Repressive coping style and its relation to psychosocial distress in males with erectile dysfunction

A cross-sectional study of sexual dysfunction in chinese mainland female patients with rheumatoid arthritis

Objectives

This study aims to investigate the effects of rheumatoid arthritis (RA) on Chinese mainland female patients’ sexual function compared with healthy subjects and to determine the risk factors of sexual dysfunction.

Patients and methods

A total of 151 female RA patients (mean age: 46.3±8.6 years) and 146 healthy female controls (mean age 45.7±7.6 years) were included in this cross-sectional study whose data were collected consecutively by questionnaires between November 2017 and June 2019. Data were collected by using demographics, disease-related information, Female Sexual Function Index, Dyadic Adjustment Scale, Medical Coping Modes Questionnaire, other psychological parameters and the Short Form-36.

Results

Our results showed that the prevalence of female sexual dysfunction was 67.5% in RA patients, which was significantly higher than the controls (54.1%) (p<0.05). Body mass index, resignation coping style, physical component summary, marital dysfunction and postmenopausal status were significant correlation factors by backward stepwise binary logistic regression.

Conclusion

Rheumatoid arthritis negatively affected sexual function of patients who had considerably impaired sexual function compared to controls.

Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients

Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients. Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report. Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping. Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.

Relationship Between Cannabis Use and Erectile Dysfunction: A Systematic Review and Meta-Analysis

Globally, there is increasing usage and legalization of cannabis. In addition to its reported therapeutic effects, cannabis has several health risks which are not clearly defined. Erectile dysfunction (ED) is the most common male sexual disorder and there are plausible mechanisms linking cannabis use to ED. No attempt has been made to collate the literature on this topic. The aim of this review was to summarize the prevalence and risk of ED in cannabis users compared to controls.

A systematic review of major databases from inception to January 1, 2019, without language restriction, was undertaken to identify studies investigating cannabis use and presence of ED. The analysis compared the prevalence of ED in cannabis users versus controls. Consequently, the odds ratio (OR) with 95% confidence intervals (CI) was calculated, applying a random-effect model.

Five case–control studies were included with data from 3,395 healthy men, 1,035 using cannabis (smoking) and 2,360 nonusers. The overall prevalence of ED in cannabis users was 69.1% (95% CI: 38.0–89.1), whilst the correspondent figure in controls was 34.7% (95% CI: 20.3–52.7). The OR of ED in cannabis users was almost four times that of controls (OR = 3.83; 95% CI: 1.30–11.28; p = .02), even if characterized by high heterogeneity (I² = 90%) and the prediction intervals overlapped 1.00 (95% CI: 0.35–7.26).

Data suggest that ED is twice as high in cannabis users compared to controls. Future longitudinal research is needed to confirm/refute this and explore if a dose–response relationship between cannabis and ED may be evident.

Risk factors and negative consequences of patient's delay for penile carcinoma

BACKGROUND

Delayed first medical consultation (patient's delay) is quite common in cases of penile carcinoma (PC), but its reasons and impacts remain unclear. We conducted this study to ascertain risk factors resulting in delayed treatment seeking and evaluate its influence on prognosis.

METHODS

From 2004 to 2010 at 4 centers, 254 patients were enrolled into this study from 262 consecutive PC cases. Patients' sexual performance was investigated using the International Index of Erectile Function (IIEF)-15 at the sixth-month end after treatment. Data for prognostic analyses was obtained via a 5-year follow-up.

RESULTS

A multivariate model ascertained 4 risk factors (single, living in rural areas, heavy drinking alcohol, and aspecific initial symptoms) and 1 protective factor (history of condyloma) significantly associated with patient's delay. Delay >3 months led to significant risks for adverse clinical characteristics, low penis-sparing rate, and poor sexual function restoration. Although patient's delay was not found to impact on postoperative relapses and 5-year overall survival (OS), patients with delay >6 months had significantly inferior 2-year OS.

