Sexual dysfunction in medical practice

Sexual Dysfunction in Diabetic Patients: Τhe Role of Advanced Glycation End Products

Sexual dysfunction is a common but underestimated disorder of diabetic patients of both genders, entailing specific and complex pathogenesis and severely affecting reproductive health and quality of life. Hyperglycemia, dyslipidemia, hypertension, obesity, aging, and psychological factors underlie its pathogenesis. A large body of evidence indicates that advanced glycation end products and oxidative stress have a distinct impact on the pathogenesis of diabetes and its complications, including hypogonadism, which is closely related to sexual dysfunction. Advanced glycation end products seem to affect sexual function either directly by accumulation in various regions of the reproductive system and/or correlation or indirectly through oxidative stress induction via several mechanisms. They are also involved in the pathogenesis of diabetic complications, which are related to sexual dysfunction. Herein, we review the issue of sexual dysfunction in diabetic males and females, with special emphasis on the impact of advanced glycation end products in the pathogenesis of sexual dysfunction, the relationship of advanced glycation end products with low testosterone levels in diabetic subjects, which account for the proportion of disorder and the available therapeutic interventions.

A systematic review of Indian studies on sexual dysfunction in patients with substance use disorders

BACKGROUND AND AIMS

Sexual dysfunction is often associated with substance use disorders. This study aimed to synthesize Indian literature on sexual dysfunction among patients with substance use disorders.

MATERIALS AND METHODS

Electronic search engines were used to identify studies of the last 20 years that reported sexual dysfunction with different substance use disorders. Information was extracted using a predefined template. Quality appraisal of the included studies was carried out using Joanna Briggs Institute checklist.

RESULTS

Twenty-seven relevant papers were identified that pertained to 24 distinct studies. Most of them were in patients with alcohol dependence, and fewer were in patients with opioid dependence. The study designs were primarily single-group cross-sectional, though many case-control, cross-sectional studies were also identified. The proportion of participants with sexual dysfunction ranged from 22.2% to 76% for studies related to alcohol dependence and 40% to 90% for studies pertaining to opioid dependence. Varied types of sexual dysfunctions were identified, including poor satisfaction, lack of desire, premature ejaculation, and erectile dysfunction. Efforts to address bias and confounders were not reported in most studies.

CONCLUSION

Sexual dysfunction affects a substantial proportion of patients with substance use disorders. Clinicians can make an effort to ascertain and address sexual dysfunction in their routine clinical practice while dealing with patients with substance use disorders.

Sexuality, sexual well being, and intimacy during COVID-19 pandemic: An advocacy perspective

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS)-CoV-2, has emerged as a global public health threat. The implications are much beyond just health crisis, and it has long-lasting psychosocial and economic implications. Although the psychological offshoots such as depression, anxiety, posttraumatic stress, and sleep disturbances are being studied in-depth, there is a dearth of literature on the sexual well-being and sexual practices during this pandemic. Considering the physical distancing; travel restrictions; the high human-human transmission rate; misinformation and uncertainty about the sexual routes of transmission for SARS-CoV-2; and fear about intimacy, sexuality, and safe sexual practices have increased significantly. This is more prominent in newly settled or distanced couples and the frontline health workers, with increased risk exposure to the virus. For them, guilt and distress associated with sexual relationships might increase primary psychiatric and sexual disorders. This, in turn, impacts relationships and emotional bonding in couples and affects healthy coping during the pandemic crisis. Although sexual abstinence is the safest practice to prevent transmission, it is not practically feasible in all cases. Risk reduction counseling, sex with quarantined partners, and digital sex are other options that are worth exploring. There are additional concerns of digital safety, unhealthy use of technology, cyber-crimes, and online extortion. Keeping this in the background, this advocacy article glances through the effects of past outbreaks on sexuality, reviews the current recommendations, and proposes methods and approaches for sexual well-being during the COVID-19 pandemic, which is vital for overall public health.

Phase I and registry study of autologous bone marrow concentrate evaluated in PDE5 inhibitor refractory erectile dysfunction

Background

Bone marrow mononuclear cells have been successfully utilized for numerous regenerative purposes. In the current study, patients suffering from erectile dysfunction (ED) unresponsive to phosphodiesterase 5 inhibitors were administered autologous bone marrow concentrate delivered intracavernously utilizing a point of care FDA cleared medical device.

Methods

A total of 40 patients were treated in the primary trial and 100 in the clinical registry, with the longest follow up of 12 months.

Results

Minimal treatment associated adverse effects where observed related to short term bruising at the site of harvest or injection. No long-term adverse events were noted related to the intervention. Mean improvements in IIEF-5 score were 2 in the Caverstem 1.0 low dose group, 3 in the high dose Caverstem 1.0 group and 9 in the Caverstem 2.0 group. Furthermore, improvements peaked by 3 months and maintained at 6 months follow-up.

