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Stefanac S, Smith L, Grabovac I, Jacob L, López Sánchez GF, Ilie PC, Koyanagi A, Schiffler T, Kostev K. Changes in frequency of urology clinic visits and diagnosis of erectile dysfunction in Germany before and during COVID-19. Rev Epidemiol Sante Publique 2023; 71:102181. [PMID: 37918041 DOI: 10.1016/j.respe.2023.102181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES To explore and analyze [1] the differences in the total number of patients visiting urology practices in Germany, [2] explore and analyze any differences in the number of newly diagnosed erectile dysfunction (ED) patients as well as [3] the number of new drug prescription, before and during the COVID-19 pandemic in Germany (April 2019-March 2020 and April 2020-March 2021). METHODS This retrospective cross-sectional study used data from the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years with at least one visit to one of 85 urology practices across Germany. Outcomes were the mean number of patients with [1] new diagnosis of ED and [2] new prescription of drugs for erectile dysfunction per practice, in pandemic (April 2020-March 2021) versus non-pandemic (April 2019-March 2020) time periods. Differences between the periods were assessed using Wilcoxon tests. RESULTS In the non-pandemic period, there were 195,895 men, and in the pandemic period, 192,659 men visiting urology practices in Germany. A total of 10,977 men were initially diagnosed with ED in non-pandemic and 12,213 (+11.26%) men in pandemic time periods. Although the differences of new ED diagnoses were not statistically significant, a non-significant increase of new ED diagnoses was observed across all age groups. Also, a non-significant increase in new ED prescription drugs was detected across all age groups. CONCLUSIONS Even though less urology practice-visits of men with ED were recorded during the COVID-19 pandemic, an increase of new ED diagnosis was observed across all age groups between April 2020 and March 2021.
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Affiliation(s)
- Sinisa Stefanac
- Centre for Medical Statistics, Informatics and Intelligent Systems, Institute for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Université Paris Cité, AP-HP, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, Paris, France
| | - Guillermo F López Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain.
| | - Petre Cristian Ilie
- Research and Innovation Department, The Queen Elizabeth Hospital Foundation Trust, King's Lynn, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain
| | - Tobias Schiffler
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
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Way BM, Griffin KR, Kraus SW, Tsai J, Pietrzak RH. Erectile Dysfunction in a U.S. National Sample of Male Military Veterans. Mil Med 2023; 188:2837-2843. [PMID: 35792506 DOI: 10.1093/milmed/usac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men and often co-occurs with physical and mental health issues. Military veterans are at elevated risk for many comorbid physical and mental health issues, including ED, although little research has examined the prevalence and health burden of ED in the general U.S. veteran population. The present study calculated the weighted lifetime prevalence of ED and its association with physical and mental health conditions in a nationally representative sample of U.S. veterans. MATERIALS AND METHODS Using data from a nationally representative sample of 921 male U.S. veterans, self-report assessments assessed major depressive disorder (MDD), generalized anxiety disorder, probable post-traumatic stress disorder (PTSD), at-risk/problem gambling, and past two-week suicidal ideation and attempts, as well as 22 physical health conditions. RESULTS The weighted lifetime prevalence of ED among veterans was 14.2% (95% CI = 12.0%-16.0%). Veterans with ED were more likely to be older than 60, unemployed, to have served less than four years in the military, and to have served in combat roles and in the Vietnam War. Relative to veterans without ED, veterans with ED had higher rates of sleep disorders (adjusted odds ratio [aOR] = 3.23), arthritis (aOR = 2.60), high cholesterol (aOR = 2.30), diabetes (aOR = 2.29), high blood pressure (aOR = 2.14), obesity (aOR = 2.12), heart disease (aOR = 2.10), cancer (aOR = 2.07), respiratory illness (aOR = 2.02), and chronic pain (aOR = 1.86). After adjusting for sociodemographic characteristics and physical health conditions, ED was associated with increased odds of MDD (aOR = 2.88), at-risk/problem gambling (aOR = 2.45), and suicidal ideation (aOR = 1.91) but not for generalized anxiety disorder (aOR = 1.69) or probable PTSD (aOR = 1.63). When considered in the context of all mental health variables, MDD was independently associated with ED (aOR = 3.39). CONCLUSION This study examined both mental and physical health conditions associated with ED in a U.S. nationally representative sample of veterans. ED is prevalent in veterans and associated with elevated physical and mental health burden. Results highlight the importance of considering ED in disease prevention and treatment efforts in this population. These findings may help inform prevention approaches as well as clinical targets for early screening and treatment in vulnerable subgroups of this population. Notably, data collected relied on self-report assessments; data on race and socioeconomic status were not collected.
