Female Genital Dialogues: Female Genital Self-Image, Sexual Dysfunction, and Quality of Life in Patients With Vitiligo With and Without Genital Affection

Patient Burden of Nonsegmental Vitiligo: A US Real-World Survey of Dermatologists and Their Patients

INTRODUCTION

Vitiligo is a chronic autoimmune disease characterized by destruction of melanocytes, leading to skin depigmentation. Vitiligo can have a high quality-of-life burden and profound impact on psychosocial well-being. The objectives of this study were to describe the self-reported patient burden among patients with nonsegmental vitiligo with ≤ 10% affected body surface area, summarize the physician-reported psychosocial and psychological impact of vitiligo on patient lives, and describe disease characteristics and treatment history, goals, and satisfaction.

METHODS

Data were drawn from the Adelphi Vitiligo Disease Specific Programme™, a real-world, cross-sectional survey with retrospective data collection of physicians and patients with vitiligo, collected in the United States between October 2021 and April 2022. Separate surveys for dermatologists and patients contained questions on clinical and demographic characteristics of patients with vitiligo and burden of vitiligo. Treatment history, goals, and satisfaction were assessed together with the impact of vitiligo on quality of life.

RESULTS

Sixty-one dermatologists provided data for 326 patients with ≤ 10% affected body surface area (adults, n = 221; adolescents, n = 105); 90 of those patients also responded to the survey. The most common treatments were topical corticosteroids, topical calcineurin inhibitors, and narrow-band ultraviolet-B phototherapy, with the main treatment goal being repigmentation. Physician-reported treatment satisfaction was 56%; 25% of patients reported frustration with treatment options. Physicians reported impact of vitiligo on everyday life in 46% of patients. Patients reported 12.7% overall work impairment; mean scores for Hospital Anxiety and Depression Scale anxiety and depression domains were 3.5 and 2.2, respectively, and mean Vitiligo-specific Quality of Life index score was 26.9. Patients with facial involvement experienced higher burden than those without.

CONCLUSION

A high patient burden was reported by dermatologists and their patients with vitiligo who had ≤ 10% affected body surface area, including psychosocial and psychological consequences. These findings highlight an unmet need in the treatment of vitiligo.

[Quality of life, disease burden and healthcare need of patients with vitiligo]

BACKGROUND

With a prevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has a disfiguring, often stigmatising character and is often associated with psychosocial distress.

OBJECTIVE

To provide an overview of the psychosocial impairment, disease burden and resulting health care needs of patients with vitiligo.

MATERIALS AND METHODS

Narrative review based on a literature search in PubMed for the years 1996-2022 on disease burden, quality of life and stigmatization is provided.

RESULTS

The search yielded 175 relevant original papers including clinical studies, meta-analyses and systematic reviews (n = 65) for the search period. A large number of studies document that vitiligo is associated with considerable psychosocial stress and relevant losses in quality of life. Problem areas particularly concern stigmatisation, sexual dysfunction, anxiety, reduced self-esteem and problems at work. The observed increased levels of anxiety and depression correlate with the severity and activity of vitiligo. Often, comorbidity also contributes to reduced self-esteem and social isolation. These factors determine a high need for care in a relevant proportion of those affected.

CONCLUSION

Vitiligo is not primarily a cosmetic problem, but a disease requiring treatment according to the World Health Organisation's definition of health as physical, mental and social well-being. The benefits of treatment options are to be measured by their effects on patient-reported outcomes.

Do complaints related to vitiligo affect sexual quality of life and marital adjustment?

The authors aimed at evaluating the effect of vitiligo on female sexual function and Dyadic Adjustment in a hospital-based study as gender negatively affected the marital quality of vitiligo patients, more in women. A total of 153 patients who applied to the dermatology outpatient clinic of a tertiary university hospital were interviewed. However, 120 vitiligo patients who were married and had a sexually active partner and suitable the inclusion criteria were included in the study. It is seen that the mean score of the DAC is 43.13±5.11, and the mean score of the SQOL-F is 52.57±5.39. Vitiligo has a negative effect on a woman's sexual life and Dyadic Adjustment. Early identification of sexual problems in vitiligo patients and planning their future course of management can aid in improving the marital adjustment and quality of life.

