is affected by many concerns. The concerns may be a knowledge deficit related to not receiving necessary consultation on this topic. Nurses, as first-line care givers, can provide appropriate consultation and education for patients post-MI. As a result, breaking taboo imposed by cultural barriers, personal assumptions, or lack of confidence on giving sexual consultation may ultimately help patients to improve their quality of life.
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16
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Arenhall E, Eriksson M, Nilsson U, Steinke EE, Fridlund B. Decreased sexual function in partners after patients’ first-time myocardial infarction. Eur J Cardiovasc Nurs 2018; 17:521-526. [DOI: 10.1177/1474515117751904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied. Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner. Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics. Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency. Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction.
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Affiliation(s)
- Eva Arenhall
- Department of Cardiology, Örebro University, Sweden
- School of Medical Sciences, Örebro University, Sweden
| | - Mats Eriksson
- School of Health Sciences, Örebro University, Sweden
| | | | | | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Sweden
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Rundblad L, Zwisler AD, Johansen PP, Holmberg T, Schneekloth N, Giraldi A. Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study. J Sex Med 2017; 14:785-796. [PMID: 28583340 DOI: 10.1016/j.jsxm.2017.04.673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/26/2017] [Accepted: 04/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ischemic heart disease and heart failure often lead to sexual difficulties in men, but little is known about the sexual difficulties in women and patients with other heart diagnoses or the level of information patients receive about the risk of sexual difficulties. AIM To investigate perceived sexual difficulties and associated factors in a mixed population of men and women newly diagnosed with heart disease and provide insight into sexual counseling and information given by health care professionals. METHODS This article reports on a cross-sectional, questionnaire study sent to a randomly selected sample of men and women newly diagnosed with heart failure, ischemic heart disease, atrial fibrillation, or heart valve surgery. Eligible patients were identified by diagnosis using the Danish National Patient Register, which contains all diagnoses. OUTCOMES Sexual difficulties were self-reported using single-item questions, and factors associated with sexual difficulties were collected from the survey and national registers. RESULTS The study population consisted of 1,549 men and 807 women (35-98 years old) with heart failure (n = 243), ischemic heart disease (n = 1,036), heart valve surgery (n = 375), and atrial fibrillation (n = 702). Sexual difficulties were reported by 55% of men and 29% of women. In a multiple regression analysis, difficulties in men were associated with being older (≥75 years old; odds ratio [OR] = 1.97, 95% CI = 1.13-3.43), having heart failure (OR = 2.07, 95% CI = 1.16-3.71), diabetes (OR = 1.80, 95% CI = 1.15-2.82), hypertension (OR = 1.43, 95% CI = 1.06-1.93), receiving β-blockers (OR = 1.37, 95% CI = 1.02-1.86), or having anxiety (OR = 2.25, 95% CI = 1.34-3.80) or depression (OR = 2.74, 95% CI = 1.38-5.43). In women, difficulties were significantly associated with anxiety (OR = 3.00, 95% CI = 1.51-5.95). A total of 48.6% of men and 58.8% of women did not feel informed about sexuality, and 18.1% of men and 10.3% of women were offered sexual counseling. CLINICAL IMPLICATIONS Heart disease increases the risk of sexual difficulties and there is a need for improved information and counseling about sex and relationships for patients. STRENGTHS AND LIMITATIONS This large nationwide survey of men and women combined a survey with administrative data from national registries. However, this study used non-validated single-item questions to assess sexual difficulties without addressing sexual distress. CONCLUSION More than half the men and one fourth the women across common heart diagnoses had sexual difficulties. No difference was found among diagnoses, except heart failure in men. Despite guidelines recommending sexual counseling, sexual difficulties were not met by sufficient information and counseling. Rundblad L, Zwisler AD, Johansen PP, et al. Perceived Sexual Difficulties and Sexual Counseling in Men and Women Across Heart Diagnoses: A Nationwide Cross-Sectional Study. J Sex Med 2017;14:785-796.
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Affiliation(s)
- Lucas Rundblad
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark and University Hospital Odense, Nyborg, Denmark; Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Ann Dorthe Zwisler
- Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark and University Hospital Odense, Nyborg, Denmark
| | - Pernille Palm Johansen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Teresa Holmberg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Nanna Schneekloth
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Reese JB, Beach MC, Smith KC, Bantug ET, Casale KE, Porter LS, Bober SL, Tulsky JA, Daly MB, Lepore SJ. Effective patient-provider communication about sexual concerns in breast cancer: a qualitative study. Support Care Cancer 2017; 25:3199-3207. [PMID: 28451911 PMCID: PMC5803445 DOI: 10.1007/s00520-017-3729-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/17/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Breast cancer patients commonly experience sexual concerns, yet rarely discuss them with clinicians. The study examined patient and provider experiences and preferences related to communication about breast cancer-related sexual concerns with the goal of informing intervention development. METHODS Patient data (n = 28) were derived from focus groups and interviews with partnered and unpartnered women treated for breast cancer reporting sexual concerns. Provider data (n = 11) came from interviews with breast cancer oncologists and nurse practitioners. Patient and provider data were analyzed separately using the framework method of qualitative analysis. RESULTS Findings revealed individual and institutional barriers to effective communication about sexual concerns and highlighted key communication facilitators (e.g., a positive patient-provider relationship, patient communication as a driver of provider communication, and vice versa). Patients expressed preferences for open, collaborative communication; providers expressed preferences for focused intervention targets (identifying concerns, offering resources/referrals) and convenient format. A model of effective communication of sexual concerns was developed to inform communication interventions. CONCLUSIONS Findings suggest that to improve patient-provider communication about sexual concerns, knowledge and skills-based interventions that activate patients and that equip providers for effective discussions about sexual concerns are needed, as are institutional changes that could incentivize such discussions.