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Affiliation(s)
- Bailey M Way
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
| | - Kaelyn R Griffin
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV 89154, USA
- Department of Psychiatry, UNLV School of Medicine, Las Vegas, NV 89154, USA
| | - Jack Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL, USA
- University of Texas Health Science Center at Houston, School of Public Health, San Antonio Campus, TX 78229, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06511, USA
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3
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van Woudenberg C, Voorendonk EM, Tunissen B, van Beek VHF, Rozendael L, Van Minnen A, De Jongh A. The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD. Front Psychol 2023; 14:1191916. [PMID: 37614489 PMCID: PMC10442952 DOI: 10.3389/fpsyg.2023.1191916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) often experience sexual disturbances. Objective To determine whether intensive trauma-focused treatment is associated with an improvement in sexual functioning (i.e., sexual satisfaction and sexual desire) in individuals with PTSD. Method In total, 227 patients with PTSD (68.7% women, mean age = 40.97) participated in an intensive eight-day trauma-focused treatment program consisting of prolonged exposure, eye movement and desensitization and reprocessing (EMDR) therapy, physical activity, and psychoeducation. Patients were assessed (i.e., Clinician Administered PTSD Scale and Sexual Functioning Questionnaire) pre- and post-treatment and at 6-months follow-up. Results Sexual satisfaction and sexual desire increased significantly associated with trauma-focused treatment from pre-treatment to 6-months follow-up, albeit the effect sizes were small (Cohen's d = 0.39 and 0.17, respectively). Although men reported greater overall sexual desire than women, sexual functioning improved after treatment in both men and women. Furthermore, those with remission of PTSD reported greater sexual functioning post-treatment and at 6-months follow-up, than those without remission. However, changes in PTSD symptoms associated with treatment were not predictive of the level of sexual satisfaction or sexual desire 6 months after treatment. Conclusion The results of this uncontrolled study suggest that intensive treatment for PTSD can have beneficial effects on sexual satisfaction and desire in both men and women; however, this may not necessarily be due to a decrease in PTSD symptoms.
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Affiliation(s)
| | - Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Bo Tunissen
- Research Department, PSYTREC, Weert, Netherlands
| | | | | | - Agnes Van Minnen
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Ad De Jongh
- Research Department, PSYTREC, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Psychology, Queen’s University, Belfast, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
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Protuđer M, Stevanović A, Letica-Crepulja M. Sexual Dysfunctions among Veterans with and without PTSD. Healthcare (Basel) 2023; 11:1861. [PMID: 37444696 PMCID: PMC10340479 DOI: 10.3390/healthcare11131861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Research on the relationship between posttraumatic stress disorder (PTSD) and sexual dysfunctions (SD) has clearly recognized the association among these conditions. The main objective of this research was to compare the levels of the overall and the level of certain domains of sexual functioning among veterans with and those without PTSD. METHODS Two hundred and fifty veterans with PTSD and 187 veterans without PTSD were included in the comparative study. The following assessments were conducted: LEC-5, PCL-5, ITQ, IIEF, PEDT, and MINI. RESULTS Veterans with PTSD had significantly higher levels of all types of SD in the PTSD group compared with the non-PTSD veterans. Veterans with PTSD more frequently experienced psychiatric and somatic comorbidities and use of medication that may contribute to the occurrence and severity of SD. CONCLUSIONS The present study emphasized that SDs are an important issue among patients with PTSD. The study comprehensively accounted for conditions that may contribute to the occurrence and severity of SD among veterans with PTSD. Future directions of the research that could further improve the healthcare of the patients were indicated.
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Affiliation(s)
- Marina Protuđer
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (M.P.); (A.S.)
| | - Aleksandra Stevanović
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (M.P.); (A.S.)
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for PTSD of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia
- Department of Basic Medical Sciences, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Marina Letica-Crepulja
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (M.P.); (A.S.)
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center for PTSD of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia
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Ackerman A. The effect of combat exposure on sexually transmitted diseases. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101142. [PMID: 35525101 DOI: 10.1016/j.ehb.2022.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
Traumatic exposures can affect beliefs and behaviors related to the spread of sexually transmitted diseases (STDs), a persistent public health problem. I leverage a natural experiment created by variation in US military deployment location assignments to estimate how combat exposure changes a surviving deployed male veteran's probability of acquiring a sexually transmitted disease. I analyze longitudinal data from 1994 to 2008 on 485 deployed veterans with information theoretic methods to reduce the sensitivity of estimates to small samples, an infrequently observed outcome, and highly correlated covariates. For veterans assigned to a combat zone, I estimate combat exposure results in a 5.4 percentage point increase in the probability of acquiring an STD. Additional estimations provide evidence suggesting risky behaviors involving substance use or multiple sexual partners may serve as pathways from combat exposure to STDs. My results are relevant to discussions regarding STD screening and care needs for trauma exposed individuals.
