Sexual function and relationship satisfaction: an investigation into men's attitudes and perceptions

Discussing sexual health with patients eligible for spine surgery: An online survey in spine surgeon and pain physicians

Introduction

Spinal pain syndromes have a severe impact on the patient's sex life, contributing to a decrease in sexual function and sexual satisfaction. Despite the importance of sexual health on mental and physical wellbeing, sexual health is rarely discussed during consultations.

Research question

The aim of this study is to explore to what extent influencing factors can alter the discussion about sexual health during consultations. More specifically, we will evaluate the influence of healthcare profession, sex of the patient and the surgical approach that is proposed.

Material and methods

An online survey was sent to neurosurgeons, pain physicians and orthopedists in Belgium and The Netherlands in April 2019. Participants were asked about; counseling routine, knowledge, and opinion on sexual health. Answers were scored on a 5-point Likert scale. Independence between the response levels and type of surgery as well as profession were tested.

Results

In total, 350 respondents were approached of whom 57 completed the survey. The majority of respondents (61.4%) indicated that they rarely or never discussed sexual disturbances. Profession and type of surgery had an influence on discussing erectile dysfunction, retrograde ejaculation, and alterations in orgasms. Thirty-five percent of healthcare providers considered it the patient's responsibility to bring up the subject of sexual health.

Discussion and conclusion

Sexual health is rarely addressed by healthcare providers during spinal care. Profession as well as type of surgery seems to play a role on whether sexual health is discussed during consultations.

Sexual Dysfunction and Satisfaction in Kidney Transplant Patients

INTRODUCTION

10% of the world's population suffers from chronic kidney disease. Kidney transplants provide an improvement in the quality of life of those patients. Sexual dysfunction is common after kidney transplantation, and its etiology is presumed to be multifactorial. It has a negative impact on sexual satisfaction and health-related quality-of-life. The integration of a new organ into the body can imply an adjustment of body image, which may eventually have a negative influence on intimacy and sexual behaviors.

AIM

To evaluate male sexual function, sexual satisfaction, and body image satisfaction among a convenience sample of patients who have had a kidney transplant.

METHODS

This is a cross-sectional study that included 460 patients, from a single healthcare center, who had undergone a kidney transplant procedure >4 weeks ago. A total of 112 respondents (mean = 55.5 years, SD = 11.4) answered the questionnaires properly.

MAIN OUTCOME MEASURES

All recruited patients answered a self-reported sociodemographic questionnaire, in addition to the International Index of Erectile function, the New Scale of Sexual Satisfaction, the Brief Symptom Inventory, and the Body Image Scale.

RESULTS

A correlation was found between sexual function and sexual satisfaction (r = 0.598, P < .001, n = 112), as well as between body image satisfaction and sexual function (r = -0.193, P = .042, n = 112). The length of time after a kidney transplant (≤ or >36 months) was not associated with a difference in sexual functioning or sexual satisfaction.

CLINICAL IMPLICATIONS

This study showed the obvious implications of sexual function on sexual satisfaction, which should alert healthcare professionals to the importance of identifying and managing sexual dysfunction in patients with chronic kidney disease, to optimize their global and sexual health satisfaction.

STRENGTH & LIMITATIONS

This study identified a high prevalence of sexual dysfunction among kidney transplant recipients. This should reinforce the need for the medical community to evaluate the quality-of-life domains of patients with chronic disease. There is still a lack of information concerning any longitudinal evaluation of kidney transplant patients' sexual function and the effects that this surgery has on sexuality.

CONCLUSIONS

This study corroborated the severe effects that kidney transplant patients often report regarding their sexuality. Among the patients who participated in the study, sexual function proved to be relevant in relation to sexual satisfaction. Mota RL, Fonseca R, Santos JC, et al. Sexual Dysfunction and Satisfaction in Kidney Transplant Patients. J Sex Med 2019;16:1018-1028.

The Natsal-SF Measure of Sexual Function: Comparison of Three Scoring Methods

The Natsal-SF is a psychometrically validated measure of sexual function for use in community health surveys, derived from 17 questions reflecting three components of sexual function. Scoring requires knowledge of complex statistical modeling and, given the methodological complexities, we assessed the validity of two simplified scoring methods calculated using the factor loadings produced when originally modeling the Natsal-SF items. Method 1 uses these factor loadings to three decimal places, while method 2 assigns whole numbers to each item based on the factor loadings. Scores from these simplified methods are compared to the original score using correlation coefficients, by comparing the distributions and the scores of each method in a linear regression model with key variables. We found scores from the simplified methods both correlate highly with the original score, and the distributions of scores closely match. The simplified methods result in different regression coefficients for gender and relationship context but estimate the coefficients of all other variables similarly to the original method. While the Natsal-SF should ideally be scored using latent variable modeling, the simplified methods perform well so can be used in similar contexts, increasing the utility of the Natsal-SF and enabling future studies to measure sexual function more comprehensively.

Sexual Behavior and Sexual Satisfaction according to Gender in Korean Patients with Cancer

PURPOSE

This study was done to investigate sexual behavior and sexual satisfaction according to gender difference in Korean patients with cancer.