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Affiliation(s)
- Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave., 4th Floor, Young Pavilion, Philadelphia, PA, 19111, USA.
| | - Mary Catherine Beach
- Department of Medicine, Johns Hopkins School of Medicine, 2024 E. Monument St., Baltimore, MD, 21205, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 726, Baltimore, MD, 21205, USA
| | - Elissa T Bantug
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, EB-1650 Orleans St CRB-1 189, Baltimore, MD, 21287, USA
| | - Kristen E Casale
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave., 4th Floor, Young Pavilion, Philadelphia, PA, 19111, USA
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, DUMC 90399, Durham, NC, 27708, USA
| | - Sharon L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, Shields-Warren 320, Boston, MA, 02215, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, DA-2016A, Boston, MA, 02215, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Ave., 4th Floor, Young Pavilion, Philadelphia, PA, 19111, USA
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave., Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
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The Influence of Comorbidities, Risk Factors, and Medications on Sexual Activity in Individuals Aged 40 to 59 Years With and Without Cardiac Conditions: US National Health and Nutrition Examination Survey, 2011 to 2012. J Cardiovasc Nurs 2017; 33:118-125. [PMID: 28661990 DOI: 10.1097/jcn.0000000000000433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexual activity is increasingly recognized as an important aspect of quality of life for many individuals with cardiovascular disease, although less is known about the factors contributing to sexual functioning in younger adults. OBJECTIVE This study examined factors influencing sexual activity in individuals aged 40 to 59 years, comparing those reporting a cardiac condition with those without a cardiac condition, in a national population-based sample. METHODS The data were derived from the 2011 to 2012 National Health and Nutrition Examination Survey, a publicly available data set with a noninstitutionalized nationally representative sample. The sample included individuals between the ages of 40 and 59 years (N = 1741) who completed relevant items related to cardiovascular disease, cardiovascular risk factors, comorbidities, cardiac symptoms, sexual activity, and medication use. Recommended weighting was applied, and the data were analyzed using χ and logistic regression. RESULTS Overall, 94% of the sample reported sexual activity, although those with coronary artery disease, angina, and myocardial infarction engaged in significantly less sexual activity. Individuals who smoked; had a weight problem, depression, or lung problems; or experienced symptoms of shortness of breath or chest pain with exertion reported less sexual activity. Medications negatively affecting sexual function were central α agonists, potassium sparing diuretics, and antilipidemic agents. Predictors of less sexual activity were smoking, chest pain walking uphill, and weight problems. Unexpectedly more reported, sexual activity was predicted by one or more cardiac conditions. CONCLUSION In men and women ages 40 to 59 years, certain cardiac conditions, risk factors, comorbidities, symptoms, and medications negatively affected sexual activity, illustrating the need for sexual assessment and counseling to support sexual quality of life.
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Bdair IAA, ConsTantino RE. Barriers and Promoting Strategies to Sexual Health Assessment for Patients with Coronary Artery Diseases in Nursing Practice: A Literature Review. Health (London) 2017. [DOI: 10.4236/health.2017.93034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kałka D, Gebala J, Borecki M, Pilecki W, Rusiecki L. Return to sexual activity after myocardial infarction - An analysis of the level of knowledge in men undergoing cardiac rehabilitation. Eur J Intern Med 2017; 37:e31-e33. [PMID: 27697352 DOI: 10.1016/j.ejim.2016.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Dariusz Kałka
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, ul. K. Marcinkowskiego 1, 50-368 Wrocław, Poland; Centre for Men's Health in Wroclaw, ul. Saperów 19/21, 53-151 Wrocław, Poland.
| | - Jana Gebala
- Centre for Men's Health in Wroclaw, ul. Saperów 19/21, 53-151 Wrocław, Poland; Cardiosexology Students' Scientific Club, Wrocław Medical University, ul. K. Marcinkowskiego 1, 50-368 Wrocław, Poland.
| | - Michael Borecki
- Cardiosexology Students' Scientific Club, Wrocław Medical University, ul. K. Marcinkowskiego 1, 50-368 Wrocław, Poland.
| | - Witold Pilecki
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, ul. K. Marcinkowskiego 1, 50-368 Wrocław, Poland.
| | - Lesław Rusiecki
- Cardiosexology Unit, Department of Pathophysiology, Wrocław Medical University, ul. K. Marcinkowskiego 1, 50-368 Wrocław, Poland.
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Trompeter SE, Bettencourt R, Barrett-Connor E. Metabolic Syndrome and Sexual Function in Postmenopausal Women. Am J Med 2016; 129:1270-1277.e1. [PMID: 27132570 PMCID: PMC5086302 DOI: 10.1016/j.amjmed.2016.03.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Limited literature suggests that sexual dysfunction in women covaries with the metabolic syndrome. This study examined the association of sexual function with metabolic syndrome and cardiovascular disease in healthy older women. METHODS There were 376 postmenopausal, community-dwelling women from the Rancho Bernardo Study (mean baseline age = 73 years) that completed a clinic visit during 1999-2002 and returned the Female Sexual Function Index (FSFI) questionnaire mailed in 2002. RESULTS Thirty-nine percent reported being sexually active; 41.5% met a diagnosis of metabolic syndrome. The number of metabolic syndrome components was strongly associated with decreased sexual activity, desire, and low sexual satisfaction. Waist girth, diabetes, and hypertension were associated with decreased sexual activity. Elevated triglycerides were associated with low desire. Among the cardiovascular endpoints, heart attack, coronary artery bypass, and angina were associated with decreased sexual activity, but not with sexual desire or satisfaction. Past diagnosis of heart failure, poor circulation, and stroke were not associated with sexual function. Sexually active women with metabolic syndrome met criteria for sexual dysfunction in desire, arousal, orgasm, and satisfaction domains. The FSFI Total Score did not differ significantly between sexually active and inactive women. CONCLUSIONS Metabolic syndrome was associated with decreased sexual activity, desire, and satisfaction in all women and with sexual dysfunction in most domains in sexually active women. Coronary artery disease was more prevalent in women with low sexual activity.
