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Cassioli E, Tarchi L, Rossi E, Faldi M, Dani C, Giuranno G, Siviglia S, Baroncelli A, Maggi M, Vignozzi L, Giraldi A, Ricca V, Castellini G. Early traumatic experiences are linked to hypersexual behavior and erectile dysfunction in men through the mediation of body uneasiness and general psychopathology. J Sex Med 2024:qdae058. [PMID: 38778740 DOI: 10.1093/jsxmed/qdae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 04/11/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Childhood traumatic experiences have been associated with hypersexuality and sexual dysfunctions. However, the mediators of the interactions between these variables should be clarified in men. AIM This study aimed to investigate the interaction of early traumatic experiences, psychopathology, and sexuality with respect to erectile dysfunction (ED) and hypersexual behavior. The hypothesized model expected that traumatic experiences would be associated with hypersexual behavior and reduced sexual functioning through the mediation of body uneasiness and psychological distress. METHODS The study was cross-sectional and observational. A total of 317 men were enrolled. Male patients with a primary complaint of ED and an indication for psychiatry referral represented the clinical sample (n = 116; mean ± SD age, 42.82 ± 16.89 years). Clinical classification was assessed with the Structured Interview on Erectile Dysfunction. The second sample (n = 201, 30.82 ± 11.94 years) was recruited from the general population. All participants were administered the following questionnaires: Brief Symptom Inventory, Childhood Trauma Questionnaire-Short Form, Hypersexual Behavior Inventory, Body Uneasiness Test-A, and 5-item International Index of Erectile Function. OUTCOMES Psychopathology and sexual functioning were assessed by a dimensional approach, and a multivariate model was computed by structural equation model analysis. RESULTS When compared with the sample from the general population, the clinical sample exhibited a higher prevalence of early traumatic experiences, as measured by scores on the Childhood Trauma Questionnaire-Short Form (45.08 ± 14.25 vs 39.03 ± 10.22, F = 17.63, P < .001), and a higher tendency to engage in hypersexual behaviors (34.63 ± 13.55 vs 30.79 ± 12.44, F = 6.97, P < .01). Structural equation model analysis showed excellent fit indices indicating that early traumatic experiences predicted hypersexual behaviors and ED through the exacerbating mediating effect of body uneasiness and psychopathology. CLINICAL IMPLICATIONS Clinicians should not limit their attention to the behavioral level when assessing sexual dysfunction in men; rather, they should also consider the complex psychopathologic consequences of childhood trauma. Integrated treatments that address the potential presence of childhood trauma with its wider psychological correlates (eg, emotion dysregulation, body uneasiness) might improve treatment response. STRENGTHS AND LIMITATIONS The study reports novel data on the relationship among childhood maltreatment, male sexuality, and psychopathologic mediators with a dimensional assessment. However, the assessment was cross-sectional, and causality was mainly derived from previous studies. CONCLUSION The present study enriches the current literature, strengthening the hypothesis that childhood traumatic experiences significantly shape development and sexuality. Body uneasiness and psychopathology can both tax sexual functioning, as assessed by erectile functioning or hypersexuality.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Marco Faldi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Gabriele Giuranno
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Serena Siviglia
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Andrea Baroncelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Mario Maggi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, 50100, Italy
| | - Annamaria Giraldi
- Sexological Clinic, Mental Health Center Copenhagen, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, 2200, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, 50100, Italy
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Schmidt NM, Hennig J, Munk AJL. Interplay between sexual excitation and inhibition: impact on sexual function and neural correlates of erotic stimulus processing in women. Front Behav Neurosci 2024; 18:1386006. [PMID: 38813468 PMCID: PMC11133591 DOI: 10.3389/fnbeh.2024.1386006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024] Open
Abstract
Background As outlined by the dual control model (DCM), individual differences in the regulation of sexual arousal following sexual stimulation depend on two distinct neurophysiological processes: sexual excitation (SE) and sexual inhibition (SI). Although associations with sexual function, behavior, and cue processing have been demonstrated in previous research, underlying neural correlates remain insufficiently explored. Moreover, interactive effects of SE/SI as proposed by the DCM, as well as factors impacting SE/SI properties, such as the use of oral contraceptives (OCs), have not received adequate attention in existing research. Methods 90 healthy, sexually active women (n = 51 using OCs, n = 39 naturally cycling) completed an Emotional-Picture-Stroop-Paradigm (EPSP) while a 64-channel EEG was recorded. LPP amplitudes toward erotic and neutral stimuli were consecutively computed as a marker of motivational salience and approach motivation. Additionally, women provided self-reports of SE/SI and sexual function. Moderation analyses were performed to assess interactive effects of SE/SI in predicting LPP amplitudes and sexual function. Results Sexual function was negatively associated with SI levels but unrelated to SE. Higher SI was associated with reduced LPP amplitudes in response to erotic stimuli. This negative association was, however, attenuated for women high in SE, suggesting interactive effects of SE/SI. Furthermore, women using OCs reported lower SE compared to naturally cycling women. Conclusion The observed findings provide additional psychophysiological evidence supporting the DCM and underscore the relevance of interactive SE/SI effects in stimulus processing and approach motivation. They also highlight the possible impact of OCs on psychosexual variables that warrants further research.
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Affiliation(s)
- Norina M. Schmidt
- Department of Differential and Biological Psychology, Justus-Liebig-University Giessen, Giessen, Germany
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Lafortune D, Dubé S, Lapointe V, Bonneau J, Champoux C, Sigouin N. Virtual Reality Could Help Assess Sexual Aversion Disorder. JOURNAL OF SEX RESEARCH 2024; 61:588-602. [PMID: 37556729 DOI: 10.1080/00224499.2023.2241860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Virtual reality (VR) may improve our understanding of sexual dysfunctions' manifestations, although research in this area remains limited. This study assessed the potential use of a VR Behavior Avoidance Test (VR-BAT) as a tool for examining the clinical features of Sexual Aversion Disorder (SAD): the experience of fear, disgust, and avoidance when facing sexual cues/contexts. A sample of 55 adults (≥ 18y) with (n = 27) and without SAD (n = 28) completed a self-report measure of sexual avoidance. Their anxiety, disgust, electrodermal activity, heart rate, and visual and behavioral avoidance were then examined during two VR-BATs involving sexual or non-sexual stimuli. Mixed repeated measures ANOVAs, t-tests, and correlational analyses were performed. Results showed that individuals in the SAD group reported greater anxiety and disgust compared to their non-SAD counterparts during the sexual stimuli condition. Sexual avoidance scores were largely positively related to anxiety and disgust during the VR sexual condition, and moderately negatively related to the time spent touching the virtual character's genitals. This study is important given the prevalence of sexual difficulties, such as SAD, and the new research avenues offered by emerging technologies, like VR.