Association between vitiligo and sexual dysfunction: current evidence

BACKGROUND

We discovered that vitiligo was associated with sexual dysfunction in clinical diagnosis and treatment; however, no further analysis had been performed due to a lack of data.

OBJECTIVE

This study aimed to clarify the relationship between vitiligo and sexual dysfunction.

METHODS

We searched six databases (PubMed, Embase, Cochrane, China National Knowledge Infrastructure, China Science and Technology Journal, and Wanfang Data Knowledge Service Platform) for nearly 40 years.

RESULTS

According to the search strategy, 91 relevant studies were retrieved, of which 4 were included in the analysis. The Arizona Sexual Experience Scale (ASEX) score (mean difference [MD] 4.96, 95% confidence interval [CI] 2.78-7.13, p < 0.00001) was higher in the vitiligo group than in the control group. The Arabic version of the Female Sexual Function Index (AVFSFI) score (mean difference [MD] - 3.40, 95% confidence interval [CI] - 5.49 to -1.31, p = 0.001) was lower in the vitiligo group than in the control group.

CONCLUSIONS

Patients with vitiligo were found to be at greater risk of sexual dysfunction. Moreover, the association between vitiligo and sexual dysfunction was stronger in women than in men.Key MessagesPatients with vitiligo were found to be at greater risk of sexual dysfunction.The association between vitiligo and sexual dysfunction was stronger in women than in men.

Unveiling the Unseen Struggles: A Comprehensive Review of Vitiligo's Psychological, Social, and Quality of Life Impacts

This review explores the psychosocial impact of vitiligo on patients, its consequences for their quality of life, and the need for holistic support. Vitiligo's psychosocial burden, driven by the need to conceal lesions and societal beauty ideals, leads to stress, sadness, and low self-esteem. Social stigma affects self-esteem, especially in cultural contexts, exacerbating the need for culturally sensitive support. Anxiety and depression are common due to visible differences and societal pressures. Vitiligo significantly reduces the quality of life, especially in younger patients, impacting daily activities, careers, and relationships. Disease severity worsens these effects, particularly in visible areas and among individuals with darker skin tones. Long-term disease activity may improve acceptance and quality of life. Psychological support and counseling are crucial, as many patients don't seek medical help. Education plays a key role, improving understanding and reducing anxiety. Raising awareness about the impact of vitiligo can challenge perceptions and contribute to enhancing patients' well-being. In conclusion, this review highlights the interplay between psychosocial factors, quality of life, and the importance of addressing social stigma, providing psychological support, and advancing education and awareness for those with vitiligo.

Genital Self-Image, Sexual Function, and Quality of Life Among Individuals with Vulvar and Non-Vulvar Inflammatory Dermatoses

Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to impact on genital self-image. A 20-min web-based survey was distributed September-November 2020 through social media ads, support groups, and online research recruitment services. Individuals in the USA over age 18 who were assigned female at birth and self-reported having been diagnosed with an inflammatory dermatosis were eligible. The primary outcome was the Female Genital Self-Image Scale (FGSIS). Secondary outcomes included the Female Sexual Function Index (FSFI), the Skindex-16 (a skin-related quality of life measure), the PROMIS Global-10 (assessing global physical/mental health), and sexual behavior histories. Participants (n = 348) reported mean age of 43.1 ± 15.5 (range = 19-81). Nearly one-third (n = 101; 29.0%) reported VID, 173 (50%) had NVID, and 74 (21%) experienced both vulvar and non-vulvar symptoms; they were analyzed as part of the VID group. The mean FGSIS score among participants with VID was 16.9 ± 4.1 and was significantly (p < .01) lower than that of participants with NVID (M = 21.2 ± 4.3), indicating lower genital self-image. Mental health (as measured by PROMIS-Global 10) was also impaired in VID. Rates of sexual dysfunction were high in both groups (> 60%). Findings suggest that in VID, lower genital self-image is correlated with poorer sexual function, quality of life, and global physical and mental health. Additional recommendations for VID management are proposed.