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Affiliation(s)
- Susan E Trompeter
- Division of General Internal Medicine, Department of Medicine, University of California, San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Ricki Bettencourt
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
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23
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Lindau ST, Abramsohn E, Bueno H, D'Onofrio G, Lichtman JH, Lorenze NP, Sanghani RM, Spatz ES, Spertus JA, Strait KM, Wroblewski K, Zhou S, Krumholz HM. Sexual Activity and Function in the Year After an Acute Myocardial Infarction Among Younger Women and Men in the United States and Spain. JAMA Cardiol 2016; 1:754-764. [PMID: 27579897 PMCID: PMC5459405 DOI: 10.1001/jamacardio.2016.2362] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Most younger adults who experience an acute myocardial infarction (AMI) are sexually active before the AMI, but little is known about sexual activity or sexual function after the event. Objective To describe patterns of sexual activity and function and identify indicators of the probability of loss of sexual activity in the year after AMI. Design, Setting, and Participants Data from the prospective, multicenter, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study (conducted from August 21, 2008, to January 5, 2012) were assessed at baseline, 1 month, and 1 year. Participants were from US (n = 103) and Spanish (n = 24) hospitals and completed baseline and all follow-up interviews. Data analysis for the present study was conducted from October 15, 2014, to June 6, 2016. Characteristics associated with loss of sexual activity were assessed using multinomial logistic regression analyses. Main Outcomes and Measures Loss of sexual activity after AMI. Results Of the 2802 patients included in the analysis, 1889 were women (67.4%); median (25th-75th percentile) age was 49 (44-52) years (range, 18-55 years). At all time points, 637 (40.4%) of women and 437 (54.9%) of men were sexually active. Among people who were active at baseline, men were more likely than women to have resumed sexual activity by 1 month (448 [63.9%] vs 661 [54.5%]; P < .001) and by 1 year (662 [94.4%] vs 1107 [91.3%]; P = .01) after AMI. Among people who were sexually active before and after AMI, women were less likely than men to report no sexual function problems in the year after the event (466 [40.3%] vs 382 [54.8%]; P < .01). In addition, more women than men (211 [41.9%] vs 107 [30.5%]; P < .01) with no baseline sexual problems developed 1 or more incident problems in the year after the AMI. At 1 year, the most prevalent sexual problems were lack of interest (487 [39.6%]) and trouble lubricating (273 [22.3%]) among women and erectile difficulties (156 [21.7%]) and lack of interest (137 [18.8%]) among men. Those who had not communicated with a physician about sex in the first month after AMI were more likely to delay resuming sex (adjusted odds ratio [AOR], 1.51; 95% CI, 1.11-2.05; P = .008). Higher stress levels (AOR, 1.36; 95% CI, 1.01-1.83) and having diabetes (AOR, 1.90; 95% CI, 1.15-3.13) were significant indicators of the probability of loss of sexual activity in the year after the AMI. Conclusions and Relevance Impaired sexual activity and incident sexual function problems were prevalent and more common among young women than men in the year after AMI. Attention to modifiable risk factors and physician counseling may improve outcomes.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois2Department of Medicine-Geriatrics, University of Chicago, Chicago, Illinois3University of Chicago Comprehensive Cancer Center, Chicago, Illinois4The MacLean Center on Clinical Medical Ethics, University of Chicago, Illinois
| | - Emily Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Instituto de investigación i+12, Madrid, Spain6Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | - Gail D'Onofrio
- Yale University School of Medicine, New Haven, Connecticut
| | - Judith H Lichtman
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Nancy P Lorenze
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Rupa Mehta Sanghani
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Erica S Spatz
- Yale University School of Medicine, New Haven, Connecticut
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri12University of Missouri-Kansas City, Kansas City, Missouri
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Shengfan Zhou
- Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut16Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut17Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut18Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
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Son YJ, Jang M, Jun EY. Prevalence of Erectile Dysfunction and Associated Factors in Korean Older Adults With Coronary Artery Disease. J Gerontol Nurs 2016; 42:32-41. [PMID: 27379456 DOI: 10.3928/00989134-20160701-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 06/10/2016] [Indexed: 12/21/2022]
Abstract
The current study aimed to identify the prevalence and associated factors of erectile dysfunction (ED) among 161 Korean adults 60 and older with coronary artery disease (CAD). ED was diagnosed in 72.2% of patients-the prevalence of which was significantly associated with age, education, employment, monthly income, frequency of sexual intercourse, body mass index, and low-density lipoprotein. Health-related quality of life (HRQoL) was lower in patients with ED than in those without ED (p < 0.001). Hierarchical multiple regression analysis revealed that ED significantly influenced HRQoL in patients with CAD after adjusting for sociodemographic and disease-related characteristic variables (p < 0.001). Interventions and training courses for health care providers should focus on improving caregivers' knowledge and communication skills with patients and spouses regarding sexual health. Furthermore, guidelines to improve HRQoL in patients with CAD should consider incorporating sexual counseling. [Journal of Gerontological Nursing, 42(10), 32-41.].
