Prevalence of sexual dysfunction in three psychiatric outpatient settings: A drug misuse service, an alcohol misuse service and a general adult psychiatry clinic

An overlooked issue: sexual dysfunctions in men addicted to alcohol

Introduction According to the data obtained in the EZOP Poland study (2015), the prevalence of alcohol dependence in lifetime in Poland amounts to about 2.2% of the population, entailing enormous social, family and personal harm, including health damage. It is estimated that about 72% of alcohol-dependent patients complain about one or more problems related to the sexual sphere, which may result from both the development of somatic complications in the course of alcohol dependence, and from psychiatric complications that themselves can lead to sexual dysfunction. There are reports and clinical observations indicating that the occurrence of sexual dysfunction (SD) can affect the shortening or interruption of the period of abstinence.

Aim The aim of this work is to show sexual dysfunctions in alcohol-dependent men and to discuss the factors that may affect the occurrence of the above-mentioned dysfunctions.

Material and methods The available literature was reviewed using Medline, Google Scholar and ScienceDirect browsers by entering the keywords: alcohol dependence, sexual dysfunction, comorbidity, alcohol-caused diseases and time descriptors: 1979-2016.

Results

• Alcohol dependence is associated with the occurrence of various types of sexual dysfunctions (SD).

• The diagnosis of SD should take into account all possible causes that may lead to the development of SD in this group of patients, including the comorbidity of somatic diseases or the negative impact of drugs on sexual function.

• Occurrence of SD is connected with a higher risk of abstinence interruption.

• There is a need to carry out more research in order to better understand the relationship between alcohol dependence and the prevalence of sexual dysfunctions.

Graduate Counseling Psychology Training in Sex and Sexuality: An Exploratory Analysis

In this manuscript, we explore the need for inclusion of sex-positivity training in counseling psychology doctoral program curricula. We surveyed 25 counseling psychology doctoral program administrators throughout the United States and asked about the inclusion of human sexuality coursework and training opportunities as well as sex positivity within their curricula. We report our findings, noting the number of programs that include human sexuality coursework, incorporate sex positivity, discuss sex positivity, and discuss sex positivity from a multicultural lens. The implications of these findings for research, practice, training, and advocacy within counseling psychology are discussed.

Let’s Talk About Sex: Integrating Sex Positivity in Counseling Psychology Practice

Counseling psychologists should take an active approach in broaching issues of sex and sexuality, given that clients may hesitate to initiate such conversations due to their discomfort or fears about therapists’ attitudes or judgments. Research has suggested that mental health providers need to be skilled and comfortable addressing issues of sex and sexuality in order to provide culturally competent, holistic care for clients. Consistent with a sex-positive approach, which views sexuality as a universal human experience and an important aspect of overall psychological health, quality of life, and relational satisfaction, in this article we present five recommendations for counseling psychologists, encouraging them to integrate topics of sex and sexuality into clinical practice. Following Pederson’s (2000) Triad Training Model of awareness, knowledge, and skills, we provide recommendations accompanied with questions and examples of proactive and sex-positive language.

Hypersexuality and couple relationships in bipolar disorder: A review

BACKGROUND

Although change in sexual behavior is recognized as an integral part of bipolar disorder, most of the relevant literature on sexual issues in patients with this illness concerns medication side effects and does not differentiate bipolar disorder from other serious mental disorders. Surprisingly, little has been published on mania-induced hypersexuality and the effects of mood cycling on couple relationships. In this review, we examine the extant literature on both of these subjects and propose a framework for future research.

METHODS

A search of PsycINFO and PubMed was conducted using keywords pertaining to bipolar disorder, hypersexuality and couple relationships. A total of 27 articles were selected for review.

RESULTS

Despite lack of uniformity in diagnosis of bipolar disorder and no formal definition of hypersexuality, the literature points to an increased incidence of risky sexual behaviors in bipolar patients during manic episodes compared to patients with other psychiatric diagnoses. Further, it appears that bipolar patients are more similar to healthy controls than to other psychiatric patients when it comes to establishing and maintaining couple relationships. Nonetheless, the studies that examined sexuality in couples with one bipolar partner found decreased levels of sexual satisfaction associated with the diagnosis, varying levels of sexual interest across polarities, increased incidence of sexual dysfunction during depressive episodes, and disparate levels of satisfaction in general between patients and their partners.

LIMITATIONS

Due to changes in diagnostic criteria over time, there is a lack of uniformity in the definition of bipolar disorder across studies. Hypersexuality is not systematically defined and therefore the construct was not consistent across studies. Some of the older articles date back more than 30 years, making them subject to the biases of sexual and gender norms that have since become outdated. Finally, the heterogeneity of the samples, which include patients with comorbid substance use as well as inpatient, outpatient, symptomatic and euthymic patients, may limit the generalizability of results.

CONCLUSIONS

Although bipolar patients experience disease-specific sexual problems of mania-induced hypersexuality and specific effects of mood cycling on couple relationships, the existing literature is mostly outdated and lacks a consistent definition of hypersexuality. Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms.

Associations between common mental disorders and sexual dissatisfaction in the general population

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.

Belonging and doing: important factors for satisfaction with sexual relations as perceived by people with persistent mental illness

BACKGROUND

It is increasingly acknowledged that satisfaction with sexual relations forms an important aspect of people's lives, but little is known of factors associated with this phenomenon among people with mental illness.