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Affiliation(s)
- D Lafortune
- Department of Sexology, Université du Québec à Montréal
| | - S Dubé
- Department of Psychology, Concordia University
| | - V Lapointe
- Department of Psychology, Université du Québec à Montréal
| | - J Bonneau
- School of Media, Université du Québec à Montréal
| | - C Champoux
- School of Media, Université du Québec à Montréal
| | - N Sigouin
- School of Media, Université du Québec à Montréal
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Rao TSS, Tripathi A, Manohar S, Tandon A. Promoting sexual well-being. Indian J Psychiatry 2024; 66:S262-S271. [PMID: 38445287 PMCID: PMC10911331 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_612_23] [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: 08/15/2023] [Revised: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 03/07/2024] Open
Affiliation(s)
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India E-mail:
| | - Shivanand Manohar
- Department of Psychiatry, JSS Medical College, Mysore, Karnataka, India
| | - Abhinav Tandon
- Department of Psychiatry, MLN Medical College, Prayagraj, Uttar Pradesh, India
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Lafortune D, Dussault É, Vaillancourt-Morel MP, Lapointe VA, Blais M, Godbout N. Is Sexual Aversion a Distinct Disorder or a Trans-Diagnostic Symptom across Sexual Dysfunctions? A Latent Class Analysis. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:105-120. [PMID: 37771315 DOI: 10.1080/0092623x.2023.2261933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Sexual aversion disorder (SAD) is a chronic condition that impacts sexual and psychological well-being. However, the relevance of SAD as a discrete disorder remains highly debated. This study aimed to clarify the status of SAD as either a distinct disorder or a trans-diagnostic symptom shared among sexual dysfunctions. This cross-sectional study used a latent class analysis approach among a Canadian community sample (n = 1,363) to identify how patterns of SAD symptoms (i.e., sexual fear, disgust, and avoidance) emerge across different spheres of sexual functioning (i.e., desire and arousal, erection or lubrication, genito-pelvic pain, and orgasm) and examine sociodemographic and psychosexual correlates of the identified classes. Examination of fit indices suggested four classes: Sexually functional, Impaired desire and responsiveness, Sexual aversion, and Comorbid sexual dysfunctions. Sexual aversion class members were more likely to be single, had experienced sexual assault in adulthood, and report lower levels of sexual satisfaction and psychological well-being, compared to Sexually functional class members. Results suggest that SAD is a distinct clinical syndrome, while its symptoms may co-occur with other sexual dysfunctions. To ensure that the needs of people with SAD are met with tailored treatment options, future nosography might consider reclassifying SAD as a specific disorder.
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Affiliation(s)
- David Lafortune
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
| | - Éliane Dussault
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
| | | | - Valerie A Lapointe
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Martin Blais
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
| | - Natacha Godbout
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
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Karakose S, Urs M, Marshall JE, Ledermann T. Depression, Anxiety, Stress, and Sexual Satisfaction in Couples. JOURNAL OF SEX & MARITAL THERAPY 2023:1-14. [PMID: 36688349 DOI: 10.1080/0092623x.2023.2166637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Sexual satisfaction is an important concept in relationships contributing to psychological general well-being. The present study examined dyadic associations between mental health variables, particularly depression, anxiety, and stress, and sexual satisfaction. Using data of 102 heterosexual married couples from Turkey (mean age = 30.06 years), we sought to investigate whether a person's depression, anxiety, and stress were associated with his or her own as well as the partner's sexual satisfaction. Actor-Partner Independence Model (APIM) analysis revealed that husbands' anxiety and stress were associated with their own sexual satisfaction and husbands' depression was associated with both their own and the wives' sexual satisfaction. Wives' depression and stress were associated with their own sexual satisfaction but not with the satisfaction of their husbands. Additionally, wives' anxiety was not neither associated with their own nor their husbands' sexual satisfaction.
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Affiliation(s)
- Selin Karakose
- Department of Human Development and Family Science, Florida State University, Tallahassee, FL, USA
| | | | - Jordan E Marshall
- Department of Human Development and Family Science, Florida State University, Tallahassee, FL, USA
| | - Thomas Ledermann
- Department of Human Development and Family Science, Florida State University, Tallahassee, FL, USA
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Bittoni C, Kiesner J. Sexual Desire in Women: Paradoxical and Nonlinear Associations with Anxiety and Depressed Mood. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3807-3822. [PMID: 36123564 PMCID: PMC9663363 DOI: 10.1007/s10508-022-02400-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 06/01/2023]
Abstract
The aim of the present study was to expand previous findings regarding paradoxical effects of negative mood on sexual desire. This was done by considering the full range of depressed mood and anxiety symptoms and using methods that are unaffected by recall bias and that don't require participants to infer causal associations between their mood and sexual desire. A convenience sample of 213 university students completed daily questionnaires for approximately two months. Multilevel random-effects models were used to estimate average effects for the entire sample and to test for variability across participants in the associations between negative mood and sexual desire, controlling also for potential influences of the menstrual cycle. Previous findings showing that some women report decreased sexual desire and others increased sexual desire when depressed or anxious were confirmed. More importantly, for both depressed mood and anxiety, results demonstrated the presence of within-person paradoxical associations, whereby there were some women for whom both low and high levels of negative mood were associated with the same change (an increase or a decrease) in sexual desire. Related to these diverse response patterns, paradoxical associations between negative mood and sexual desire were also present at low levels of negative mood. The discussion underlines the importance of considering individual variability and multifactorial nonlinear models when studying sexual desire.
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Affiliation(s)
- Celeste Bittoni
- Department of Development and Social Psychology, University of Padova, via Venezia 8, 35131, Padua, Italy
| | - Jeff Kiesner
- Department of Development and Social Psychology, University of Padova, via Venezia 8, 35131, Padua, Italy.
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Prevalence and Correlates of Sexual Aversion: A Canadian Community-Based Study. J Sex Med 2022; 19:1269-1280. [DOI: 10.1016/j.jsxm.2022.05.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022]
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Anxiety in Attachment and Sexual Relationships in Adolescence: A Moderated Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074181. [PMID: 35409864 PMCID: PMC8998572 DOI: 10.3390/ijerph19074181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022]
Abstract
Adolescence is characterized by several transformations, such as identity construction, progressive estrangement from parents, relational interest in peers, and body changes that also involve sexuality issues. In this process, attachment patterns play a fundamental role in relationships, and when these are dysfunctional, they can result in internalizing and externalizing problems. Often, females show their relational difficulties through internalizing expressions and males through externalizing expressions. Additionally, given the sexual progress involved in this life moment, psychological symptomatology may influence adolescents’ perception of sex and performance. Our purpose is to study the mediating role of internalizing and externalizing symptomatology in the relationship between attachment patterns and sexual and psychological dimensions. In addition, we investigated the moderating effect of the sex assigned at birth on this mediation model. n = 493 adolescents (38.3% males; Mage = 16.51; SD = 1.17) participated in the study. The results show a significant mediation effect of internalizing symptomatology on the relationship between attachment and sexual anxiety. Additionally, this effect is moderated significantly by assigned-at-birth sex. These results confirm that in adolescence, attachment patterns can influence adolescents’ perception of sex. The connection between these two psychological dimensions is influenced by symptomatologic expression. Further investigations are needed.
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Velurajah R, Brunckhorst O, Waqar M, McMullen I, Ahmed K. Erectile dysfunction in patients with anxiety disorders: a systematic review. Int J Impot Res 2022; 34:177-186. [PMID: 33603242 PMCID: PMC8964411 DOI: 10.1038/s41443-020-00405-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 01/03/2023]
Abstract
Men with anxiety disorders have been identified as high risk of developing erectile dysfunction (ED). The aim of this review is to define the prevalence and severity of ED in the male anxiety disorder population. A literature search of three electronic databases (PubMed, Embase and PsychINFO) and a grey literature registry was conducted. Inclusion criteria were studies that investigated adult males, documented diagnosis of anxiety disorders made by a qualified psychiatrist and use of a validated tool to diagnose ED such as International Index of Erectile Function or ICD-10/DSM-IV. The search yielded 1220 articles and 12 studies were selected. The anxiety disorders investigated were post-traumatic stress disorder, obsessive-compulsive disorder, social phobia/social anxiety disorder and panic disorder. We found that the median [IQR] prevalence of ED was 20.0 [5.1-41.2]% and the median [IQR] International Index of Erectile Function-5 scores were 17.62 [13.88-20.88], indicating a mild to moderate severity. Our review suggests a high prevalence of ED in the anxiety disorder population and ED may be more severe in this cohort, therefore advocating this is an important clinical topic. However, the evidence is limited due to the high heterogeneity between the studies and more research is required in this field.
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Affiliation(s)
- Rajalaxmi Velurajah
- GKT School of Medicine, Department of Bioscience Education, King's College London, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK
| | - Muhammad Waqar
- Department of Urology, King's College Hospital, London, UK
| | | | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, UK.
- Department of Urology, King's College Hospital, London, UK.