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25
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Flynn KE, Lin L, Bruner DW, Cyranowski JM, Hahn EA, Jeffery DD, Reese JB, Reeve BB, Shelby RA, Weinfurt KP. Sexual Satisfaction and the Importance of Sexual Health to Quality of Life Throughout the Life Course of U.S. Adults. J Sex Med 2016; 13:1642-1650. [PMID: 27671968 DOI: 10.1016/j.jsxm.2016.08.011] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/16/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Discussions about sexual health are uncommon in clinical encounters, despite the sexual dysfunction associated with many common health conditions. Understanding of the importance of sexual health and sexual satisfaction in U.S. adults is limited. AIM To provide epidemiologic data on the importance of sexual health for quality of life and people's satisfaction with their sex lives and to examine how each is associated with demographic and health factors. METHODS Data are from a cross-sectional self-report questionnaire from a sample of 3,515 English-speaking U.S. adults recruited from an online panel that uses address-based probability sampling. MAIN OUTCOME MEASURES We report ratings of importance of sexual health to quality of life (single item with five-point response) and the Patient-Reported Outcomes Measurement Information System Satisfaction With Sex Life score (five items, each with five-point responses, scores centered on the U.S. mean). RESULTS High importance of sexual health to quality of life was reported by 62.2% of men (95% CI = 59.4-65.0) and 42.8% of women (95% CI = 39.6-46.1, P < .001). Importance of sexual health varied by sex, age, sexual activity status, and general self-rated health. For the 55% of men and 45% of women who reported sexual activity in the previous 30 days, satisfaction with sex life differed by sex, age, race-ethnicity (among men only), and health. Men and women in excellent health had significantly higher satisfaction than participants in fair or poor health. Women with hypertension reported significantly lower satisfaction (especially younger women), as did men with depression or anxiety (especially younger men). CONCLUSION In this large study of U.S. adults' ratings of the importance of sexual health and satisfaction with sex life, sexual health was a highly important aspect of quality of life for many participants, including participants in poor health. Moreover, participants in poorer health reported lower sexual satisfaction. Accordingly, sexual health should be a routine part of clinicians' assessments of their patients. Health care systems that state a commitment to improving patients' overall health must have resources in place to address sexual concerns. These resources should be available for all patients across the lifespan.
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Affiliation(s)
- Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Li Lin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diana D Jeffery
- Defence Health Agency, Department of Defense-Health Affairs, Falls Church, VA, USA
| | - Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA; Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences Duke University School of Medicine, Durham, NC, USA
| | - Kevin P Weinfurt
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences Duke University School of Medicine, Durham, NC, USA
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Lim SK, Sim DS, Han JY. The factors associated with sexual recovery in male patients with acute myocardial infarction under phase II cardiac rehabilitation. J Clin Nurs 2016; 25:2827-34. [DOI: 10.1111/jocn.13324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Seung-Kyu Lim
- Department of Rehabilitation Medicine; Presbyterian Medical Center (Jesus Hospital); Jeonju Korea
| | - Doo sun Sim
- Department of Cardiovascular Medicine; Heart Research Center; Chonnam National University Medical School & Hospital; Gwangju City Korea
| | - Jae-Young Han
- Department of Physical & Rehabilitation Medicine; Regional Cardiocerebro Vascular Center; Center for Aging and Geriatrics; Chonnam National University Medical School & Hospital; Gwangju City Korea
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27
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Murphy PJ, Mc Sharry J, Casey D, Doherty S, Gillespie P, Jaarsma T, Murphy AW, Newell J, O'Donnell M, Steinke EE, Toomey E, Byrne M. Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention. BMJ Open 2016; 6:e011219. [PMID: 27342240 PMCID: PMC4932312 DOI: 10.1136/bmjopen-2016-011219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. METHODS AND ANALYSIS This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. ETHICS AND DISSEMINATION This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations.
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Affiliation(s)
- Patrick J Murphy
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, NUI Galway, Ireland
| | - Sally Doherty
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | | | - John Newell
- HRB Clinical Research Facility, NUI Galway, Ireland
| | | | | | - Elaine Toomey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Ireland
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Montorsi P, Ravagnani PM, Vlachopoulos C. Clinical significance of erectile dysfunction developing after acute coronary event: exception to the rule or confirmation of the artery size hypothesis? Asian J Androl 2016; 17:21-5. [PMID: 25337840 PMCID: PMC4291870 DOI: 10.4103/1008-682x.139254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Erectile dysfunction (ED) has been found to frequently precedes the onset of coronary artery disease (CAD), representing an early marker of subclinical vascular disease, included CAD. Its recognition is, therefore, a "window opportunity" to prevent a coronary event by aggressive treatment of cardiovascular risk factors. The artery size hypothesis (ASH) has been proposed as a putative mechanism to explain the relationship between ED and CAD. Since atherosclerosis is a systemic disorder all major vascular beds should be affected to the same extent. However, symptoms at different points in the system rarely become evident at the same time. This is likely the result of smaller vessels (i.e. the penile artery) being able to less well tolerate the same amount of plaque when compared with larger ones (i.e. the coronary artery). If true, ED will develop before CAD. We present a case in which ED developed after a coronary event yet before a coronary recurrence potentially representing a late marker of vascular progression. Reasons for this unusual sequence are discussed as they might still fit the ASH.
