Sex drive and sexual desire

The role of sexual self-esteem, sexual desire, and sexual assertiveness in the female sexual function

BACKGROUND

Sexual function plays a very important role in the sexual health of people, and the determination of their related factors reflects the importance of paying attention to sexual function in the cultural context.

OBJECTIVE

The present study aimed to the role of sexual self-esteem, sexual desire, and sexual assertiveness in the female sexual function.

METHODS

In this descriptive-analytical cross-sectional study, 592 married women of reproductive age referring to comprehensive health centers in Rasht city (North of Iran) and eligible for the inclusion criteria were selected by cluster random sampling. The data collection tools were demographic information form, Halbert's Sexual Rights Questionnaires, Women's Sexual Self-Esteem (short form), Halbert's Sexual Desire, and Female Sexual Function Index. Data analysis was done with descriptive and inferential statistical tests at a significant level (p < 0.05).

RESULTS

The mean and standard deviation of sexual assertiveness, sexual desire, and sexual self-esteem scores were 56.79 ± 18.24, 49.12 ± 26.04, and 98.52 ± 6.11, respectively. Sexual assertiveness (p < 0.01, r = 0.13), sexual desire (p < 0.001, r = 0.178), sexual self-esteem (p < 0.01, r = 0.34) of the participants with the total score, and all areas of female sexual function had a significant positive correlation.

CONCLUSION

Based on the findings, there is a direct and statistically significant relationship between sexual assertiveness, sexual desire, the adaptability of sexual self-esteem, and family income with sexual function in participants. However, the unemployment of the spouse had a negative effect on the female sexual function.

Clinical Practice Strategies to Address Sexual Health in Female Cancer Survivors

PURPOSE

The objectives of this narrative review are to describe (1) the evidence for interventions addressing four key issues affecting female sexual health in cancer populations (ie, low sexual desire, vulvovaginal symptoms, negative body image, and sexual partner relationships) that are ready or nearly ready for integration into practice and (2) the current state of patient-provider sexual health communication related to female sexual health as these findings could have implications for integrating sexual health into practice.

METHODS

A narrative review of recent intervention evidence for female cancer survivors' sexual health was conducted.

RESULTS

Strong evidence was found for behavioral interventions, such as psychosexual counseling and psychoeducation to treat concerns related to sexual health, including desire, body image, and sexual partner relationships. For partnered female survivors, couple-based psychosexual interventions have been found to be effective. There are no proven pharmacologic treatments for sexual-related concerns other than for vulvovaginal atrophy in female cancer survivors. Vaginal nonhormonal and low-dose hormonal agents are effective remedies for vulvovaginal symptoms. Laser treatment has not yet been fully evaluated. Sexual partners are a critical context for sexual health. Despite much need, discussions around this topic continue to be relatively infrequent. Recent technology-based interventions show promise in improving discussions around sexual health.

CONCLUSION

Effective interventions exist for many sexual health challenges for female survivors although more high-quality intervention research, particularly multimodal interventions, is needed. Many of the effective interventions are nonpharmacologic, and thus, evaluation of the use of digital delivery to improve access to these interventions is needed. Cancer care delivery research is urgently needed to translate existing effective interventions into practice, including strategies to improve patient-provider communication around this topic.

Romantic love evolved by co-opting mother-infant bonding

For 25 years, the predominant evolutionary theory of romantic love has been Fisher's theory of independent emotion systems. That theory suggests that sex drive, romantic attraction (romantic love), and attachment are associated with distinct neurobiological and endocrinological systems which evolved independently of each other. Psychological and neurobiological evidence, however, suggest that a competing theory requires attention. A theory of co-opting mother-infant bonding sometime in the recent evolutionary history of humans may partially account for the evolution of romantic love. I present a case for this theory and a new approach to the science of romantic love drawing on human psychological, neurobiological, and (neuro)endocrinological studies as well as animal studies. The hope is that this theoretical review, along with other publications, will generate debate in the literature about the merits of the theory of co-opting mother-infant bonding and a new evolutionary approach to the science of romantic love.

Sexual Motivation in Persons with Multiple Sclerosis: A Controlled Cross-Sectional Study

Purpose

Sexual motives are major determinants of sexual behaviour. It has been known that sexual motives may vary according to circumstances. Multiple sclerosis (MS) is a chronic disease causing a broad range of symptoms and disabilities, that often interfere with sexual activities. We aimed to investigate the sexual motives in persons with MS.