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Panic Disorder Correlates With the Risk for Sexual Dysfunction. J Psychiatr Pract 2020; 26:185-200. [PMID: 32421290 DOI: 10.1097/pra.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reports have suggested that sexual dysfunction is an underestimated complication of panic disorder, but little research has focused on sexual dysfunction associated specifically with panic disorder. The purpose of this systematic review was to investigate whether patients with panic disorder who are not currently receiving treatment had a higher risk of sexual dysfunction than healthy people, as well as to clarify the appropriate treatment for this patient group. METHODS Articles that reported panic disorder complicated with sexual dysfunction were identified by a systematic literature search of electronic databases, including PubMed, the Cochrane databases, EMBASE, and PsycINFO. RESULTS Six articles were included in the review. Patients with panic disorder showed a high prevalence of sexual aversion (35.7% to 64%) and sexual infrequency (36% to 44%). One cohort study indicated that untreated patients with panic disorders had a higher risk of erectile dysfunction than controls. Another article that focused specifically on female patients reported that the patients with panic disorder exhibited decreased frequency of sexual behavior and decreased sexual desire compared with the controls. However, 2 studies found conflicting results after adjustment for confounding factors. CONCLUSIONS Although the results were mixed, it appears that patients with panic disorder tended to be more susceptible to sexual dysfunction than the general population. Further trials with larger sample sizes and rigorous research designs are needed to establish the relationship between sexual dysfunction and panic disorder.
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Koolwal A, Agarwal S, Manohar S, Koolwal GD, Gupta A. Obsessive–Compulsive Disorder and Sexuality: A Narrative Review. JOURNAL OF PSYCHOSEXUAL HEALTH 2020. [DOI: 10.1177/2631831819896171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Obsessive–compulsive disorder (OCD) is one of the common psychiatric disorders. Despite being one of the basic aspects of biology, the sexual functioning in OCD patients has not received much attention, with there being very limited research on sexuality in these patients. In this review article, we try to take a look at the research on sexual functioning, sexual dysfunctions, and neurobiology of sexual dysfunctions in the anxiety disorders in general and in OCD specifically. We also take a look at the research on relationship functioning in the patients with OCD, a recently proposed entity, relationship-related obsessive compulsive phenomenon, at the sexual obsessions, and the sexual functioning in patients on active treatment for OCD. The overall research suggests that we should always take into account the sexual life and functioning of patients presenting with OCD.
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Affiliation(s)
- Arpit Koolwal
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Supriya Agarwal
- Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Shivanand Manohar
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | | | - Anubha Gupta
- Department of Pathology, PGIMS, Rohtak, Haryana, India
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Pyke RE. Sexual Performance Anxiety. Sex Med Rev 2019; 8:183-190. [PMID: 31447414 DOI: 10.1016/j.sxmr.2019.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sexual performance anxiety (SPA) is one of the most prevalent sexual complaints; yet, no diagnosis is recognized for either gender. Thus, research into treatment has been minimal. AIM Review the prevalence of SPA and its relation to sexual dysfunctions and anxiety disorders. Compare SPA to (non-sexual) performance anxiety and social anxiety (PA/SA). Apply pharmacologic principles to the known properties of drugs and phytotherapies to hypothesize treatments for SPA. METHODS Review SPA and PA/SA through PubMed searches for relevant literature from 2000 to 2018. MAIN OUTCOME MEASURE Prevalence was estimated using population-representative surveys. For treatment results, controlled clinical trial results were prioritized over open-label trial results. RESULTS SPA affects 9-25% of men and contributes to premature ejaculation and psychogenic erectile dysfunction (ED). SPA affects 6-16% of women and severely inhibits sexual desire. Cognitive behavior therapy and mindfulness meditation training have been proven effective for PA/SA and are recommended for SPA, but controlled studies are lacking. Phosphodiesterase type 5 inhibitors are effective for psychogenic ED and premature ejaculation, both of which include SPA as a major element. Drugs proven for PA/SA have adverse sexual and sedative effects, but serotonergic anxiolytics with prosexual effects (buspirone ± testosterone, trazodone ± bupropion) may have potential, and sage, passionflower, l-theanine, and bitter orange are anxiolytic. Nitric oxide boosters (l-citrulline, l-arginine, Panax ginseng) have the potential for increasing genital tumescence and lubrication, and plant-based alpha-adrenergic antagonists may aid sexual arousal (yohimbine/yohimbe, Citrus aurantium/p-synephrine). CONCLUSION SPA causes or maintains most common sexual dysfunction. No treatments are well proven, although cognitive behavior therapy, mindfulness meditation training, and serotonergic anxiolytics (buspirone, trazodone, gepirone) have potential, and phosphodiesterase type 5 inhibitors are effective for psychogenic ED and premature ejaculation. Several phytotherapies also appear to have potential. Pyke RE. Sexual Performance Anxiety. J Sex Med 2020;8:183-190.
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Yang Y, Song Y, Lu Y, Xu Y, Liu L, Liu X. Associations between erectile dysfunction and psychological disorders (depression and anxiety): A cross-sectional study in a Chinese population. Andrologia 2019; 51:e13395. [PMID: 31434163 DOI: 10.1111/and.13395] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/26/2019] [Accepted: 07/20/2019] [Indexed: 12/21/2022] Open
Abstract
The present cross-sectional survey was performed to evaluate the prevalences and correlations of depression and anxiety among Chinese erectile dysfunction (ED) men. Between February 2017 and January 2019, male patients with or without ED treated in andrology clinic and urology clinic were enrolled in the investigation. All enrolled patients were required to fill in the International Index of Erectile Function Questionnaire (IIEF-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7) which intended to evaluate the diagnosis and severity of ED, depression and anxiety respectively. Of the 958 included participants, 79.82% (613/768) and 79.56% (611/768) ED patients appeared to have anxiety and depression; 13.68% (26/190) of men without ED had anxiety and depression. In addition, young ED patients (age ≤35 years) and long ED duration patients (duration >12 months) had higher incidences and severities of anxiety and depression (p < .05). After adjusting the age, IIEF-5 was negatively correlated with PHQ-9 (adjusted r = -.653, p < .001) and GAD-7 scores (adjusted r = -.607, p < .001). The prevalences of anxiety and depression were 79.82% and 79.56% in Chinese ED patients. The prevalences and severities of anxiety and depression increased as the ED severity increased. Based on the high incidences of anxiety and depression among Chinese ED patients, clinicians are supposed to pay more attention to early diagnosis and therapy of psychiatric symptoms for ED patients, especially among young patients and patients with long ED duration.
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Affiliation(s)
- Yongjiao Yang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yi Lu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yawei Xu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
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Rowland DL, van Lankveld JJDM. Anxiety and Performance in Sex, Sport, and Stage: Identifying Common Ground. Front Psychol 2019; 10:1615. [PMID: 31379665 PMCID: PMC6646850 DOI: 10.3389/fpsyg.2019.01615] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Anxiety has long been associated with diminished performance within a number of domains involving evaluative interpersonal interactions, including Sex, Sport, and Stage. Here, we pose three questions: (1) how do these disparate fields approach and understand anxiety and performance; (2) how does the understanding of the issue within one field offer insight to another field; and (3) how could each field benefit from the ideas and strategies used by the others. We begin with a short review of models of anxiety/arousal and performance and then explore definitions, models, presumed underlying physiological processes, and characterizing and influencing factors within each domain separately in a narrative review. This discussion is followed by a synthesis that identifies elements specific to and common across the various domains, with the latter captured in a model of essential characteristics. Concluding remarks note the potential value of promoting increased cross-disciplinary conversation and research, with each domain likely benefiting from the conceptualizations and expert knowledge of the others.