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Affiliation(s)
- Piero Montorsi
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Steptoe A, Jackson SE, Wardle J. Sexual activity and concerns in people with coronary heart disease from a population-based study. Heart 2016; 102:1095-9. [PMID: 27126394 PMCID: PMC4941181 DOI: 10.1136/heartjnl-2015-308993] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/18/2016] [Indexed: 12/28/2022] Open
Abstract
Objective Sexual activity is a central component of intimate relationships, but sexual function may be impaired by coronary heart disease (CHD). There have been few representative population-based comparisons of sexual behaviour and concerns in people with and without CHD. We therefore investigated these issues in a large nationally representative sample of older people. Methods We analysed cross-sectional data from 2979 men and 3711 women aged 50 and older from the English Longitudinal Study of Ageing. Sexual behaviour and concerns were assessed by validated self-completion questionnaire and analyses were weighted for non-response. Covariates included age, partnerships status and comorbidities. Results There were 376 men and 279 women with CHD. Men with CHD were less likely to be sexually active (68.7% vs 80.0%, adjusted OR 0.62, 95% CI 0.47 to 0.81), thought less about sex (74.7% vs 81.9%, OR 0.72, CI 0.54 to 0.95), and reported more erectile difficulties (47.4% vs 38.1%, OR 1.46, CI 1.10 to 1.93) than men without CHD. Effects were more pronounced among those diagnosed within the past 4 years. Women diagnosed <4 years ago were also less likely to be sexually active (35.4% vs 55.6%, OR 0.44, CI 0.23 to 0.84). There were few differences in concerns about sexual activity. Cardiovascular medication showed weak associations with erectile dysfunction. Conclusions There is an association between CHD and sexual activity, particularly among men, but the impact of CHD is limited. More effective advice after diagnosis might reverse the reduction in sexual activity, leading to improved quality of life.
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Affiliation(s)
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sarah E Jackson
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation 2016; 133:916-47. [PMID: 26811316 DOI: 10.1161/cir.0000000000000351] [Citation(s) in RCA: 763] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.
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Flynn KE, Lindau ST, Lin L, Reese JB, Jeffery DD, Carter J, Baron SR, Abramsohn E, Weinfurt KP. Development and Validation of a Single-Item Screener for Self-Reporting Sexual Problems in U.S. Adults. J Gen Intern Med 2015; 30:1468-75. [PMID: 25893421 PMCID: PMC4579234 DOI: 10.1007/s11606-015-3333-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/12/2015] [Accepted: 03/30/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Brief self-assessment of sexual problems in a clinical context has the potential to improve care for patients through the ability to track trends in sexual problems over time and facilitate patient-provider communication about this important topic. However, instruments designed for research are typically too long to be practical in clinical practice. OBJECTIVE To develop and validate a single-item self-report clinical screener that would capture common sexual problems and concerns for men and women. DESIGN We created three candidate screener items, refined them through cognitive interviews, and administered them to a large sample. We compared the prevalence of responses to each item and explored the discrepancies between items. We evaluated the construct validity of the items by comparing them to scores on the Patient-Reported Outcomes Measurement Information System® Sexual Function and Satisfaction (PROMIS® SexFS) measure. PARTICIPANTS Local patients participated in two rounds of cognitive interviews (n = 7 and n = 11). A probability-based random sample of U.S. adults comprised the item-testing sample (n = 3517). MAIN MEASURES The items were as follows: 1) a yes/no item on any sexual problems or concerns ("general screener"), 2) a yes/no item on problems experienced for 3 months or more during the past 12 months, with a list of examples ("long list screener"), and 3) an item identical to the long list screener except that examples appeared individually as response options and respondents could check all that applied ("checklist screener"). KEY RESULTS All of the screeners tested showed evidence for basic validity and had minimal missing data. Percentages of women and men endorsing the screeners were 10 % and 15 % (general); 20 % and 17 % (long list); and 38 % and 30 % (checklist), respectively. Participants who endorsed the screeners had lower function compared to those who did not endorse them. CONCLUSIONS We recommend the checklist screener for its specificity and ability to identify specific problems associated with decreased sexual function.
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Affiliation(s)
- Kathryn E Flynn
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, 53226, USA.
| | - Stacy Tessler Lindau
- Department of Obstetrics/Gynecology, University of Chicago, Chicago, IL, USA.,Department of Medicine-Geriatrics, Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Li Lin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer Barsky Reese
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Diana D Jeffery
- Defense Health Agency, Department of Defense, Falls Church, VA, USA
| | - Jeanne Carter
- Departments of Surgery and Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirley R Baron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Abramsohn
- Department of Obstetrics/Gynecology, University of Chicago, Chicago, IL, USA
| | - Kevin P Weinfurt
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Rothenbacher D, Dallmeier D, Mons U, Rosamond W, Koenig W, Brenner H. Sexual Activity Patterns Before Myocardial Infarction and Risk of Subsequent Cardiovascular Adverse Events. J Am Coll Cardiol 2015; 66:1516-7. [DOI: 10.1016/j.jacc.2015.07.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022]
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Steinke EE, Mosack V, Hill TJ. Change in sexual activity after a cardiac event: the role of medications, comorbidity, and psychosocial factors. Appl Nurs Res 2015; 28:244-50. [DOI: 10.1016/j.apnr.2015.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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Longitudinal Trends in Sexual Behaviors with Advancing Age and Menopause Among Women With and Without HIV-1 Infection. AIDS Behav 2015; 19:931-40. [PMID: 25245474 DOI: 10.1007/s10461-014-0901-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
We assessed changes in self-reported sexual activity (SA) over 13 years among HIV-infected and uninfected women. The impact of aging and menopause on SA and unprotected anal or vaginal intercourse (UAVI) was examined among women in the Women's Interagency HIV Study (WIHS), stratifying by HIV status and detectable viral load among HIV-infected women. Generalized mixed linear models were fitted for each outcome, adjusted for relevant covariates. HIV-uninfected women evidenced higher levels of SA and UAVI than HIV-infected. The odds of SA declined by 62-64 % per decade of age. The odds of SA in a 6-month interval for women aged 40-57 declined by 18-22 % post-menopause (controlling for age). Among HIV+/detectable women only, the odds of any UAVI decreased by 17 % per decade of age; the odds of UAVI were unchanged pre-menopause, and then decreased by 28 % post-menopause. Elucidating the factors accounting for ongoing unprotected sex among older women should inform interventions.