The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes

Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.

Genital whitening with topical Cyperus rotundus Oil enhance sexuality and quality of life

BACKGROUND

Cyperus Rotundus Essential Oil (CREO) is an anti-inflammatory and depigmenting agent that helps treat hyperpigmentation.

OBJECTIVES

The purpose of this study was to evaluate the depigmenting effect of CREO on genital hyperpigmentation to that of arbutin (ARB), as well as to evaluate the association between genital lightening, genital self-image, sexual performance, and life quality.

MATERIAL AND METHODS

Three hundred and eight healthy people were categorized into 3 groups: the CREO group, the ARB group, and the cold cream group (CC). In genital pigmentation, the tristimulus colorimeter is used to assess erythema and pigmentation. Additionally, we aided in the development of the female genital self-image scale (FGSIS-4), the female sexual function index (FSFI), and the dermatology life quality index (DLQI).

RESULT

The reduction in genital hyperpigmentation was significantly greater in the CREO and ARB groups than in the CC group; in physician global assessment and patients' self-assessment, the results in treated bikini with the CREO and ARB groups were excellent when compared to the CC. Furthermore, no adverse effects were found in the CREO group, but mild irritation was found in the ARB group; additionally, the percentage of hair growth, color and luminance reduction, and hair thickness were significantly reduced in the CREO group only. In addition, there were significantly different in FGSIS, FSFI, and DLQI between the CREO and ARB groups and the CC group.

CONCLUSION

CREO is equivalently efficacious in decreasing pigmentation, inflammation, and hair growth in the genital area. Positive changes boost female genital self-image, self-esteem, and sexual performance. Improving sexual health has a positive impact on quality of life.

Self-acceptance Affects Attitudes in Caring for Sexual Function after Hysterectomy

BACKGROUND: A comprehensive understanding of several approaches, both pharmacological and non-pharmacological, is needed to reduce sexual function problems after hysterectomy. As one example, the research of Rawland et al. (2015) and that study found that cognitive, affective, motivational, behavioral, self-efficacy, and sexual acceptance responses could potentially play an important roles in the assessment of appropriate care. However, in general, there is no research that explains that self-acceptance can affect attitudes. AIM: This study aims to analyze the correlation between self-acceptance with attitudes toward caring for sexual function after hysterectomy. METHODS: The data measured were self-acceptance and attitudes toward treatment of sexual function after hysterectomy which was obtained from post-hysterectomy women. Data on self-acceptance using the Self-acceptance – Scale for Persons with Early Blindness (SAS-EB) questionnaire and data on attitudes toward caring for sexual function were made by researchers using references from the theory planned of behavior (TPB) (Alshawish et al., 2020). Statistical analysis used was Chi-square to analyze self-acceptance with attitudes to caring for sexual function after hysterectomy. RESULTS: This study found the importance of self-acceptance in determining attitudes toward caring for sexual function after hysterectomy. A person’s positive attitude will affect behavior to treat sexual function after hysterectomy. CONCLUSION: In general, this study proves that self-acceptance is related to attitudes to caring for sexual function after hysterectomy.

Psychosocial Effects of Vitiligo: A Systematic Literature Review

Background

Patients with vitiligo experience reduced quality of life.

Objective

To comprehensively describe the available evidence for psychosocial burden in vitiligo.

Methods

A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis.

Results

Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment.

Limitations

Available studies were heterogeneous and often had limited details; additionally, publication bias is possible.

Conclusions

The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease.

Protocol Registration

PROSPERO (CRD42020162223).