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Affiliation(s)
- David L Rowland
- Department of Psychology, Valparaiso University, Valparaiso, IN, United States
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Porst H, Burri A. Novel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review. Sex Med Rev 2019; 7:129-140. [DOI: 10.1016/j.sxmr.2018.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/03/2018] [Accepted: 05/12/2018] [Indexed: 12/18/2022]
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Kempeneers P, Andrianne R, Cuddy M, Blairy S. Sexual Cognitions, Trait Anxiety, Sexual Anxiety, and Distress in Men With Different Subtypes of Premature Ejaculation and in Their Partners. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:319-332. [PMID: 29161211 DOI: 10.1080/0092623x.2017.1405299] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined trait anxiety and sexual cognitions in 610 men with premature ejaculation (PE) (DSM-IV-TR criteria) and in 107 partners of these men, and compared their scores to normative data. Sexual anxiety, intravaginal ejaculatory latency time, feeling of control over ejaculation, and PE-related distress were also assessed. The scores of 343 participants (56.23%) with clearly identifiable subtypes of PE according to Waldinger's classification system (lifelong, acquired, variable, and subjective subtypes) were compared in these domains. Finally, the predictive value of these factors in determining PE-related distress was explored. The following conclusions can be summarized from the results: (1) Men affected by PE are more distressed by the problem than their partners; (2) there is no evidence that levels of trait anxiety in individuals with PE are dissimilar to those found in the general population; (3) "dysfunctional" sexual cognitions likely play a role in PE, especially with regard to PE-related distress; (4) different subtypes of PE have similar profiles on measures of trait anxiety, sexual anxiety, and sexual cognitions; (5) differences between subtypes are only apparent with regard to feeling of control over ejaculation, with men with lifelong or acquired PE scoring significantly lower than those with a subjective form of the problem.
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Affiliation(s)
- Philippe Kempeneers
- a University of Liege , Department of Psychology , Liege , Belgium
- b Alexians' Hospital , Henri-Chapelle , Belgium
| | | | - Marion Cuddy
- d Talking Therapies Southwark , Maudsley Hospital , London , UK
| | - Sylvie Blairy
- a University of Liege , Department of Psychology , Liege , Belgium
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Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. WOMEN'S HEALTH (LONDON, ENGLAND) 2018; 14:1745506518762664. [PMID: 29649948 PMCID: PMC5900810 DOI: 10.1177/1745506518762664] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 01/28/2018] [Indexed: 12/13/2022]
Abstract
Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients' sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients' wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.
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Affiliation(s)
| | - Thea Gilks
- The University of British Columbia, Vancouver, BC, Canada
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Costa ECV, Pessoa C, Ribeiro D, Correia P. Associação entre estados afetivos negativos e comportamentos sexuais de risco. REVISTA DE ESTUDIOS E INVESTIGACIÓN EN PSICOLOGÍA Y EDUCACIÓN 2017. [DOI: 10.17979/reipe.2017.0.14.2925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
O presente trabalho teve como objetivo analisar, através da revisão da literatura, a associação entre estados afetivos negativos (e.g., depressão, ansiedade) e comportamentos sexuais de risco. Verificou-se que alguns estudos indicam uma associação entre problemas ao nível da saúde mental e/ou estados afetivos negativos e comportamentos sexuais de risco. Através da revisão da literatura concluiu-se que os estados afetivos negativos como a depressão, a ansiedade, e as experiências traumáticas se encontram associadas com comportamentos sexuais de risco e têm sido alvo de pouca atenção por parte da comunidade científica.
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Reinert AE, Simon JA. “Did You Climax or Are You Just Laughing at Me?” Rare Phenomena Associated With Orgasm. Sex Med Rev 2017; 5:275-281. [DOI: 10.1016/j.sxmr.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 12/14/2022]
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Fanni E, Castellini G, Corona G, Boddi V, Ricca V, Rastrelli G, Fisher AD, Cipriani S, Maggi M. The Role of Somatic Symptoms in Sexual Medicine: Somatization as Important Contextual Factor in Male Sexual Dysfunction. J Sex Med 2017; 13:1395-1407. [PMID: 27555509 DOI: 10.1016/j.jsxm.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/05/2016] [Accepted: 07/05/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION An important feature of somatic symptom disorder is the subjective perception of the physical symptoms and its maladaptive interpretation. Considering that psychological distress is often expressed through somatic symptoms, it is possible that they underlie at least a part of the symptoms in subjects complaining of sexual dysfunction. Nevertheless, studies on the impact of somatoform disorders in sexual dysfunction are scanty. AIM To define the psychological, relational, and organic correlates of somatic symptoms in a large sample of patients complaining of sexual problems. METHODS A consecutive series of 2833 men (mean age 50.2 ± 13.5 years) was retrospectively studied. MAIN OUTCOME MEASURES Somatic symptoms were assessed using the "somatized anxiety symptoms" subscale of the Middlesex Hospital Questionnaire (MHQ-S). Several clinical, biochemical, psychological, and relational parameters were studied. Patients were interviewed with the previously validated Structured Interview on Erectile Dysfunction (SIEDY), and ANDROTEST (a structured interview for the screening of hypogonadism in patients with sexual dysfunction). RESULTS Among the 2833 patients studied, subjects scoring higher on somatic symptoms were older, more obese, reporting unhealthy lifestyle (current smoking, alcohol consumption), and a lower education (all P < .05). Moreover, they reported a general impairment of their sexuality more often, including erectile problems (spontaneous or sexual-related), low sexual desire, decreased frequency of intercourse, and perceived reduction of ejaculate volume (all P < .005). Interestingly, we observed a significant association between MHQ-S scoring with a reduced testosterone level and hypogonadism symptoms (both P < .05). Finally, we found a significant association between somatic symptoms and both SIEDY Scales 1 (organic domain of ED) and 3 (intrapsychic domain of ED) (both P < .0001). CONCLUSION The present study demonstrates that the presence of somatic symptoms can represent an important contextual factor in the determination of or in the exacerbation of male sexual dysfunction. High levels of somatic symptoms in subjects with sexual dysfunction can be related to the sexual symptom itself. The consequences of this pattern have great clinical relevance in a sexual medicine setting, considering their severe impact on sexuality.
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Affiliation(s)
- Egidia Fanni
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychology, Drug Research and Child Health, Department of Neuroscience, University of Florence, Florence, Italy
| | - Giovanni Corona
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Valentina Boddi
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychology, Drug Research and Child Health, Department of Neuroscience, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandra Daphne Fisher
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Sarah Cipriani
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Andrology Unit, Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
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Forbes MK, Baillie AJ, Eaton NR, Krueger RF. A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology. JOURNAL OF SEX RESEARCH 2017; 54:465-485. [PMID: 28121167 PMCID: PMC5433908 DOI: 10.1080/00224499.2016.1269306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sexual dysfunctions commonly co-occur with various depressive and anxiety disorders. An emerging framework for understanding the classification of mental disorders suggests that such comorbidity is a manifestation of underlying dimensions of psychopathology (or "spectra"). In this review, we synthesize the evidence that sexual dysfunctions should be included in the empirical taxonomy of psychopathology as part of the internalizing spectrum, which accounts for comorbidity among the depressive and anxiety disorders. The review has four parts. Part 1 summarizes the empirical basis and utility of the empirical taxonomy of psychopathology. Part 2 reviews the prima facie evidence for the hypothesis that sexual dysfunctions are part of the internalizing spectrum (i.e., high rates of comorbidity; shared cognitive, affective, and temperament characteristics; common neural substrates and biomarkers; shared course and treatment response; and the lack of causal relationships between them). Part 3 critically analyzes and integrates the results of the eight studies that have addressed this hypothesis. Finally, Part 4 examines the implications of reconceptualizing sexual dysfunctions as part of the internalizing spectrum, and explores avenues for future research.
