Latent Structures of Male Sexual Functioning

A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology

Sexual dysfunctions commonly co-occur with various depressive and anxiety disorders. An emerging framework for understanding the classification of mental disorders suggests that such comorbidity is a manifestation of underlying dimensions of psychopathology (or "spectra"). In this review, we synthesize the evidence that sexual dysfunctions should be included in the empirical taxonomy of psychopathology as part of the internalizing spectrum, which accounts for comorbidity among the depressive and anxiety disorders. The review has four parts. Part 1 summarizes the empirical basis and utility of the empirical taxonomy of psychopathology. Part 2 reviews the prima facie evidence for the hypothesis that sexual dysfunctions are part of the internalizing spectrum (i.e., high rates of comorbidity; shared cognitive, affective, and temperament characteristics; common neural substrates and biomarkers; shared course and treatment response; and the lack of causal relationships between them). Part 3 critically analyzes and integrates the results of the eight studies that have addressed this hypothesis. Finally, Part 4 examines the implications of reconceptualizing sexual dysfunctions as part of the internalizing spectrum, and explores avenues for future research.

A Structural Equation Modeling Analysis of the Relationships between Depression, Anxiety, and Sexual Problems over Time

Sexual dysfunctions are related to depressive and anxiety disorders, but the nature of these relationships remains unclear. This study examined the relationship among symptoms of these disorders over time by comparing (a) a model that included causal relationships, (b) a model that accounted for change over time with a shared underlying factor (or latent liability) among all the disorders, and (c) a model that conceptualized sexual dysfunctions as unrelated to depressive and anxiety disorders over time. Participants (n = 1,012) completed online self-report measures of sexual dysfunctions and depressive and anxiety disorders across six time points at either weekly or monthly intervals. Models 1 and 2 provided equal best fit for men and women based on data collected four weeks apart, but there were no evident causal relationships in Model 1. Subsequent analyses using data collected one week and six months apart found Model 2 provided robust fit for women, but these data were not examined for men due to inadequate sample sizes. The results are consistent with a shared latent liability of internalizing psychopathology driving the change in these disorders over time, which provides a clear direction for an empirically driven nosology and for future research into transdiagnostic treatments.

Sexual Dysfunction and Sexual Behaviors in a Sample of Brazilian Male Substance Misusers

The aim of this study was to evaluate the potential relationship between self-reported sexual dysfunction, sexual behavior, and severity of addiction of drug users. A cross-sectional design study was conducted at an inpatient addiction treatment unit in Sao Paulo, Brazil, with a sample of 508 male drug users. Sociodemographic data, sexual behavior, and severity of dependence were evaluated.The prevalence of sexual dysfunction was 37.2% and premature ejaculation was 63.8%. Men with sexual dysfunction presented from moderate to severe level of alcohol, tobacco, and other drugs of dependence. The findings from this study are particularly relevant identifying those sociodemographic factors, severity of drug use, and sexual behavior are related to men who experience sexual dysfunction. Health promotion and motivational interventions on sexual health targeted to male drug users can contribute in reducing these at-risk behaviors. More interdisciplinary research is desirable in future in considering men’s sexual health.

Endorsement of models describing sexual response of men and women with a sexual partner: an online survey in a population sample of Danish adults ages 20-65 years

INTRODUCTION

Several models have been used to describe men's and women's sexual responses. These models have been conceptualized as linear or circular models. The circular models were proposed to describe women's sexual function best.

AIM

This study aims to determine whether men and women thought that current theoretical models of sexual responses accurately reflected their own sexual experience and to what extent this was influenced by sexual dysfunction.

METHODS

A cross-sectional study of a large, broadly sampled, nonclinical population, cohort of Danish men and women. The Female Sexual Function Index, Female Sexual Distress Scale, and the International Index of Erectile Function were used to describe sexual function. Also, participants completed questionnaires with written descriptions of different sexual responses to describe their most experienced sexual response.

MAIN OUTCOME MEASURE

For women, we measured desire, arousal, lubrication, orgasm, sexual satisfaction, pain during sexual activity, sexual distress, and satisfaction with sexual life. For men, we measured erectile function, orgasm, desire, intercourse satisfaction, overall satisfaction, and satisfaction with sexual life.

RESULTS

A total of 499 men and 573 women participated. We only analyzed responses from sexually active participants with a partner (401 men and 429 women). The majority of men endorsed the Masters & Johnson model (48.5%) or the Kaplan model (38.3%); only 5.4% endorsed the Basson model, and 7.3% endorsed none of the models. Among women, 34% endorsed the Kaplan model, 28% the Masters & Johnson model, 25.6% the Basson model, and 12.5% none of the models. Among women, sexual dysfunction and distress were significantly (P = 0.01) related to endorsement of the Basson model or none of the models. Among men, erectile dysfunction and dissatisfaction with sexual life were significantly related to endorsement of the Basson model or none of the models (P = 0.01).

CONCLUSIONS

No single model of sexual response could describe men's and women's sexual responses. The majority of men and women with no sexual dysfunction that were satisfied with their sexual life endorsed the linear models.

Prevalence of sexual problems in Portugal: results of a population-based study using a stratified sample of men aged 18 to 70 years

Despite the use of different methodologies, target populations, and clinical definitions of sexual problems, recent epidemiological studies have shown that the occurrence of sexual difficulties is a very common experience among men from the general population regardless of their age. The objective of this study was to present epidemiological data on the prevalence of sexual difficulties in a community sample of 650 sexually active Portuguese men, stratified by age, marital status, and educational level. Participants completed a self-reported questionnaire assessing sexual function in the previous four weeks (International Index of Erectile Function). Results showed that sexual difficulties were relatively common among this sample. Rapid ejaculation was the most frequently reported sexual difficulty (23.2%), followed by erectile difficulties (10.2%), orgasm problems (8.2%), and low desire (2.9%) in the previous four weeks. With the exception of rapid ejaculation, all categories showed age-specific prevalence rates, with sexual difficulties increasing gradually in men above age 45. Age was a significant predictor of all sexual difficulties except rapid ejaculation, and lower educational levels were related to orgasm difficulties. Findings are consistent with the majority of epidemiological studies indicating a high prevalence of sexual difficulties among men in the general population and highlight the importance and the need to implement sexual health promotion programs in the target population.