Graphic Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s40257-021-00631-6.

A Standardized Evaluation Method for Assessing Patients With Genital Dyschromia

Objective

The population's ever-growing concern with genital aesthetic dysfunctions reflects an increasing demand in the field of intimate aesthetics. For this reason, as well as the lack of a standardized evaluation, this paper aims to develop a form that facilitates the initial investigation of aesthetic genital dysfunctions. 

Methods

An evaluation form for female and male genital dyschromia was developed between July and November 2018. Following initial development, the form was evaluated for quality and was updated by a panel of specialists (a psychologist, two pelvic dysfunction physiotherapists, and two dermato-functional physiotherapists) via email and through a content validity questionnaire. The face validity of the form was assessed by five physiotherapy and medical students who were randomly selected. The students answered a questionnaire evaluating the proposed form. The reliability of the form was established through the test-retest procedure by evaluating its reproducibility over time.

Results

The “Genital Dyschromia Evaluation Form'' (composed of identification, anamnesis, and physical examination sections) was approved by the specialist panel. They suggested questions to be added in the anamnesis (dermatological lesions or fungal and bacterial infections) and physical examination (hyperemia, edema in the perianal and internal thigh region) sections. As for the image analysis, an increase in quality, resolution, and sharpness was suggested. Lastly, for the cutaneous phototype evaluation, the DoctorSkinFototipo® digital analyzer device was chosen since it is small, portable, easily positioned on the genital area, and can be readily cleaned between patients. 

Conclusion

The “Genital Dyschromia Evaluation Form” is a questionnaire approved by specialists and could represent a suitable option for health professionals.

Evaluation of the Dermatological Life Quality Index, sexual dysfunction and other psychiatric diseases in patients diagnosed with vitiligo with and without genital involvement

BACKGROUND

Because skin lesions affect self-image, vitiligo affects an individual's emotional and psychological well-being, sexual life and relationships with other people. The literature contains a limited number of studies regarding the localization of vitiligo with respect to its effect on certain variables.

AIM

To investigate the effects of the presence or absence of genital involvement in vitiligo on sexual dysfunction, dermatological quality of life (QoL), and susceptibility to other psychiatric disorders such as anxiety and depression.

METHODS

In total, 90 patients who were admitted to the dermatology outpatient clinic of a tertiary university hospital; the patients included 30 patients with vitiligo with genital involvement, 30 patients with vitiligo without genital involvement and 30 controls (HCs). All groups were evaluated with the Dermatological Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HAD), Arizona Sexual Experience Scale (ASEX) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

RESULTS

The HC groups exhibited lower total scores on the DLQI, HAD total score, ASEX and GRISS compared with the vitiligo groups (P < 0.05). No statistically significant difference was found between the vitiligo group with genital involvement and the vitiligo group without genital involvement in terms of DLQI, and total scores for HAD, ASEX and GRISS (P > 0.05).

CONCLUSION

The presence or absence of genital involvement in vitiligo did not have dissimilar effects on the individual's QoL, or their sexual and psychological state.

Evaluating prevalence of depression, anxiety and hopelessness in patients with Vitiligo on an Iranian population

INTRODUCTION

Vitiligo is caused by partial or complete destruction of melanocytes in the affected skin area and influences the patient's quality of life. Besides physical involvement, vitiligo patients experience a high level of stress. Depression and Anxiety are common psychiatric disorders in vitiligo patients.

AIM

This study, as the first study, evaluates hopelessness, anxiety, depression and general health of vitiligo patients in comparison with normal controls in an Iranian population.

METHOD

Hundred patients with vitiligo and hundred healthy controls were examined. General health, depression, hopelessness and anxiety were evaluated based on general health questionnaire. Anxiety, depression and hopelessness levels were analyzed using Chi-Square, and the mean value of general health was evaluated through t-test.