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Affiliation(s)
- Miriam K Forbes
- a Departments of Psychiatry and Psychology , University of Minnesota
| | - Andrew J Baillie
- b Centre for Emotional Health and Centre of Research Excellence in Mental Health and Substance Use , Macquarie University
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Newly diagnosed panic disorder and the risk of erectile dysfunction: A population-based cohort study in Taiwan. Psychiatry Res 2016; 244:229-34. [PMID: 27497294 DOI: 10.1016/j.psychres.2016.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/23/2022]
Abstract
Previous studies indicated that panic disorder is correlated with erectile dysfunction (ED). The primary aim of this study was to explore the incidence rate of ED among panic disorder patients in an Asian country. The secondary aim was to compare the risk of ED in panic disorder patients that were treated with different kinds of antidepressants, and to explore the possible mechanism between these two disorders. We identified 1393 male patients with newly diagnosed panic disorder from the Taiwan's National Health Insurance Database. Four matched controls per case were selected for the study group by propensity score. After adjusting for age, obesity and comorbidities, the panic disorder patients had a higher hazard ratio of ED diagnosis than the controls, especially among the untreated panic disorder patients. This retrospective dynamic cohort study supports the link between ED and prior panic disorder in a large sample of panic disorder patients. This study points out the need of early antidepressant treatment for panic disorder to prevent further ED.
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McMahon CG, Jannini EA, Serefoglu EC, Hellstrom WJG. The pathophysiology of acquired premature ejaculation. Transl Androl Urol 2016; 5:434-49. [PMID: 27652216 PMCID: PMC5001985 DOI: 10.21037/tau.2016.07.06] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The second Ad Hoc International Society for Sexual Medicine (ISSM) Committee for the Definition of Premature Ejaculation defined acquired premature ejaculation (PE) as a male sexual dysfunction characterized by a the development of a clinically significant and bothersome reduction in ejaculation latency time in men with previous normal ejaculatory experiences, often to about 3 minutes or less, the inability to delay ejaculation on all or nearly all vaginal penetrations, and the presence of negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy. The literature contains a diverse range of biological and psychological etiological theories. Acquired PE is commonly due to sexual performance anxiety, psychological or relationship problems, erectile dysfunction (ED), and occasionally prostatitis and hyperthyroidism, consistent with the predominant organic etiology of acquired PE, men with this complaint are usually older, have a higher mean BMI and a greater incidence of comorbid disease including hypertension, sexual desire disorder, diabetes mellitus, chronic prostatitis, and ED compared to lifelong, variable and subjective PE.
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Affiliation(s)
| | - Emmanuele A Jannini
- School of Sexology, Department of Experimental Medicine, University of L'Aquila, L'Aquila, Italy
| | - Ege C Serefoglu
- Department of Urology, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Wayne J G Hellstrom
- Department of Urology, Tulane University School of Medicine, New Orleans, USA
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Terlecki MA, Ecker AH, Buckner JD. College drinking problems and social anxiety: The importance of drinking context. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2016; 28:545-52. [PMID: 24955673 DOI: 10.1037/a0035770] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Social anxiety more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently linked to heavy alcohol use. Elucidation of the relation between social anxiety and alcohol use is an important next step in treating and preventing risky drinking. College students routinely face potentially anxiety-provoking social situations (e.g., meeting new people) and socially anxious undergraduates are especially vulnerable to alcohol-related impairment. Drinking to cope with social anxiety is thought to reinforce alcohol use, yet research on coping-motivated drinking among socially anxious students has yielded inconsistent findings. Further, undergraduate drinking varies by drinking context, yet the role of context in drinking behaviors among socially anxious individuals remains unclear. The current study sought to examine the relationship of social anxiety and drinking quantity in specific drinking contexts among undergraduates (N = 611). We also evaluated whether relevant drinking contexts mediated the relationship between social anxiety and alcohol-related problems. Clinically elevated social anxiety was related to heavier consumption in negative emotion (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) contexts, but not social/convivial contexts (e.g., parties, bars). Quantity of alcohol consumed in negative emotion and personal/intimate contexts mediated the relationship between social anxiety and drinking problem severity. Drinking in personal/intimate contexts demonstrated a unique mediational role. Findings suggest that heavy drinking in particular contexts (especially personal/intimate and negative emotion) may play an important role in drinking problems among socially anxious individuals.
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Brotto L, Atallah S, Johnson-Agbakwu C, Rosenbaum T, Abdo C, Byers ES, Graham C, Nobre P, Wylie K. Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. J Sex Med 2016; 13:538-71. [DOI: 10.1016/j.jsxm.2016.01.019] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 01/16/2016] [Accepted: 01/19/2016] [Indexed: 12/11/2022]
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Nørr L, Bennedsen B, Fedder J, Larsen ER. Use of selective serotonin reuptake inhibitors reduces fertility in men. Andrology 2016; 4:389-94. [PMID: 27019308 DOI: 10.1111/andr.12184] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/29/2016] [Accepted: 02/20/2016] [Indexed: 11/27/2022]
Abstract
Clinical review of the present data on the effects of selective serotonin reuptake inhibitors (SSRIs) on male fertility was the objective of the study. PubMed and Scopus were searched for publications in English or Danish and reviewed. Human trials, animal studies and in vitro studies were included. Use of SSRIs negatively affects semen parameters in most studies. In some studies, SSRIs are also shown to reduce DNA integrity. SSRIs can also delay ejaculation. Depression and anxiety can cause reduced libido, erectile dysfunction and delayed ejaculation as well. The use of SSRIs seems to reduce male fertility by affecting semen parameters, although most studies have a degree of confounding by indication caused by the underlying depression.
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Affiliation(s)
- L Nørr
- Department of Affective Disorders Q, Mood Disorders Research Unit, Aarhus University Hospital, Risskov, Denmark
| | - B Bennedsen
- Department of Affective Disorders Q, Clinic for OCD and Anxiety Disorders, Aarhus University Hospital, Risskov, Denmark
| | - J Fedder
- Centre of Andrology, Fertility Clinic, Department D, Odense University Hospital, Odense, Denmark
| | - E R Larsen
- Department of Affective Disorders Q, Mood Disorders Research Unit, Aarhus University Hospital, Risskov, Denmark
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Forbes MK, Baillie AJ, Schniering CA. Should Sexual Problems Be Included in the Internalizing Spectrum? A Comparison of Dimensional and Categorical Models. JOURNAL OF SEX & MARITAL THERAPY 2016; 42:70-90. [PMID: 25535819 DOI: 10.1080/0092623x.2014.996928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Preliminary research has suggested that sexual problems should be included in the internalizing spectrum alongside depressive and anxiety disorders. This study aimed to empirically examine and compare an extended internalizing spectrum model with a categorical framework model implied by the current nosological structure. Responses to an online survey from a community sample (n = 518) were analyzed to compare the fit of six alternative models of the relationship between sexual problems and depressive and anxiety disorders, separately for men and women. The best model for women (n = 336) was a dimensional spectrum model that included sexual arousal, orgasm, and pain difficulties in the internalizing spectrum. The results for men (n = 182) were less clear-cut: there were apparent categorical relationships for a small group (n = 8), and the spectrum model showed a good fit for 96% of the sample. These findings are consistent with a nosology that maintains discrete disorders and diagnostic chapters while recognizing the relationships between them, as in the new structure of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. As such, this study offers further evidence that there are dimensional relationships between sexual problems and depressive and anxiety disorders, which should be explicitly recognized in diagnostic systems.