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Intimate relationships and sexual function in partnered patients in the year before and one year after a myocardial infarction: A longitudinal study. Eur J Cardiovasc Nurs 2015; 14:468-77. [DOI: 10.1177/1474515115571061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/14/2015] [Indexed: 01/23/2023]
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Lindau ST, Abramsohn EM, Bueno H, D'Onofrio G, Lichtman JH, Lorenze NP, Mehta Sanghani R, Spatz ES, Spertus JA, Strait K, Wroblewski K, Zhou S, Krumholz HM. Sexual activity and counseling in the first month after acute myocardial infarction among younger adults in the United States and Spain: a prospective, observational study. Circulation 2014; 130:2302-9. [PMID: 25512442 DOI: 10.1161/circulationaha.114.012709] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND United States and European cardiovascular society guidelines recommend physicians counsel patients about resuming sexual activity after acute myocardial infarction (AMI), but little is known about patients' experience with counseling about sexual activity after AMI. METHODS AND RESULTS The prospective, longitudinal Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, conducted at 127 hospitals in the United States and Spain, was designed, in part, to evaluate gender differences in baseline sexual activity, function, and patient experience with physician counseling about sexual activity after an AMI. This study used baseline and 1-month data collected from the 2:1 sample of women (N=2349) and men (N=1152) ages 18 to 55 years with AMI. Median age was 48 years. Among those who reported discussing sexual activity with a physician in the month after AMI (12% of women, 19% of men), 68% were given restrictions: limit sex (35%), take a more passive role (26%), and/or keep the heart rate down (23%). In risk-adjusted analyses, factors associated with not discussing sexual activity with a physician included female gender (relative risk, 1.07; 95% confidence interval, 1.03-1.11), age (relative risk, 1.05 per 10 years; 95% confidence interval, 1.02-1.08), and sexual inactivity at baseline (relative risk, 1.11; 95% confidence interval, 1.08-1.15). Among patients who received counseling, women in Spain were significantly more likely to be given restrictions than U.S. women (relative risk; 1.36, 95% confidence interval, 1.11-1.66). CONCLUSIONS Very few patients reported counseling for sexual activity after AMI. Those who did were commonly given restrictions not supported by evidence or guidelines. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00597922.
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Affiliation(s)
- Stacy Tessler Lindau
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.).
| | - Emily M Abramsohn
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Héctor Bueno
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Gail D'Onofrio
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Judith H Lichtman
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Nancy P Lorenze
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Rupa Mehta Sanghani
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Erica S Spatz
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - John A Spertus
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Kelly Strait
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Kristen Wroblewski
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Shengfan Zhou
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Harlan M Krumholz
- From the Department of Obstetrics and Gynecology, Program in Integrative Sexual Medicine (S.T.L., E.M.A.), and the Department of Medicine-Geriatrics, The MacLean Center on Clinical Medical Ethics, Chicago Core on Biomeasures in Population-Based Aging Research at the NORC Chicago Center on Demography and Economics of Aging (S.T.L.), University of Chicago, Chicago, IL; Department of Cardiology, Hospital General Universitario Gregorio Marañón, and Instituto de Investigación Gregorio Marañón, and Universidad Complutense de Madrid, Madrid, Spain (H.B.); Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT (G.D.); Yale School of Public Health, New Haven, CT (J.H.L.); Center for Outcomes Research and Evaluation, Yale University, New Haven, CT (N.P.L., E.S.S., K.S., S.Z., H.M.K.); Department of Medicine, Section of Cardiology, University of Chicago, Chicago, IL (R.M.S.); Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); Yale University/Yale-New Haven Hospital, New Haven, CT (E.S.S., K.S., H.M.K.); Saint Luke's Mid America Heart Institute/University of Missouri - Kansas City, Kansas City, MO (J.A.S.); Department of Health Studies, University of Chicago, Chicago, IL (K.W.); Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Health services research in obstetrics and gynecology: the legacy of the Robert Wood Johnson Foundation Clinical Scholars. Curr Opin Obstet Gynecol 2014; 26:545-9. [PMID: 25310530 DOI: 10.1097/gco.0000000000000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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López-Medina IM, Gil-García E, Sánchez-Criado V, Pancorbo-Hidalgo PL. Patients’ Experiences of Sexual Activity Following Myocardial Ischemia. Clin Nurs Res 2014; 25:45-66. [DOI: 10.1177/1054773814534440] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this article is to describe patients’ experiences of sexual activity after suffering myocardial ischemia. We conducted semi-structured qualitative interviews with people who had suffered myocardial ischemia in the last 6 to 24 months before the interview. We used maximum variation sampling method. After reaching theoretical saturation, a 19-informants sample was formed. Data were analyzed using the Giorgi method. Four themes were identified: “sexual activity becomes different,” “determinants of the return to sexual activity,” “how sexual activity ought to be,” and “sexual information received.” Patients showed a decrease both in frequency and desire for sexual activity influenced by fear of sexual activity and health care professionals’ recommendations. These recommendations were about “avoiding sexuality at the beginning” and conducting “sexual activity without overdoing it.” Health care professionals should educate patients about the right time to resume sexual activity. Nurses can help patients to deal with fears related to sexual activity.