Conclusion

These data support the safety and efficacy of point of care, minimally to non-manipulated, non-expanded bone marrow concentrate for the treatment of ED.

Trial registration Funded by Creative Medical Health, Inc.; Clinicaltrials.gov number: NCT03699943; https://clinicaltrials.gov/ct2/show/NCT03699943?term=caverstem&rank=1; initially registered December 12, 2015.

From Promoting Healthy Sexual Functioning to Managing Biomedical Sexual Dysfunction: Health Professional Views of Youth Sexual Health

A body of work emerging in the last few years has expanded the focus of youth sexual health to include problems in sexual functioning. Recent surveys show that rates of youth sexual functioning problems are similar to those of adults. Physicians' lack of awareness about problems of sexual functioning has been identified as a major obstacle in treatment. Yet little is known about health-care provider (HCP) perspectives on youth sexual functioning. We conducted a descriptive qualitative study with HCPs to learn about their perceptions of adolescent sexual problems and HCP roles in managing these issues including sexual functioning. Nineteen HCPs: Family physicians, nurse practitioners, and public health nurses working primarily with youth in universities, schools, or sexual health clinics were recruited to draw on their expert knowledge and experience. All completed in-depth individual interviews. Data were analyzed using directed qualitative content analysis. Our findings illuminate inconsistent views. Some HCPs, particularly those in youth-focused services, adopt a holistic role in promoting healthy sexual functioning, and others, commonly those in general practice, attend only to biomedical issues related to sexual dysfunction. All HCPs in our study were challenged by a paucity of sexual health preparation in their formal education. HCP interest in youth sexual health affected their efforts to acquire new information and training and, along with the structure of their practice setting, influenced whether they framed their role in youth sexual health holistically within a context of social determination or constrained their role to a medical model. These findings draw attention to the need for new approaches for strengthening knowledge, training, and resources to foster HCP promotion of healthy sexual functioning and prevention of lifelong sexual health problems.

The combined polymorphisms of interleukin-6-174GG genotype and interleukin-10 ATA haplotype are associated with a poor quality of life in patients with chronic hepatitis C

PURPOSE

Chronic hepatitis C (CHC) is associated with a decreased health-related quality of life (HRQOL). More recent studies have pointed toward a genetic basis of patient-reported quality of life outcomes. Taking into account that the influence of single-nucleotide polymorphisms (SNPs) on the HRQOL of CHC patients has not been studied, we investigated the combined IL10-1082G/A, - 819C/T, and - 592C/A SNPs, and IL6-174G/C SNP. We also evaluated the association between demographic, clinical, psychiatric, virological, and genetic variables with domains and summaries of HRQOL in CHC patients.

METHODS

132 consecutive CHC patients and 98 controls underwent psychiatric evaluation by using the Mini International Neuropsychiatric Interview. HRQOL was assessed by a generic questionnaire, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and by the specific Liver Disease Quality of Life Questionnaire (LDQOL). IL6 and IL10 polymorphisms were evaluated by Taqman SNP genotyping assay. Multivariate analysis was used to evaluate the associations.

RESULTS

Major depressive disorder was associated with lower SF-36 and LDQOL scores in seven and ten domains, respectively. Diabetes and hypertension were also associated with reduced HRQOL. CHC patients carrying the combination of IL10 ATA haplotype/IL6-GG genotype had lower scores in the SF-36-physical functioning domain, and reduced scores in the LDQOL effects of liver disease on activities of daily living, quality of social interaction, and sexual function domains than the non-carriers of the combined haplotype/genotype.

CONCLUSION

This is the first study to demonstrate that combined IL6 high-producer GG genotype and IL10 low-producer ATA haplotype is associated with poorer HRQOL in CHC patients.

Sexual disorders beyond DSM-5: the unfinished affaire

PURPOSE OF REVIEW

To provide an overview of post-The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. classifications related to human sexuality. After reviewing the literature on classification and clinical practice of sexual disorders, some of the most important contributions on main sexological classifications and frameworks were selected, especially from January 2016 till June 2017.

RECENT FINDINGS

New relevant contributions on psychiatric and sexological classifications and frameworks have been proposed, such as the international classification of diseases 11th revision (ICD-11), research domain criteria, the third edition of the Diagnostic Manual in Sexology and the person-centered psychiatry perspective.

SUMMARY

ICD-11 proposals regarding conditions related to sexual health including sexual dysfunctions and gender incongruence as well as vaginismus, such as sexual pain disorder, paraphilic disorders as mental Disorders. The disorders associated with sexual development and orientation, are proposed for deletion. The other perspectives aforementioned are also presented.