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Affiliation(s)
- Miriam K Forbes
- a Centre for Emotional Health, Department of Psychology , Macquarie University , Sydney , Australia
- b NHMRC Centre of Research Excellence in Mental Health and Substance Use , Sydney , Australia
| | - Andrew J Baillie
- b NHMRC Centre of Research Excellence in Mental Health and Substance Use , Sydney , Australia
- c Department of Psychology , Macquarie University , Sydney , Australia
| | - Carolyn A Schniering
- a Centre for Emotional Health, Department of Psychology , Macquarie University , Sydney , Australia
- b NHMRC Centre of Research Excellence in Mental Health and Substance Use , Sydney , Australia
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Clayton AH, Durgam S, Tang X, Chen C, Ruth A, Gommoll C. Characterizing sexual function in patients with generalized anxiety disorder: a pooled analysis of three vilazodone studies. Neuropsychiatr Dis Treat 2016; 12:1467-76. [PMID: 27382289 PMCID: PMC4922821 DOI: 10.2147/ndt.s103408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vilazodone has been shown to reduce core symptoms of generalized anxiety disorder (GAD) in three randomized, double-blind, placebo-controlled trials. Since sexual dysfunction (SD) is not well characterized in GAD, a post hoc analysis of these trials was conducted to evaluate the effects of vilazodone on sexual functioning in GAD patients. MATERIALS AND METHODS Data were pooled from one fixed-dose trial of vilazodone 20 and 40 mg/day (NCT01629966) and two flexible-dose studies of vilazodone 20-40 mg/day (NCT01766401, NCT01844115) in adults with GAD. Sexual functioning was assessed using the Changes in Sexual Functioning Questionnaire (CSFQ). Outcomes included mean change from baseline to end of treatment (EOT) in CSFQ total score and percentage of patients shifting from SD at baseline (CSFQ total score ≤47 for males, ≤41 for females) to normal functioning at EOT. Treatment-emergent adverse events related to sexual functioning were also analyzed. RESULTS A total of 1,373 patients were included in the analyses. SD at baseline was more common in females (placebo, 46.4%; vilazodone, 49%) than in males (placebo, 35.1%; vilazodone, 40.9%). CSFQ total score improvement was found in both females (placebo, +1.2; vilazodone, +1.6) and males (placebo, +2.1; vilazodone, +1.0), with no statistically significant differences between treatment groups. The percentage of patients who shifted from SD at baseline to normal sexual functioning at EOT was higher in males (placebo, 40.6%; vilazodone, 35.7%) than in females (placebo, 24.9%; vilazodone, 34.9%); no statistical testing was performed. Except for erectile dysfunction and delayed ejaculation in vilazodone-treated males (2.4% and 2.1%, respectively), no treatment-emergent adverse events related to sexual functioning occurred in ≥2% of patients in either treatment group. CONCLUSION Approximately 35%-50% of patients in the vilazodone GAD studies had SD at baseline. Vilazodone and placebo had similar effects on CSFQ outcomes in both females and males, indicating a limited adverse impact on sexual functioning with vilazodone.
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Affiliation(s)
- Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA
| | | | | | | | - Adam Ruth
- Prescott Medical Communications Group, Chicago, IL, USA
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Abstract
Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties.
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Affiliation(s)
- Marcel D Waldinger
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of BetaSciences, Utrecht University, Utrecht, The Netherlands.
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Rajkumar RP, Kumaran AK. Depression and anxiety in men with sexual dysfunction: a retrospective study. Compr Psychiatry 2015; 60:114-8. [PMID: 25818906 DOI: 10.1016/j.comppsych.2015.03.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Comorbid anxiety disorders and depression are commonly seen in men with sexual disorders such as erectile dysfunction (ED) and premature ejaculation (PE). However, they are often undiagnosed and untreated, and their relationship to sexual dysfunction is complex. This study examines the frequency and correlates of comorbid anxiety and depression in men with ED or PE. METHODS The case records of 64 men with ED or PE attending a clinic for psychosexual disorders in a general hospital psychiatry unit during the period 2010-14 were reviewed. Information on comorbid anxiety disorders and depression was extracted from these records, and their clinical and demographic associations were analyzed. RESULTS Eight (12.5%) men had comorbid depressive disorders, and fifteen (23.4%) had anxiety disorders. These disorders predated the onset of sexual dysfunction in the majority of patients. Generalized anxiety disorder was the commonest anxiety disorder. Men with comorbid depression had significantly elevated rates of suicidal ideation or behavior related to their sexual dysfunction, and were more likely to report a lack of libido. Men with pre-existing anxiety disorders were more likely to experience performance anxiety related to sex, and to have PE without comorbid ED. CONCLUSIONS Depression and anxiety affect a substantial minority of men with sexual dysfunction. Men presenting for the evaluation of ED and PE should be carefully screened for these disorders. The links between anxiety disorders and sexual performance anxiety merit further investigation in this patient group.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar, Pondicherry, 605 006, India.
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Terlecki MA, Buckner JD. Social anxiety and heavy situational drinking: coping and conformity motives as multiple mediators. Addict Behav 2015; 40:77-83. [PMID: 25233446 DOI: 10.1016/j.addbeh.2014.09.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/27/2014] [Accepted: 09/03/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Individuals with clinically elevated social anxiety are at greater risk for alcohol use disorder, and the relation between social anxiety and drinking problems is at least partially accounted for by drinking more in negative emotional (e.g., feeling sad or angry) and personal/intimate (e.g., before sexual intercourse) situations. Identification of cognitive/motivational factors related to drinking in these high-risk situations could inform the development of treatment and prevention interventions for these high-risk drinkers. METHOD The current cross-sectional study examined the mediating effect of drinking motives on the relationship between social anxiety and drinking these high-risk situations among undergraduates (N=232). RESULTS Clinically elevated social anxiety was associated with greater coping and conformity motives. Both coping and conformity motives mediated the relation between social anxiety and heavier alcohol consumption in negative emotional and personal/intimate contexts. CONCLUSIONS Multiple mediation analyses indicated that these motives work additively to mediate the social anxiety-drinking situations relationship, such that heavy situational drinking among undergraduates with clinically elevated social anxiety can be jointly attributed to desire to cope with negative affect and to avoid social scrutiny.
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Affiliation(s)
- Meredith A Terlecki
- School of Psychology, University of East London, Stratford, London E15 4LZ, United Kingdom.
| | - Julia D Buckner
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, United States
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Kashdan TB, Adams LM, Farmer AS, Ferssizidis P, McKnight PE, Nezlek JB. Sexual healing: daily diary investigation of the benefits of intimate and pleasurable sexual activity in socially anxious adults. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1417-1429. [PMID: 23982567 DOI: 10.1007/s10508-013-0171-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 03/20/2013] [Accepted: 06/06/2013] [Indexed: 06/02/2023]
Abstract
A growing literature attests to deficits in social and romantic life quality in people with elevated social anxiety, but no research to date has explored how intense intimate encounters influence social anxiety symptoms. This study investigated whether the presence and quality of sexual activity on a given day predicted less social anxiety and negative cognitions on a subsequent day. We also explored whether the benefits of sexual activity would be stronger for more socially anxious individuals. Over 21 days, 172 undergraduate students described the presence and quality of sexual activity, social anxiety symptoms, and use of social comparisons on the day in question. Time-lagged analyses determined that being sexually active on one day was related to less social anxiety symptoms and the generation of fewer negative social comparisons the next day. Furthermore, more intense experiences of pleasure and connectedness during sex predicted greater reductions in social anxiety the next day for people high in trait social anxiety, compared to those low in trait social anxiety. These results were similar regardless of whether sex occurred in the context of romantic relationships or on weekdays versus weekends. The results suggest that sexual activity, particularly when pleasurable and intimate, may mitigate some of the social anxiety and negative comparisons frequently experienced by people with high trait social anxiety.
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Affiliation(s)
- Todd B Kashdan
- Department of Psychology, George Mason University, MS 3F5, Fairfax, VA, 22030, USA,
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Vanwesenbeeck I, Have MT, de Graaf R. Associations between common mental disorders and sexual dissatisfaction in the general population. Br J Psychiatry 2014; 205:151-7. [PMID: 24764543 DOI: 10.1192/bjp.bp.113.135335] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about the associations between common mental disorders and sexual dissatisfaction in the general population. AIMS To assess the associations between the presence of 12-month and remitted (lifetime minus 12-month) mood, anxiety and substance use disorders and sexual dissatisfaction in the general population of The Netherlands. METHOD A total of 6646 participants, aged 18-64, took part in a face-to-face survey using the Composite International Diagnostic Interview 3.0. Childhood trauma, somatic disorders and sexual dissatisfaction were also assessed in an additional questionnaire. Associations were assessed with multivariate regression analyses. RESULTS In total, 29% reported some sexual dissatisfaction. Controlling for demography, somatic disorders and childhood trauma, significant associations with 12-month mood disorder (B = 0.31), substance use disorder (B = 0.23) and anxiety disorder (B = 0.16) were found. Specifically, relatively strong associations were found for alcohol dependence (B = 0.54), bipolar disorder (B = 0.45) and drug dependence (B = 0.44). The association between remitted disorders and sexual dissatisfaction showed significance for the category substance use disorder. CONCLUSIONS People with mood, anxiety and substance use disorders show elevated scores on sexual dissatisfaction, even when relevant confounders are controlled for. Sexual satisfaction appears to be reduced most by alcohol and drug dependence and bipolar disorder. Once remitted, substance use disorder shows a persisting association with present sexual dissatisfaction.