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Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endocrinol 2014; 2014:878670. [PMID: 24744785 PMCID: PMC3976909 DOI: 10.1155/2014/878670] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/06/2014] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
Erectile dysfunction (ED) is one of the most common chronic diseases affecting men and its prevalence increases with aging. It is also the most frequently diagnosed sexual dysfunction in the older male population. A number of different diseases potentially worsening sexual function may occur in elderly people, together with polypharmacy. Related causes of ED are variable and can include arterial, neurogenic, hormonal, cavernosal, iatrogenic, and psychogenic causes. The aim of the present review was to examine the main aspects of erectile dysfunction going through epidemiology and pathophysiology and revise most of ED in elderly disabled men and in those affected with psychiatric disorders. Lastly we tried to focus on the main aspects of nonpharmacological and pharmacological treatments of ED and the recreational use in the elderly. Phosphodiesterase-5 inhibitors (PDE5-I) are commonly used for on-demand or chronic treatment of ED. It is widely known that PDE5-I have lower response rates in older men than in younger patients, but they have the advantages of ease of use and excellent safety profile, also in the elderly. The old and new PDE5-I as well as the alternative treatments for ED are extensively discussed.
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Affiliation(s)
- Pietro Gareri
- Elderly Health Care, ASP Catanzaro, Via Spasari, 3, 88100 Catanzaro, Italy
| | | | - Davide Francomano
- Department of Medical Pathophysiology, "Sapienza" University of Rome, 00198 Rome, Italy
| | - Gregorio Cerminara
- Department of Science of Health, School of Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy ; Psychiatry Unit, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
| | - Pasquale De Fazio
- Department of Science of Health, School of Medicine, University "Magna Græcia" of Catanzaro, 88100 Catanzaro, Italy ; Psychiatry Unit, "Mater Domini" University Hospital, 88100 Catanzaro, Italy
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Field N, Mercer CH, Sonnenberg P, Tanton C, Clifton S, Mitchell KR, Erens B, Macdowall W, Wu F, Datta J, Jones KG, Stevens A, Prah P, Copas AJ, Phelps A, Wellings K, Johnson AM. Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet 2013; 382:1830-44. [PMID: 24286788 PMCID: PMC3898988 DOI: 10.1016/s0140-6736(13)62222-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Physical and mental health could greatly affect sexual activity and fulfilment, but the nature of associations at a population level is poorly understood. We used data from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) to explore associations between health and sexual lifestyles in Britain (England, Scotland, and Wales). METHODS Men and women aged 16-74 years who were resident in households in Britain were interviewed between Sept 6, 2010, and Aug 31, 2012. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data for self-reported health status, chronic conditions, and sexual lifestyles, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. FINDINGS Interviews were done with 15,162 participants (6293 men, 8869 women). The proportion reporting recent sexual activity (one or more occasion of vaginal, oral, or anal sex with a partner of the opposite sex, or oral or anal sex or genital contact with a partner of the same sex in the past 4 weeks) decreased with age after the age of 45 years in men and after the age of 35 years in women, while the proportion in poorer health categories increased with age. Recent sexual activity was less common in participants reporting bad or very bad health than in those reporting very good health (men: 35·7% [95% CI 28·6-43·5] vs 74·8% [72·7-76·7]; women: 34·0% [28·6-39·9] vs 67·4% [65·4-69·3]), and this association remained after adjusting for age and relationship status (men: adjusted odds ratio [AOR] 0·29 [95% CI 0·19-0·44]; women: 0·43 [0·31-0·61]). Sexual satisfaction generally decreased with age, and was significantly lower in those reporting bad or very bad health than in those reporting very good health (men: 45·4% [38·4-52·7] vs 69·5% [67·3-71·6], AOR 0·51 [0·36-0·72]; women: 48·6% [42·9-54·3] vs 65·6% [63·6-67·4], AOR 0·69 [0·53-0·91]). In both sexes, reduced sexual activity and reduced satisfaction were associated with limiting disability and depressive symptoms, and reduced sexual activity was associated with chronic airways disease and difficulty walking up the stairs because of a health problem. 16·6% (95% CI 15·4-17·7) of men and 17·2% (16·3-18·2) of women reported that their health had affected their sex life in the past year, increasing to about 60% in those reporting bad or very bad health. 23·5% (20·3-26·9) of men and 18·4% (16·0-20·9) of women who reported that their health affected their sex life reported that they had sought clinical help (>80% from general practitioners; <10% from specialist services). INTERPRETATION Poor health is independently associated with decreased sexual activity and satisfaction at all ages in Britain. Many people in poor health report an effect on their sex life, but few seek clinical help. Sexual lifestyle advice should be a component of holistic health care for patients with chronic ill health. FUNDING Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and Department of Health.
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Affiliation(s)
- Nigel Field
- Research Department of Infection and Population Health, University College London, London, UK.
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Nascimento ER, Maia ACO, Pereira V, Soares-Filho G, Nardi AE, Silva AC. Sexual dysfunction and cardiovascular diseases: a systematic review of prevalence. Clinics (Sao Paulo) 2013; 68:1462-8. [PMID: 24270960 PMCID: PMC3812559 DOI: 10.6061/clinics/2013(11)13] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 06/06/2013] [Indexed: 12/21/2022] Open
Abstract
The aim of this study was to conduct a systematic review of the literature regarding the prevalence of sexual dysfunction in patients with cardiovascular diseases. An article search of the ISI Web of Science and PubMed databases using the search terms "sexual dysfunction", "cardiovascular diseases", "coronary artery disease", "myocardial infarct" and "prevalence" was performed. In total, 893 references were found. Non-English-language and repeated references were excluded. After an abstract analysis, 91 references were included for full-text reading, and 24 articles that evaluated sexual function using validated instruments were selected for this review. This research was conducted in October 2012, and no time restrictions were placed on any of the database searches. Reviews and theoretical articles were excluded; only clinical trials and epidemiological studies were selected for this review. The studies were mostly cross-sectional, observational and case-control in nature; other studies used prospective cohort or randomized clinical designs. In women, all domains of sexual function (desire, arousal, vaginal lubrication, orgasm, sexual dissatisfaction and pain) were affected. The domains prevalent in men included erectile dysfunction and premature ejaculation and orgasm. Sexual dysfunction was related to the severity of cardiovascular disease. When they resumed sexual activity, patients with heart disease reported significant difficulty, including a lack of interest in sex, sexual dissatisfaction and a decrease in the frequency of sexual activity.