CONCLUSIONS

Single, living in rural areas, heavy drinking alcohol, and aspecific initial symptoms are significant risk factors of PC associated with patient's delay. Delay >3 months will lead to significantly inferior clinical consequences. Minimizing patient's delay is the key to avoid amputation and retain superior sexual potency. Improving patient education on initial symptoms of PC is necessary in men of >40 years old.

Association between ED in ankylosing spondylitis: a population-based study

Even though a growing number of studies have found that patients with ankylosing spondylitis (AS) suffer from sexual problems, only very few studies have specifically addressed the relationship between AS and ED. Using a population-based data set, this case-control study aimed to examine the association of ED with a prior diagnosis of AS in Taiwan. We selected 2213 ED patients ≥40 years old and 17,704 matched controls. We considered the date of the first diagnosis of ED as the index date for cases. Multivariate logistic regression was performed to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between previously diagnosed AS and ED. A total of 224 out of the 19,917 sampled subjects (1.1%) had been diagnosed with AS before the index date. Prior AS was found in 42 (1.9%) cases and 182 (1.0%) controls. After adjusting for geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, depressive disorder and alcohol abuse/alcohol-dependence syndrome, multivariate logistic regression revealed that cases were more likely to have been previously diagnosed with AS than controls (OR=1.58, 95% CI=1.09-2.19, P=0.019). There was an association between ED and AS. We suggest that physicians should be attentive to sexual complaints from AS patients in order to refer them to other specialists for multidisciplinary management.

Association of erectile dysfunction with atopic dermatitis: a population-based case-control study

INTRODUCTION

Some studies have highlighted the high prevalence of erectile dysfunction (ED) in patients with dermatological diseases such as psoriasis, chronic hand eczema, and systemic sclerosis. However, to date, there is still no study that has explored the relationship between ED and atopic dermatitis (AD).

AIM

Using a population-based data set, this case-control study aimed to examine the association of ED with prior AD by comparing the risk of prior AD between patients with ED and matched controls in Taiwan.

METHODS

This study used administrative claims data from the Taiwan National Health Insurance program. We identified 3,997 patients with newly diagnosed ED as cases and randomly selected 19,985 subjects without a history of ED as controls. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) for previously diagnosed AD between cases and controls.

MAIN OUTCOME MEASURE

The prevalence and risk of having been previously diagnosed with AD between cases and controls were calculated.

RESULTS

Of the 23,982 sampled subjects, 1,758 (7.3%) had been previously diagnosed with AD; it was found among 425 (10.6%) cases and among 1,333 (6.7%) controls (P<0.001). Conditional logistic regression analysis demonstrated that cases were more likely to have prior AD than controls (OR=1.60, 95% CI=1.42-1.80, P<0.001) after adjusting for monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome.

CONCLUSIONS

There was an association between ED and prior AD. We suggest that clinicians should be more attentive to sexual complaints from patients with AD.

Asthma and risk of erectile dysfunction--a nationwide population-based study

INTRODUCTION

The increased prevalence of erectile dysfunction (ED) has been reported in patients with chronic obstructive pulmonary disease, and sustained systemic inflammation seems to play a central role in this linkage. Asthma is also a chronic inflammatory airway disorder, eliciting a low-grade systemic inflammation; however, the influence of asthma on ED has not been investigated.

AIM

Our study strived to explore the relationship of asthma and the subsequent development of ED using a nationwide, population-based database.

METHODS

From 2000 to 2007, we identified newly diagnosed asthma cases involving male patients 18-55 years old. A control cohort without asthma, which was matched for age and comorbidities, was selected for comparison.

MAIN OUTCOME MEASURES

The two cohorts were followed up, and we observed the occurrence of ED by registry of ED diagnosis in the database.