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Affiliation(s)
- Ine Vanwesenbeeck
- Ine Vanwesenbeeck, PhD, Department of Interdisciplinary Social Science, Utrecht University, Utrecht and Rutgers WPF, Utrecht; Margreet ten Have, PhD, Ron de Graaf, PhD, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Margreet Ten Have
- Ine Vanwesenbeeck, PhD, Department of Interdisciplinary Social Science, Utrecht University, Utrecht and Rutgers WPF, Utrecht; Margreet ten Have, PhD, Ron de Graaf, PhD, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Ine Vanwesenbeeck, PhD, Department of Interdisciplinary Social Science, Utrecht University, Utrecht and Rutgers WPF, Utrecht; Margreet ten Have, PhD, Ron de Graaf, PhD, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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Chou KL, Ng ISF, Yu KM. Lifetime abstention of sexual intercourse and health in middle-aged and older adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:891-900. [PMID: 23982569 DOI: 10.1007/s10508-013-0176-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/08/2012] [Accepted: 06/12/2013] [Indexed: 06/02/2023]
Abstract
This study aimed to examine the association of lifetime abstention of sexual intercourse with lifetime Axis I and II psychiatric disorders, attempted suicide, past-year Axis I psychiatric disorder, past-year medical condition, past-year obesity, health-related quality of life, and health service use in middle-aged and older adults in the United States. Face-to-face interviews were conducted in the 2004-2005 Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Analyses were performed for the subsample aged 40 years and older (males = 14,427; female = 19,860). Lifetime abstinence from sexual intercourse, sociodemographic variables, prevalence of lifetime Axis I and II DSM-IV psychiatric disorders, schizophrenia, and attempted suicide, past-year Axis I psychiatric disorders, 14 medical conditions, obesity, health-related quality of life, and health service use were obtained. The prevalence of lifetime abstinence from sexual intercourse was 0.90 % (0.88 % for males; 1.00 % for females). The adjusted risks of any lifetime and past-year Axis I disorder, any lifetime and past-year substance-use disorders, lifetime alcohol-use disorder, lifetime and past-year alcohol-abuse disorder, lifetime nicotine dependence, lifetime drug-use disorder, and lifetime drug-abuse disorder were significantly lower for who abstained from sexual intercourse than for those who did not. However, those who abstained from sexual intercourse were more likely to have a diagnosis of obesity and lifetime avoidant and dependent personality disorders. The unadjusted risk of dysthymic disorder was also significantly greater for those who abstained from sexual intercourse. Results indicate that the effect of lifetime absence of sexual intercourse on psychiatric disorders is mixed.
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Affiliation(s)
- Kee-Lee Chou
- Department of Asian and Policy Studies, The Hong Kong Institute of Education, 10 Lo Ping Road, Hong Kong, China,
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Oznur T, Akarsu S, Karaahmetoğlu B, Doruk A. A rare symptom in posttraumatic stress disorder: Spontaneous ejaculation. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:69-73. [PMID: 24587852 PMCID: PMC3936917 DOI: 10.12659/ajcr.889658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/28/2013] [Indexed: 11/12/2022]
Abstract
Patient: Male, 25 Final Diagnosis: Post Traumatic Stress Disorder Symptoms: Insomnia • nightmares • spontaneous ejaculation Medication: Paroxentine Clinical Procedure: — Specialty: Psychiatry
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Affiliation(s)
- Taner Oznur
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
| | - Süleyman Akarsu
- Department of Psychiatry, Aksaz Military Hospital, Marmaris, Turkey
| | | | - Ali Doruk
- Department of Psychiatry, Gülhane Military Medical Academy, Ankara, Turkey
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Brotto LA, Klein C. Psychological factors involved in women’s sexual dysfunctions. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Oliveira C, Nobre PJ. The role of trait-affect, depression, and anxiety in women with sexual dysfunction: a pilot study. JOURNAL OF SEX & MARITAL THERAPY 2013; 39:436-452. [PMID: 23560661 DOI: 10.1080/0092623x.2012.665813] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Despite the increasing number of studies, it is not yet clear how emotions affect sexual response in women with and without sexual problems. The aim of this study was to explore the relation among trait-affect, depression, anxiety, and sexual functioning. Participants were 237 women: 167 without sexual problems, 37 with low levels of sexual functioning, and 17 with sexual dysfunction. Participants completed the Positive and Negative Affect Schedule, the Brief Symptom Inventory, the Beck Depression Inventory, and the Female Sexual Function Index. Results showed that women with sexual problems presented lower levels of positive trait-affect in comparison with women without sexual problems. Mediation analysis indicated that depression mediated 44% of the total effect of positive trait-affect and 83% of the total effect of negative trait-affect on sexual functioning. Moreover, anxiety (Brief Symptom Inventory subscale) mediated 18% of the total effect of positive trait-affect on sexual functioning and 61% of the total effect of negative trait-affect on sexual functioning. These results may help explain the high comorbidity among sexual dysfunction, depression, and anxiety, and raise the hypothesis that trait-affect may act as a common vulnerability factor for these clinical conditions.
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Affiliation(s)
- Cátia Oliveira
- Departamento de Ciências da Educação, Universidade de Aveiro, Aveiro, Portugal.
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Dèttore D, Pucciarelli M, Santarnecchi E. Anxiety and female sexual functioning: an empirical study. JOURNAL OF SEX & MARITAL THERAPY 2013; 39:216-240. [PMID: 23356511 DOI: 10.1080/0092623x.2011.606879] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Previous research regarding anxiety and female sexual functioning has yielded conflicting conclusions. This study examined the effect of state/trait anxiety and anxiety sensitivity on sexual responding and the propensity toward sexual inhibition/excitation in women without an anxiety disorder (n = 100, M age = 28.8 years) compared with women with an anxiety disorder (panic disorder or generalized anxiety disorder, n = 30, M age = 30.2 years). Participants completed self-report measures of state and trait anxiety, anxiety sensitivity, sexual functioning, and sexual inhibition/excitation. Women with an anxiety disorder reported worse sexual functioning compared with those without an anxiety disorder (except for desire, lubrication, and pain) and a greater propensity toward sexual inhibition, because of the threat of performance failure and its consequences. Dispositional anxiety and related worries significantly predicted various types of sexual dysfunctions. Findings suggested the importance of considering the relation between anxiety and sexual functioning to design optimal prevention and therapeutic interventions for women with anxiety disorders.
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Affiliation(s)
- Davide Dèttore
- Department of Health Sciences, University of Florence, Florence, Italy.
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Forbes MK, Schniering CA. Are sexual problems a form of internalizing psychopathology? A structural equation modeling analysis. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:23-34. [PMID: 22562617 DOI: 10.1007/s10508-012-9948-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 12/05/2011] [Accepted: 01/15/2012] [Indexed: 05/31/2023]
Abstract
Sexual dysfunctions, depression, and anxiety disorders have high rates of comorbidity. The aim of this study was to empirically evaluate an expanded model of internalizing psychopathology (Krueger, 1999) that includes sexual problems, based on these patterns of comorbidity. Responses to an online survey from a sexually active community sample (n = 563) were analyzed using structural equation modeling to compare the fit of four alternative models for males and females. An expanded model of the internalizing spectrum that included sexual problems was a good fit for the pattern of interrelationships in the female data. However, the weak relationships between the observed variables in the male data meant that none of the models provided an adequate fit for men. This study offers preliminary evidence for the utility of a model of the internalizing spectrum that includes sexual problems for women, which could facilitate a better understanding of the role of common underlying psychopathological processes between disorders and offer a first step towards effective diagnosis and treatment. Future research should focus on clinical and representative samples, using other measurement methods.