Patients and Methods

Cross-sectional study in 157 persons with MS and 157 controls matched for age, gender, relationship, duration of relationship and educational status via propensity score matching. The Reasons for Having Sex (YSEX) questionnaire assessed the proportion with which a person had engaged in sexual intercourse for each of 140 distinct motives to have sex. Estimated mean differences in scores for four primary factors (Physical, Goal attainment, Emotional, Insecurity) and 13 sub-factors, and sexual satisfaction and importance of sex were calculated as Average Treatment Effect of the Treated using 99% confidence intervals.

Results

Persons with MS reported a lower proportion of engaging in sex compared with the controls for the factors Physical (-0.29), Emotional (-0.23) and Insecurity (-0.10); and for the physical sub-factors Pleasure (-0.48), Experience seeking (-0.32), Stress reduction (-0.24), and Physical desirability (-0.16), the emotional sub-factors Love and commitment (-0.27) and Expression (-0.17), and the insecurity sub-factor Self-esteem boost (-0.23). In the control group seven of the top 10 sexual motives were physical versus five in the MS group. The importance of sex was lower in the MS group (-0.68).

Conclusion

Findings of this controlled cross-sectional study suggest a reduction in the number of sexual motives in persons with MS, especially of physical motives related to pleasure and experience seeking. Health care professionals may consider assessing sexual motivation when dealing with persons with MS who suffer from decreased sexual desire or another sexual dysfunction.

Randomized Controlled Phase II Evaluation of Two Dose Levels of Bupropion Versus Placebo for Sexual Desire in Female Cancer Survivors: NRG-CC004

PURPOSE

Because of the negative impact of cancer treatment on female sexual function, effective treatments are warranted. The purpose of this multisite study was to evaluate the ability of two dose levels of extended-release bupropion, a dopaminergic agent, to improve sexual desire more than placebo at 9 weeks, measured by the desire subscale of the Female Sexual Function Index (FSFI), and to evaluate associated toxicities.

METHODS

Postmenopausal women diagnosed with breast or gynecologic cancer and low baseline FSFI desire scores (< 3.3), who had completed definitive cancer therapy, were eligible. Women were randomly assigned to receive 150 mg or 300 mg once daily of extended-release bupropion or a matching placebo. t-tests were performed on the FSFI desire subscale to evaluate whether there was a significantly greater change from baseline to 9 weeks between placebo and each bupropion arm as the primary end point. Sixty-two patients per arm provided 80% power using a one-sided t-test.

RESULTS

Two hundred thirty women were randomly assigned from 72 institutions through the NRG Oncology NCORP network. At 9 weeks, there were no statistically significant differences in change of the desire subscale scores between groups; participants in all three arms reported improvement. The mean changes for each arm were placebo 0.62 (standard deviation [SD] = 1.18), 150-mg once daily bupropion 0.64 (SD = 0.95), and 300-mg once daily bupropion 0.60 (SD = 0.89). Total and subscale scores on the FSFI were low throughout the study, indicating dysfunction in all groups.

CONCLUSION

Bupropion was not more effective than placebo in improving the desire subscale of the FSFI. Subscale and total scores of the FSFI demonstrated dysfunction throughout the 9 weeks of the study. More research is needed to support sexual function in female cancer survivors.

Self-reported lack of energy or feeling depressed 12 months after treatment in men diagnosed with prostate cancer within a population-based registry

OBJECTIVE

Feeling depressed and lethargic are common side effects of prostate cancer (PCa) and its treatments. We examined the incidence and severity of feeling depressed and lack of energy in patients in a population based PCa registry.

METHODS

We included men diagnosed with PCa between 2015 and 2019 in Victoria, Australia, and enrolled in the Prostate Cancer Outcomes Registry. The primary outcome measures were responses to two questions on the Expanded Prostate Cancer Index Composite (EPIC-26) patient reported instrument: problems with feeling depressed and problems with lack of energy 12 months following treatment. We evaluated associations between these and age, cancer risk category, treatment type, and urinary, bowel, and sexual function.

RESULTS

Both outcome questions were answered by 9712 out of 12,628 (77%) men. 981 patients (10%) reported at least moderate problems with feeling depressed; 1563 (16%) had at least moderate problems with lack of energy and 586 (6.0%) with both. Younger men reported feeling depressed more frequently than older men. Lack of energy was more common for treatments that included androgen deprivation therapy than not (moderate/big problems: 31% vs. 13%), irrespective of disease risk category. Both outcomes were associated with poorer urinary, bowel, and sexual functional domain scores.

CONCLUSIONS

Self-reported depressive feelings and lack of energy were frequent in this population-based registry. Problems with feeling depressed were more common in younger men and lack of energy more common in men having hormonal treatment. Clinicians should be aware of the incidence of these symptoms in these at-risk groups and be able to screen for them.