RESULTS

Of the 17,302 sampled patients (3,466 asthma patients vs. 13,836 control), 114 (0.66%) experienced ED during a mean follow-up period of 4.56 years, including 34 (0.98% of the asthma patients) from the asthma cohort and 80 (0.58%) from the control group. Subjects with asthma experienced a 1.909-fold (95% confidence interval [CI], 1.276-2.856; P=0.002) increase in incident ED, which was independent of age, the number of clinical visits for urologist, and other comorbidities. Kaplan-Meier analysis also revealed the tendency of asthma patients for ED development (log rank test, P=0.002). The risk of ED was higher in cases with more frequent clinical visits for asthma (asthma patients with clinical visits with >24 times/year vs. <12 times/year: hazard ratio [HR]: 4.154 [95% CI:1.392-12.396], P=0.011; clinical visits with 12-24 times/year vs. <12 times/year HR: 3.534 [95% CI:1.245-10.032], P=0.018).

CONCLUSIONS

Asthma may be an independent risk factor for ED, and risk of ED probably increases in accordance with asthma severity.

The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer

INTRODUCTION

The relationship between erectile dysfunction (ED) and depressive symptoms is well established. However, this relationship is not well explored in men with prostate cancer. Limited data suggest men with prostate cancer may experience less ED bother than men with ED who do not have prostate cancer, implying that ED and depressive symptoms may not be associated in men with prostate cancer.

AIM

To determine if ED is associated with depressive symptoms in men with prostate cancer.

MAIN OUTCOME MEASURES

Assessments of quality-of-life (The Functional Assessment of Cancer Therapy [FACT-P]), anxiety/depression (Hospital Anxiety and Depression Scale [HADS]), and erectile function. Erectile function was measured with one question from the FACT-P similar to that used by the Massachusetts Male Aging Study.

METHODS

Men with prostate cancer, and naïve of hormone treatment, completed the study questionnaires at a single time point.

RESULTS

The average age of the 339 men was 67±10 years. The average time since diagnosis was 3.9±3 years. When answering the question, "I am able to have and maintain an erection" on a 1 to 5 scale (5 representing the best function), the mean score was 2 indicating "a little bit." On univariate analysis, erectile function and depression were associated, r=-0.12, P<0.05. Other variables associated with depression were marital status, r=0.11, P<0.05; anxiety scores, r=0.56, P<0.01; and social support, r=-0.42, P<0.01. On multivariate analysis, erectile function remained a significant predictor of depression, beta=-0.10, P<0.05.

CONCLUSIONS

Erectile function was associated with depressive symptoms in both univariate and multivariate analysis, indicating that ED is independently associated with depressive symptoms even though patients were approximately 4 years post diagnosis. These cross-sectional data suggest ED in men with prostate cancer can have lasting psychological effects.

Effects of Behçet's disease on sexual function and psychological status of male patients

INTRODUCTION

There are no studies on the sexual function of male patients with Behçet's disease (BD), but it is probable that male sexual dysfunction may be seen in this chronic condition.

AIM

The aim of this study was to assess the effect of BD on male sexual function and psychiatric status, and to examine the relationship between sexual function and depression in this population.

METHODS

Patients with a diagnosis of BD for at least one year were included in the study. The patients' age, educational level, and duration of disease were recorded. A healthy control group was selected with highly similar characteristics to the patient group. The sexual functions of the patient and the control groups were assessed using the International Index of Erectile Functions (IIEF), and their emotional status was evaluated using the Beck Depression Inventory (BDI).

MAIN OUTCOME MEASURES

The results of the questionnaires in patient and control groups were compared. The relationship between the clinical findings and questionnaire scores was assessed in the patient group.

RESULTS

Forty-two patients with BD and 42 healthy individuals were included in the study. The mean subscale scores of the IIEF for erectile function were significantly lower in the patient group compared to the control group (P < 0.001). The IIEF score was not related to active skin findings, active oral ulcers, active genital ulcers, eye involvement, or medication for BD, but it was related with history of arthritis. The BDI and IIEF scores were negatively correlated in the patient group.

CONCLUSION

BD has a negative impact on men's psychological state and sexual function. We recommend that depression and sexual dysfunction be investigated and treated while assessing patients with BD.