AIM

This study aimed to investigate how demographic, social, clinical, and health-related factors were related to satisfaction with sexual relations.

METHODS

Patients with persistent mental illness (N = 103), recruited from an outpatient unit, were assessed regarding the target variables.

RESULTS

No clinical variable, and only one demographic factor, namely being a cohabitant, was found to be important to satisfaction with sexual relations. Several social factors, pertaining to how everyday occupations were valued and how the social network was perceived, were shown to be of importance. General quality of life, but not self-rated health or interviewer-assessed psychopathology, was also important for satisfaction with sexual relations. A multivariate analysis showed that the most significant factor for satisfaction with sexual relations was how everyday activities were valued, and being a cohabitant explained some additional variation.

CONCLUSION

Previous research indicates that the mental health care services largely neglect sexual problems among people with mental illness, and the findings may provide additional knowledge that may be used in the support of this target group.

Sexual dysfunction in schizophrenia: focus on recent evidence

BACKGROUND

Antipsychotic medications are known to be commonly associated with sexual dysfunction. Sexual dysfunction is estimated to affect 30-80% of patients with schizophrenia and is a major cause of poor quality of life. However, few comparative studies on the sexual dysfunction effects associated with antipsychotic medication have been published and the effects of the newer atypical antipsychotics have been largely unexamined.

OBJECTIVE

This review aims to examine the latest evidence regarding the sexual function effects of different antipsychotic medications, particularly the newer prolactin-sparing drugs, quetiapine and aripiprazole, in patients with schizophrenia and schizoaffective psychosis.

METHODS

A literature search was conducted within PubMed/MEDLINE using the terms risperidone, haloperidol, clozapine, olanzapine, ziprasidone, quetiapine, aripiprazole; sexual dysfunction; schizophrenia. The results were limited to studies published since 2002.

RESULTS

Recently published studies show that the relative impact of antipsychotics on sexual dysfunction can be summarised as risperidone > typical antipsychotics (haloperidol) > olanzapine > quetiapine > aripiprazole.

CONCLUSIONS

The availability of prolactin-sparing antipsychotics should enable psychiatrists to consider and manage proactively the sexual function consequences of pharmacological intervention, thereby improving sexual side effects, which may lead to improved treatment adherence and psychiatric outcome in patients with schizophrenia.

Erectile dysfunction medication use among men seeking substance abuse treatment

Few studies of erectile dysfunction (ED) medications use among heterosexual drug using or abusing men have been conducted. The aims of this study were to provide information on ED medication use prevalence, method of acquisition, and sexual effects among men seeking substance abuse treatment. A single time point cross-sectional anonymous survey was completed by 297 men over the age of 18 seeking substance abuse treatment at an outpatient clinic at a Veterans Affairs Medical Center in the Pacific Northwest. Mean age of participants was 49.7 years and 59.4% self-identified as Caucasian. Alcohol (56.7%) and cocaine (26.1%) were the primary drugs of abuse. Lifetime use of ED medications was reported by 24% (95%CI = 8.6%, 39.4%) of men. Almost 69% of ED medication users reported obtaining ED medications from a physician. Fifty-nine percent of ED medication users reported taking the medications to enhance their sexual experience rather than to treat ED, which was marginally associated with stimulant use (OR = 3.86, 95%CI = 0.96, 15.54, p = .057). These results add to an emerging recognition of the need to address the health implications of ED medication use among heterosexual drug using populations.

Prevalence, severity, and risk factors for erectile dysfunction in a representative sample of 3,548 portuguese men aged 40 to 69 years attending primary healthcare centers: results of the Portuguese erectile dysfunction study

INTRODUCTION

Many studies of the prevalence of erectile dysfunction have been conducted in several countries. This is the first Portuguese study that provides current and comparative data on the prevalence of erectile dysfunction.

AIM

The main objective was to estimate the prevalence of erectile dysfunction in men aged 40 to 69 years and correlate erectile dysfunction to certain risk factors.

MAIN OUTCOME MEASURES

Evaluation of erectile dysfunction was achieved using the International Index of Erectile Function (IIEF), a 15-item questionnaire that has been developed and validated as a brief and reliable self-administered scale for accessing erectile function.

METHODS

The Portuguese Erectile Dysfunction Study was based on a questionnaire that included socio-demographic variables, information on lifestyle and risk factors, and the IIEF. In total, 3,548 questionnaires were administered to men aged 40 to 69 years in 50 primary healthcare centers between July 2004 and January 2005 in a combination of both self-administration and interviews. Erectile dysfunction was defined as the inability to achieve and maintain an erection sufficient to permit satisfactory sexual intercourse.

RESULTS

The response rate was 81.3%. The total prevalence of erectile dysfunction was 48.1% (age-adjusted). Prevalence increases with age: 29%, 50%, and 74% in men aged 40 to 49 years, 50 to 59 years, and 60 to 69 years, respectively. Severity of erectile dysfunction also increases with age: 1%, 2%, and 10% of complete erectile dysfunction in men aged 40 to 49 years, 50 to 59 years, and 60 to 69 years, respectively.

CONCLUSIONS

The prevalence of erectile dysfunction is strongly related to age. There is also a correlation with the health status of participants.