METHODS

In this study, a convenience sample of Korean patients with cancer who visited hospitals in J City was used. Data were collected between September and December 2012using structured questionnaires: Sexual frequency scale and General sexual satisfaction index (GSSI).

RESULTS

Over half of the patients reported loss of sexual desire and changes in sexual behaviors. There was a significant decrease in sexual satisfaction among the male patients, compared to the female patients (t=2.34, p=.020). There were significant correlations between sexual satisfaction and sexual behaviors (male patients r=.45, p<.001; female patients r=.59, p<.001).

CONCLUSION

The results of this study demonstrate the need to take gender into account in developing interventions for patients with cancer. These results will also contribute to the development of improved interventions for sexual health care.

Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

BACKGROUND

Despite its importance to sexual health and wellbeing, sexual function is given little attention in sexual health policy. Population-based studies are needed to understand sexual function across the life course.

METHODS

We undertook a probability sample survey (the third National Survey of Sexual Attitudes and Lifestyles [Natsal-3]) of 15,162 individuals aged 16-74 years who lived in Britain (England, Scotland, and Wales). Interviews were done between Sept 6, 2010, and Aug 31, 2012. We assessed the distribution of sexual function by use of a novel validated measure (the Natsal-SF), which assessed problems with individual sexual response, sexual function in a relationship context, and self-appraisal of sex life (17 items; 16 items per gender). We assess factors associated with low sexual function (defined as the lowest quintile of distribution of Natsal-SF scores) and the distribution of components of the measure. Participants reporting one or more sexual partner in the past year were given a score on the Natsal-SF (11,690 participants). 4122 of these participants were not in a relationship for all of the past year and we employed the full information maximum likelihood method to handle missing data on four relationship items.

FINDINGS

We obtained data for 4913 men and 6777 women for the Natsal-SF. For men and women, low sexual function was associated with increased age, and, after age-adjustment, with depression (adjusted odds ratio 3·70 [95% CI 2·90-4·72] for men and 4·11 [3·36-5·04] for women) and self-reported poor health status (2·63 [1·73-3·98] and 2·41 [1·72-3·39]). Low sexual function was also associated with experiencing the end of a relationship (1·52 [1·18-1·95] and 1·77 [1·44-2·17]), inability to talk easily about sex with a partner (2·36 [1·94-2·88] and 2·82 [2·28-3·48]), and not being happy in the relationship (2·89 [2·32-3·61] and 4·10 [3·39-4·97]). Associations were also noted with engaging in fewer than four sex acts in the past 4 weeks (3·13 [2·58-3·79] and 3·38 [2·80-4·09]), having had same sex partners (2·28 [1·56-3·35] and 1·60 [1·16-2·20]), paying for sex (in men only; 2·62 [1·46-4·71]), and higher numbers of lifetime sexual partners (in women only; 2·12 [1·68-2·67] for ten or more partners). Low sexual function was also associated with negative sexual health outcomes such as experience of non-volitional sex (1·98 [1·14-3·43] and 2·18 [1·79-2·66]) and STI diagnosis (1·50 [1·06-2·11] and 1·83 [1·35-2·47]). Among individuals reporting sex in the past year, problems with sexual response were common (41·6% of men and 51·2% of women reported one or more problem) but self-reported distress about sex lives was much less common (9·9% and 10·9%). For individuals in a sexual relationship for the past year, 23·4% of men and 27·4% of women reported an imbalance in level of interest in sex between partners, and 18·0% of men and 17·1% of women said that their partner had had sexual difficulties. Most participants who did not have sex in the past year were not dissatisfied, distressed, or avoiding sex because of sexual difficulties.

INTERPRETATION

Wide variability exists in the distribution of sexual function scores. Low sexual function is associated with negative sexual health outcomes, supporting calls for a greater emphasis on sexual function in sexual health policy and interventions.

FUNDING

Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.

Eroticization as a factor influencing erectile dysfunction treatment effectiveness

We review both the medical and psychosocial literature on factors influencing male potency in order to better understand why erectile dysfunction (ED) treatments, PDE5 drugs in particular, are abandoned when otherwise effective. We incorporate anecdotal data from websites and list serves dedicated to helping patients deal with iatrogenic ED. Our goal is to distinguish between ED treatments that are medicalized versus eroticized, and how partner participation may influence their effectiveness. Recently it has been shown that ED treatment effectiveness is aided by the involvement of the patient's partner. This permits an erotic association between the partner and the ED 'aid'. We extend this idea to suggest that having the partner involved as early as possible in the discussion of treatment, and their presence at the time of prescription, should improve ED aid effectiveness. Eroticization of ED aids shifts the focus from a perceived disability of the patient toward the sexual pleasure provided by the partner. We further suggest that ED aids used without the partner's knowledge will undermine intimacy and ultimately the treatment's effectiveness. Unpartnered patients should be advised about the importance of informing potential partners about their use of such aids, as openness and honesty may increase intimacy in the long run.