RESULTS

The results showed that anxiety and hopelessness levels were significantly higher in vitiligo patients than those who are in healthy controls. This significant difference refers to high levels of anxiety and hopelessness among women with vitiligo. It was also found that the single patients were more anxious, hopeless and depressive, while the married patients were only more anxious and hopeless than those who are in the control group, respectively. General health of patients was significantly worse than in healthy controls. The low level of general health in patients was related to poorer level of general health among women with vitiligo.

CONCLUSION

It seems that women with vitiligo are more mentally stressed than men with vitiligo. Both singles and married vitiligo patients suffer from anxiety and hopelessness.

The psychosocial adaptation of patients with skin disease: a scoping review

BACKGROUND

Skin disease is a global public health problem that often has physiological, psychological and social impacts. However, it is not very clear how to adapt to these impacts, especially psychosocial adaptation of patients with skin disease.

METHODS

We searched EMBASE, PubMed, CINAHL and PsycINFO from 2009 to 2018. The following themes were extracted from the included articles: the concepts, related factors, and interventions for psychosocial adaptation of patients with skin disease. Two reviewers independently screened and analyzed.

RESULTS

From 2261 initial records, 69 studies were identified and analyzed. The concept of psychosocial adaptation in patients with skin disease was referred to under an assortment of descriptions. The related factors for psychosocial adaptation in patients with skin disease included the following: demographic factors (sex, age, education level, ethnicity, BMI, sleep quality, marital status, exercise amount, family history, the use of topical treatment only, personality and history of smoking); disease-related factors (disease severity, clinical symptoms, localization and duration); psychological factors (anxiety/depression, self-esteem, body image, stigma and suicidal ideation); and social factors (social support, social interaction, sexual life, economic burden and social acceptance). Despite being limited in quantity, several studies have clarified the benefits of adjuvant care in the form of cognitive behavioral training, educational training and self-help programs, all of which have become common methods for dealing with the psychosocial impacts.

CONCLUSIONS

Based on the previous literatures, we constructed a protocol of care model for psychosocial adaptation in patients with skin disease. It not only provided the direction for developing new instruments that could assess psychosocial adaptation statue, but also a basis for helping patients adjust to changes in skin disease.

Effectiveness of topical Nigella sativa for vitiligo treatment

Vitiligo is a pigment disease characterized by the disruption of melanocyte structure and function. Its etiology is unknown; however, genetic predisposition, biochemical factors, and neural mechanisms are thought to be effective. Although many agents are being used for its treatment, generally there is no absolute cure. The aim of the present study is to evaluate the effectiveness of topical Nigella sativa seed oil on vitiligo patients. Thirty-three vitiligo patients were included in the study. Totally 47 areas were evaluated in all patients. Cream containing N sativa seed oil was topically applied to hands, face, and genital region two times a day for 6 months. Statistically significant repigmentation was detected in hands, face, and genital region, the three treatment areas, and the p values are found .005, .001, and .004, respectively. N sativa can be used as an adjuvant therapy that can contribute to the treatment especially in sensitive skin areas like genital region.

The emotional burden of chronic skin disease dominates physical factors among women, adversely affecting quality of life and sexual function

BACKGROUND

Both physical and emotional effects are linked with the natural history of chronic skin diseases (CSD). Skin lesions can be confined to covered areas or involve emotionally charged regions (genitalia/exposed areas).

OBJECTIVE

To investigate the contribution of the physical effects of CSD and their emotional burden in adversely affecting the quality of life (QOL) and sexual function.

METHODS

Two groups were included: A group of women suffering from CSD and a control group. All participants answered the 19-item Female Sexual Function Index (FSFI) questionnaire. Women suffering from CSD answered the 10-item Dermatology Life Quality Index (DLQI) questionnaire; this group was divided into various subgroups according to the type of disease and regional involvement.