Perceived Changes in Sexuality during the COVID-19 Pandemic among Adults in the United States

In the United States, the COVID-19 pandemic has decreased partnered sexual behavior and increased the use of enhancement (e.g., toys). This has been partly attributed to reduced social interactions and stress. However, individuals’ perceptions of changes are missing in research. This study aims to examine how adults perceive changes in their sexuality during the pandemic. We conducted a nationwide survey of US adults from April–June 2020 (N = 326). This qualitative study examines the open-ended responses using thematic analyses. The following themes emerged from the data: (1) changes in the purpose of sex; (2) changes in sexual identity; (3) decreases in sex drive and desire; (4) increases in sex drive and desire; (5) fluctuations in sex drive and desire; (6) increased sexual experimentation and reflection. The stress, changes in home responsibilities and living situations, and time spent with partners (more or less) has affected individuals by increasing or decreasing their sex drive and desire. Participants responded to changes with self-reflection and awareness, and incorporating new practices (e.g., technology, kink). The purpose of sex has shifted in order to gain intimacy or connect, or to pass time. These changes were perceived as both positive and negative, and more research is needed to determine the durability of these changes.

Proximate and Ultimate Perspectives on Romantic Love

Romantic love is a phenomenon of immense interest to the general public as well as to scholars in several disciplines. It is known to be present in almost all human societies and has been studied from a number of perspectives. In this integrative review, we bring together what is known about romantic love using Tinbergen’s “four questions” framework originating from evolutionary biology. Under the first question, related to mechanisms, we show that it is caused by social, psychological mate choice, genetic, neural, and endocrine mechanisms. The mechanisms regulating psychopathology, cognitive biases, and animal models provide further insights into the mechanisms that regulate romantic love. Under the second question, related to development, we show that romantic love exists across the human lifespan in both sexes. We summarize what is known about its development and the internal and external factors that influence it. We consider cross-cultural perspectives and raise the issue of evolutionary mismatch. Under the third question, related to function, we discuss the fitness-relevant benefits and costs of romantic love with reference to mate choice, courtship, sex, and pair-bonding. We outline three possible selective pressures and contend that romantic love is a suite of adaptions and by-products. Under the fourth question, related to phylogeny, we summarize theories of romantic love’s evolutionary history and show that romantic love probably evolved in concert with pair-bonds in our recent ancestors. We describe the mammalian antecedents to romantic love and the contribution of genes and culture to the expression of modern romantic love. We advance four potential scenarios for the evolution of romantic love. We conclude by summarizing what Tinbergen’s four questions tell us, highlighting outstanding questions as avenues of potential future research, and suggesting a novel ethologically informed working definition to accommodate the multi-faceted understanding of romantic love advanced in this review.

Total glycosides from stems of Cistanche tubulosa alleviate depression-like behaviors: bidirectional interaction of the phytochemicals and gut microbiota

BACKGROUND

As the most frequently used kidney-yang tonifying herb in traditional Chinese medicine, dried succulent stems of Cistanche tubulosa (Schenk) Wight (CT) have been shown to be effective in the treatment of depression. However, the antidepressant components and their underlying mechanism remain unclear.

PURPOSE

To explore the active components of CT against depression, as well as the potential mechanisms.

STUDY DESIGN AND METHODS

Behavioral despair tests were used to assess the antidepressant activities of polysaccharides, oligosaccharides and different glycoside-enriched fractions separated from CT, as well as the typical gut microbiota metabolites including 3-hydroxyphenylpropionic acid (3-HPP) and hydroxytyrosol (HT). Furthermore, the effects of bioactive fractions and metabolites on chronic unpredictable mild stress (CUMS) model were explored with multiple pharmacodynamics and biochemical analyses. Changes in colonic histology and the intestinal barrier were observed by staining and immunohistochemical analysis. Gut microbial features and tryptophan-kynurenine metabolism were explored using 16S rRNA sequencing and western-blotting, respectively.

RESULTS

Total glycosides (TG) dramatically alleviated depression-like behaviors compared to different separated fractions, reflecting in the synergistic effects of phenylethanoid and iridoid glycosides on the hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis, severe neuro- and peripheral inflammation, and deficiencies in 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor in the hippocampus. Moreover, TG mitigated low-grade inflammation in the colon and intestinal barrier disruption, and the abundances of several bacterial genera highly correlated with the HPA axis and inflammation in CUMS rats. Consistently, the expression of indoleamine 2, 3-dioxygenase 1 (IDO1) in the colon was significantly reduced after TG administration, accompanied by the suppression of tryptophan-kynurenine metabolism. On the other hand, HT also exerted a marked antidepressant effect by ameliorating HPA axis function, pro-inflammatory cytokine release, and tryptophan-kynurenine metabolism, while it was unable to largely adjust the disordered gut microbiota in the same manner as TG. Surprisingly, superior to fluoxetine, TG and HT could further improve dysfunction of the hypothalamic-pituitary-gonadal axis and abnormal cyclic nucleotide metabolism.