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Affiliation(s)
- Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
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Kempeneers P, Andrianne R, Bauwens S, Georis I, Pairoux JF, Blairy S. Functional and psychological characteristics of belgian men with premature ejaculation and their partners. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:51-66. [PMID: 22695640 DOI: 10.1007/s10508-012-9958-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 10/06/2011] [Accepted: 12/05/2011] [Indexed: 06/01/2023]
Abstract
Physiological, behavioral, cognitive, and emotional factors are generally acknowledged to play a role in premature ejaculation (PE). However, the nature and the extent of their etiological impact remain largely imprecise. The present study examined functional and psychometric dynamics at work in a PE population. A total of 461 men with PE and 80 partners completed an online questionnaire. The main outcome measures were self-reported ejaculatory latency time, the feeling of control upon ejaculation, sexual satisfaction, distress related to PE, trait anxiety (STAI-B), sexual cognitions (Sexual Irrationality Questionnaire [SIQ]), social anxiety (Liebowitz's Social Anxiety Scale [LSAS] and Social Interaction Self-Statement Test [SISST]), and personality traits (Temperament and Character Inventory-Revised [TCI-R]). In our sample, the median latency time to ejaculation was between 1 and 2 min. Sexual satisfaction and distress correlated more strongly with the feeling of control than with the self-reported latency time. Men experienced more distress and dissatisfaction related to PE than did their partners, while overestimating their partners' distress and dissatisfaction. PE participants' scores differed significantly, albeit slightly, from STAI-B, SIQ, LSAS, and SISST norms. The differences were negligible on TCI-R. Some differences became stronger when subtypes were considered. Participants combining generalized and lifelong PE with self-reported latency times of <30 s reported lower sexual satisfaction and control, higher distress, higher social anxiety, and harm avoidance (TCI-R/HA) scores. By contrast, the situational subtype of PE was found to be characterized by a higher level of satisfaction, a greater feeling of control, less distress, and higher trait anxiety scores. However, the trends remained statistically discrete.
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Byun JS, Lyu SW, Seok HH, Kim WJ, Shim SH, Bak CW. Sexual dysfunctions induced by stress of timed intercourse and medical treatment. BJU Int 2012; 111:E227-34. [DOI: 10.1111/j.1464-410x.2012.11577.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Oliveira C, Nobre PJ. Cognitive structures in women with sexual dysfunction: the role of early maladaptive schemas. J Sex Med 2012; 10:1755-63. [PMID: 22524501 DOI: 10.1111/j.1743-6109.2012.02737.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cognitive schemas are often related to psychological problems. However, the role of these structures within sexual problems is not yet well established. AIM The aim of this study was to evaluate the presence and importance of early maladaptive schemas on women's sexual functioning and cognitive schemas activated in response to negative sexual events. METHODS A total of 228 women participated in the study: a control sample of 167 women without sexual problems, a subclinical sample of 37 women with low sexual functioning, and a clinical sample of 24 women with sexual dysfunction. MAIN OUTCOME MEASURES Participants completed several self-reported measures: the Schema Questionnaire, the Questionnaire of Cognitive Schema Activation in Sexual Context, the Brief Symptom Inventory, the Beck Depression Inventory, and the Female Sexual Function Index. RESULTS Findings indicated that women with sexual dysfunction presented significantly more early maladaptive schemas from the Impaired Autonomy and Performance domain, particularly failure (P < 0.001, η(2) = 0.08), dependence/incompetence (P < 0.05, η(2) = 0.03), and vulnerability to danger (P < 0.05, η(2) = 0.04). Additionally, in response to negative sexual events, women with sexual dysfunction presented significantly higher scores on incompetence (P < 0.001, η(2) = 0.16), self-depreciation (P < 0.01, η(2) = 0.05), and difference/loneliness (P < 0.01, η(2) = 0.05) schemas. CONCLUSIONS Results supported differences between women with and without sexual problems regarding cognitive factors. This may have implications for the knowledge, assessment, and treatment of sexual dysfunction in women.
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Affiliation(s)
- Cátia Oliveira
- Departamento de Ciências da Educação, Universidade de Aveiro Departamento de Ciências da Educação, Universidade de Aveiro, Portugal.
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Kashdan TB, Adams L, Savostyanova A, Ferssizidis P, McKnight PE, Nezlek JB. Effects of social anxiety and depressive symptoms on the frequency and quality of sexual activity: A daily process approach. Behav Res Ther 2011; 49:352-60. [DOI: 10.1016/j.brat.2011.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 03/01/2011] [Accepted: 03/11/2011] [Indexed: 10/18/2022]
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Hamilton LD, Meston CM. The role of salivary cortisol and DHEA-S in response to sexual, humorous, and anxiety-inducing stimuli. Horm Behav 2011; 59:765-71. [PMID: 21195074 PMCID: PMC3085649 DOI: 10.1016/j.yhbeh.2010.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 12/21/2022]
Abstract
Stress and anxiety are commonly thought to be detrimental to sexual function. Several studies in both the human and animal literature, however, have found that inducing anxiety can enhance sexual function in women. The mechanisms that explain a negative relationship between physical and psychological stress and sexual functioning are well documented, but little is known about how stress or anxiety might have a facilitatory effect on sexual arousal. As an initial step in exploring the relationship between anxiety and sexual arousal, the present study examined the role of the autonomic nervous system, and the adrenal hormones cortisol and dehydroepiandrosterone-sulfate (DHEA-S) in response to a sexual film, an anxiety-inducing film, and a humorous film. Nineteen premenopausal women (mean age 24.4 years) who were free from sexual difficulties came into the lab on three separate days. At each session they were shown an anxiety-inducing, sexually arousing, or humorous (control) film while their physiological arousal was measured. They also provided saliva samples before and after each film. Cortisol significantly decreased, while DHEA-S increased in the sexual and humorous conditions. Neither hormone changed significantly in the anxiety-inducing condition. Autonomic nervous system activity measured by heart rate and heart rate variability did not change in response to the sexual or anxiety-inducing films, but heart rate variability increased significantly in response to the humorous film. The cortisol/DHEA-S ratio at the post-sexual film time point was significantly negatively correlated with genital arousal (measured by vaginal pulse amplitude). Anxiety-inducing films did not result in a physiological stress response, which can explain why they do not impair sexual function.
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Affiliation(s)
- Lisa Dawn Hamilton
- Psychology Department, Mount Allison University, 49A York Street, Sackville, NB, Canada E4L 3A9
- Department of Psychology, University of Texas at Austin, 1 University Station A8000, Austin, TX, 78712, USA
| | - Cindy M. Meston
- Department of Psychology, University of Texas at Austin, 1 University Station A8000, Austin, TX, 78712, USA
- Corresponding author. Fax: +1 512 471 6175. (C.M. Meston)
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Fornaro M. Agomelatine in the treatment of panic disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:286-7. [PMID: 20933043 DOI: 10.1016/j.pnpbp.2010.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 12/26/2022]
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Munoz V, Stravynski A. Social phobia and sexual problems: A comparison of social phobic, sexually dysfunctional and normal individuals. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 49:53-66. [DOI: 10.1348/014466509x436697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ferreira-Nuño A, Fernández-Soto C, Olayo-Lortia J, Ramirez-Carreto R, Paredes RG, Velázquez-Moctezuma J, Morales-Otal A. Copulatory Pattern of Male Rats in a Multiple Partner Choice Arena. J Sex Med 2010; 7:3845-56. [DOI: 10.1111/j.1743-6109.2010.01746.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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