RESULTS

Neither the DLQI score (P = .06) nor the FSFI scores were significantly affected by the type of disease. The DLQI score was significantly higher in the subgroups with involvement of genitalia or exposed areas (P: < 0.001and 0.01, respectively). Moreover, genital involvement was associated with pervasive and significantly lower FSFI scores, and the arousal, satisfaction, and total scores were significantly lower among women with the involvement of exposed areas. The DLQI score was significantly negatively correlated with the FSFI scores.

CONCLUSION

The emotional burden of CSD should not be overlooked as it dominates the physical effects of disease by adversely affecting QOL and sexual function among women. It is necessary to provide this information to dermatologists and patients, especially in light of effective cognitive-behavior therapy that can be undertaken to ameliorate the emotional stresses.

Psychosexual disorders and dermatologists

Sexual problems that are psychological in origin, rather than physiological, are called psychosexual disorders. Multiple factors, such as general health of the patient, chronic illnesses, psychiatric/psychological disorders, and socio-cultural factors, alone or in combination can be attributed to the development of psychosexual dysfunctions. The symptoms of these disorders vary for each individual and differ with gender. These disorders may be categorized as sexual dysfunction, paraphilias, and gender identity disorders. Dermatologists are sometimes consulted for sexual dysfunctions in their routine practice by the patients visiting sexually transmitted infections (STI) clinics because a majority of the patients believe that these problems are caused by dysfunctions in the sex organs, and because people are hesitant to go to sexuality clinics and psychiatrists for such problems. Sometimes these patients are referred from other specialties such as urology or gynecology; most often, we attempt to search for STIs or other dermatoses on the genitalia and refer them back. We often underestimate the prevalence of sexual concerns of the patients or feel uncomfortable discussing matters of sexuality with them. Dermatologists should understand basic sexual medicine and ask patients for sexual problems. They should be trained to manage such patients accordingly. In this review, we will be focusing on sexual dysfunctions, their etiopathogenesis, and management from a dermatologist's perspective.

Cross-Cultural Adaptation of the Male Genital Self-Image Scale in Iranian Men

Introduction

Certain sexual health problems in men can be attributed to genital self-image. Therefore, a culturally adapted version of a Male Genital Self-Image Scale (MGSIS) could help health professionals understand this concept and its associated correlates.

Aim

To translate the original English version of the MGSIS into Persian and to assess the psychometric properties of this culturally adapted version (MGSIS-I) for use in Iranian men.

Methods

In total, 1,784 men were recruited for this cross-sectional study. Backward and forward translations of the MGSIS were used to produce the culturally adapted version. Reliability of the MGSIS-I was assessed using Cronbach α and intra-class correlation coefficients. Divergent and convergent validities were examined using Pearson correlation and known-group validity was assessed in subgroups of participants with different sociodemographic statuses. Factor validity of the scale was investigated using exploratory and confirmatory factor analyses.

Main Outcome Measures

Demographic information, the International Index of Erectile Function, the Body Appreciation Scale, the Rosenberg Self-Esteem Scale, and the MGSIS.

Results

Mean age of participants was 38.13 years (SD = 11.45) and all men were married. Cronbach α of the MGSIS-I was 0.89 and interclass correlation coefficients ranged from 0.70 to 0.94. Significant correlations were found between the MGSIS-I and the International Index of Erectile Function (P < .01), whereas correlation of the scale with non-similar scales was lower than with similar scale (confirming convergent and divergent validity). The scale could differentiate between subgroups in age, smoking status, and income (known-group validity). A single-factor solution that explained 70% variance of the scale was explored using exploratory factor analysis (confirming uni-dimensionality); confirmatory factor analysis indicated better fitness for the five-item version than the seven-item version of the MGSIS-I (root mean square error of approximation = 0.05, comparative fit index > 1.00 vs root mean square error of approximation = 0.10, comparative fit index > 0.97, respectively).

Conclusion

The MGSIS-I is a useful instrument to assess genital self-image in Iranian men, a concept that has been associated with sexual function. Further investigation is needed to identify the applicability of the scale in other cultures or populations.