CONCLUSION

TG are primarily responsible for the antidepressant activity of CT; its effect might be achieved through the bidirectional interaction of the phytochemicals and gut microbiota, and reflect the advantage of CT in the treatment of depression.

Poor sleep quality among newly diagnosed head and neck cancer patients: prevalence and associated factors

BACKGROUND

Head and neck cancer (HNC) patients often suffer from distress attributed to their cancer diagnosis which may disturb their sleep. However, there is lack of research about poor sleep quality among newly diagnosed HNC patients. Therefore, our aim was to investigate the prevalence and the associated factors of poor sleep quality among HNC patients before starting treatment.

MATERIALS AND METHODS

A cross-sectional study was conducted using the baseline data from NET-QUBIC study, an ongoing multi-center cohort of HNC patients in the Netherlands. Poor sleep quality was defined as a Pittsburgh Sleep Quality Index (PSQI) total score of > 5. Risk factors examined were sociodemographic factors (age, sex, education level, living situation), clinical characteristics (HNC subsite, tumor stage, comorbidity, performance status), lifestyle factors, coping styles, and HNC symptoms.

RESULTS

Among 560 HNC patients, 246 (44%) had poor sleep quality before start of treatment. Several factors were found to be significantly associated with poor sleep: younger age (odds ratio [OR] for each additional year 0.98, 95% CI 0.96-1.00), being female (OR 2.6, 95% CI 1.7-4.1), higher passive coping style (OR 1.18, 95% CI 1.09-1.28), more oral pain (OR 1.10, 95% CI 1.01-1.19), and less sexual interest and enjoyment (OR 1.13, 95% CI 1.06-1.20).

CONCLUSION

Poor sleep quality is highly prevalent among HNC patients before start of treatment. Early evaluation and tailored intervention to improve sleep quality are necessary to prepare these patients for HNC treatment and its consequences.

[Sexual and emotional life after allogeneic hematopoietic stem cell transplant: Guidelines and patient booklet from the Francophone Society of Bone marrow Transplant and Cellular therapy (SFGM-TC)]

The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organises annual workshops in an attempt to harmonise clinical practices among different francophone transplantation centres. The SFGM-TC harmonisation workshops aim at establishing practical guidelines, on the one hand, from data from the literature and international recommendations and, on the other hand, by consensus in the absence of formally proven data. The sexual and emotional life of allogeneic hematopoietic stem cells transplanted (HSCT) patients is often very impacted and remains a subject relatively little addressed by patients and caregivers. This article is an update from a previous workshop and is accompanied by a patient booklet, which will be included in the post allograft follow-up workbook published by the SFGM-TC. The purpose of these two documents is to facilitate discussions between patients and caregivers on the subject and to present proposals for follow-up and tools to better manage the sexual and emotional life of allotransplanted patients.

Sexual dysfunction in medical practice

PURPOSE OF REVIEW

Sexual dysfunction is associated with many medical disorders. Lack of recognition of sexual dysfunction commonly occurs in medical practice. The impact of unrecognized sexual dysfunction affects quality of life, which in turn affects the recovery from medical illness. This article reviews the recent literature regarding sexual dysfunction in medical practice published in PubMed, Clinical key, Scopus, Google scholar from November 2014 to May 2016.

RECENT FINDINGS

New findings suggest that sexual dysfunction is associated with most of the disorders affecting various systems. Sexual dysfunction associated with medical disorders, apart from having effects on patients, also has impact on spouses. Sexual dysfunction may also be a predictor of future major adverse event. Prevelance of sexual dysfunction in various major illness is in the range of 20-75%. Phosphodiesterase-5 inhibitors which are first line drugs to treat erectile dysfunction cause no increase in myocardial infarction or death.

SUMMARY

Sexual functioning is impaired in neurological, endocrinal, cardiovascular, pelvic, dermatological, and other disorders. Stroke, epilepsy, traumatic brain injury, and other neurological disorders cause significant impairment in sexual functioning. Though exact correlation between androgen and sexual functioning cannot be made, androgen plays important role various phases of sexual cycle in both men and women. Diabetes has impact on all the phases of sexual cycle. Hypertension, as well as certain drugs used to treat hypertension also causes sexual dysfunction, judicious use of hypotensive drugs is recommended.