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Affiliation(s)
- Elisabete Rodrigues Nascimento
- Laboratory of Panic and Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de JaneiroRJ, Brazil
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Mellor RM, Greenfield SM, Dowswell G, Sheppard JP, Quinn T, McManus RJ. Health care professionals' views on discussing sexual wellbeing with patients who have had a stroke: a qualitative study. PLoS One 2013; 8:e78802. [PMID: 24205318 PMCID: PMC3812130 DOI: 10.1371/journal.pone.0078802] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives To examine the experiences of health care professionals discussing sexual wellbeing with patients who have had a stroke. Design In-depth qualitative interview study with purposive sampling and thematic analysis. Participants 30 health care professionals purposively recruited to include different roles and settings along the stroke patient pathway in secondary and primary care. Setting Two hospitals and three general practices in the West Midlands, UK. Results Sexual wellbeing was a topic that participants did not raise with patients and was infrequently raised by patients. Barriers to raising discussion were on four levels: structural, health care professional, patient, and professional-patient interface. Barriers within these levels included: sexual wellbeing not present within hospital stroke policy; the perception that sexual wellbeing was not within participants' role; participants' concern that raising the issue could cause harm to the patient; and the views that discussion would be inappropriate with older people or unimportant to women. Resources exist to aid discussion but many participants were unaware of them, and most of those that were, did not use them routinely. Conclusions Participants lacked motivation, ownership, and the confidence and skills to raise sexual wellbeing routinely after stroke. Similar findings have been reported in cancer care and other taboo subjects such as incontinence potentially resulting in a sub-optimal experience for patients. Normalisation of the inclusion of sensitive topics in discussions post-stroke does not seem to need significant structural intervention and simple changes such as information provision and legitimisation through consideration of the issue in standard care policies may be all that is required. The experiences recounted by professionals in this study suggest that such changes are needed now.
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Affiliation(s)
- Ruth M. Mellor
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sheila M. Greenfield
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - George Dowswell
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - James P. Sheppard
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Tom Quinn
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Richard J. McManus
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S, Dougherty CM, Fridlund B, Kautz DD, Mårtensson J, Mosack V, Moser DK. Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Eur Heart J 2013; 34:3217-35. [PMID: 23900695 DOI: 10.1093/eurheartj/eht270] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.
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Abramsohn EM, Decker C, Garavalia B, Garavalia L, Gosch K, Krumholz HM, Spertus JA, Lindau ST. "I'm not just a heart, I'm a whole person here": a qualitative study to improve sexual outcomes in women with myocardial infarction. J Am Heart Assoc 2013; 2:e000199. [PMID: 23885024 PMCID: PMC3828784 DOI: 10.1161/jaha.113.000199] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Little is known about recovery of female sexual function following an acute myocardial infarction (MI). Interventions to improve sexual outcomes in women are limited. Methods and Results Semistructured, qualitative telephone interviews were conducted with 17 partnered women (aged 43 to 75 years) purposively selected from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status Registry to deepen knowledge of recovery of female sexual function following an acute myocardial infarction (MI) and to improve sexual outcomes in women. Sixteen women had a monogamous relationship with a male spouse; 1 had a long‐term female partner. Most women resumed sexual activity within 4 weeks of their MI. Sexual problems and concerns were prevalent, including patient and/or partner fear of “causing another heart attack.” Few women received counseling about sexual concerns or the safety of returning to sex. Most women who discussed sex with a physician initiated the discussion themselves. Inquiry about strategies to improve sexual outcomes elicited key themes: need for privacy, patient‐centeredness, and information about the timing and safe resumption of sexual activity. In addition, respondents felt that counseling should be initiated by the treating cardiologist, who “knows whether your heart is safe,” and then reinforced by the care team throughout the rehabilitation period. Conclusions Partnered women commonly resume sexual activity soon after an MI with fear but without directed counseling from their physicians. Proactive attention to women's concerns related to sexual function and the safety of sexual activity following an MI could improve post‐MI outcomes for women and their partners.
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Affiliation(s)
- Emily M Abramsohn
- Program in Integrative Sexual Medicine for Women and Girls, Department of Obstetrics and Gynecology, Section of Gynecology Oncology, the University of Chicago, Chicago, IL
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Abstract
Erectile dysfunction is common in the patient with cardiovascular disease. It is an important component of the quality of life and it also confers an independent risk for future cardiovascular events. The usual 3-year time period between the onset of erectile dysfunction symptoms and a cardiovascular event offers an opportunity for risk mitigation. Thus, sexual function should be incorporated into cardiovascular disease risk assessment for all men. A comprehensive approach to cardiovascular risk reduction (comprising of both lifestyle changes and pharmacological treatment) improves overall vascular health, including sexual function. Proper sexual counselling improves the quality of life and increases adherence to medication. This review explores the critical connection between erectile dysfunction and cardiovascular disease and evaluates how this relationship may influence clinical practice. Algorithms for the management of patient with erectile dysfunction according to the risk for sexual activity and future cardiovascular events are proposed.
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Affiliation(s)
- Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, Athens Medical School, Profiti Elia 24, Athens 14575, Greece.
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