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Affiliation(s)
- Adam Ackerman
- American University, Department of Economics, Kreeger Building, Washington DC 20016, USA.
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Kolaja CA, Roenfeldt K, Armenta RF, Schuyler AC, Orman JA, Stander VA, LeardMann CA. Sexual Health Problems among Service Men: The Influence of Posttraumatic Stress Disorder. JOURNAL OF SEX RESEARCH 2022; 59:413-425. [PMID: 33428452 DOI: 10.1080/00224499.2020.1855622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Military operational stressors, such as combat exposure, may increase the risk of sexual health problems. This study examined factors associated with sexual health problems, and tested the mediating effect of probable posttraumatic stress disorder (PTSD) on the association between stressors (i.e., combat deployment and sexual assault) and sexual health problems among U.S. service men. Using multivariable logistic regression (n = 16,603) and Cox proportional hazards models (n = 15,330), we estimated the risk of self-reported sexual health difficulties and sexual dysfunction medical encounters, respectively. Mediation analyses examined the effect of probable PTSD as an intermediate factor between high combat deployment and sexual assault on sexual health problems. Approximately 9% endorsed sexual health difficulties and 8% had a sexual dysfunction. Risk factors for these sexual health problems included older age, lower education level, enlisted rank, disabling injury, certain medical conditions, and higher body mass index. Probable PTSD significantly mediated the associations between high combat with sexual health problems and sexual assault with sexual dysfunction. Additionally, high combat was directly associated with sexual health difficulties. These findings indicate a relationship between these stressors and sexual health problems which suggests that treatment options should be expanded, especially to include psychogenic sexual dysfunctions.
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Affiliation(s)
- Claire A Kolaja
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
| | - Kimberly Roenfeldt
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
| | - Richard F Armenta
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
- Department of Kinesiology, College of Education, Health, and Human Services, California State University
| | - Ashley C Schuyler
- College of Public Health and Human Sciences, Oregon State University, San Marcos
| | - Jean A Orman
- Department of Epidemiology & Biostatistics, University of Texas Health at San Antonio, Texas
| | | | - Cynthia A LeardMann
- Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center
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7
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K Blais R, K Zalta A, S Livingston W. Interpersonal Trauma and Sexual Function and Satisfaction: The Mediating Role of Negative Affect Among Survivors of Military Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5517-NP5537. [PMID: 32990170 DOI: 10.1177/0886260520957693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Healthy sexual function among women service members/veterans (SM/Vs) is associated with higher quality of life, lower incidence and severity of mental health diagnoses, higher relationship satisfaction, and less frequent suicidal ideation. Although trauma exposure has been established as a predictor of poor sexual function and satisfaction in women SM/Vs, no study to date has examined whether specific trauma types, such as military sexual trauma (MST), increase risk for sexual issues. Moreover, the possible mechanisms of this association have not been explored. The current study examined whether posttraumatic stress disorder (PTSD) and depression symptom clusters mediated the association of trauma type and sexual function and satisfaction in 426 trauma-exposed women SM/Vs. Two hundred seventy participants (63.4%) identified MST as their index trauma. Path analyses demonstrated that MST was related to poorer sexual function and lower satisfaction relative to the other traumas (χ2[28, N = 426] = 43.3, p = 0.03, CFI = 1.00, TLI = 0.99, and RMSEA = 0.04), and this association was mediated by higher non-somatic depressive symptoms and PTSD symptom clusters of anhedonia and negative alterations in cognition and mood (NACM). Causality cannot be inferred due to the cross-sectional nature of the data. However, our findings suggest that interventions aimed at decreasing sexual issues among female SM/Vs with MST should target depressogenic symptoms, whether the origin is depression or PTSD. Longitudinal research exploring the etiological processes that contribute to sexual dysfunction among those with MST is needed.
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Mechanisms of the association between PTSD and sexual arousal and lubrication functioning among trauma-exposed female service members/veterans. J Affect Disord 2022; 301:352-359. [PMID: 34965403 DOI: 10.1016/j.jad.2021.12.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The presence of a post-traumatic stress disorder (PTSD) diagnosis or higher PTSD severity is associated with higher overall sexual dysfunction in female service members/veterans. However, the mechanisms linking PTSD to specific components of women's sexual arousal function, like lubrication and mental arousal, are unknown. METHODS We conducted a survey among 464 women who reported probable Criterion A exposure for PTSD. Path analysis examined (1) the association of PTSD with sexual arousal, (2) whether specific PTSD symptom clusters were uniquely associated with sexual arousal, and (3) whether this association is indirect, through the effects of higher depression severity and lower romantic relationship satisfaction. Arousal was operationalized to measure both mental (subjective arousal) and physical (lubrication) experiences. RESULTS Higher PTSD severity was associated with lower lubrication and arousal function. The association of PTSD severity with arousal was indirect, through lower romantic relationship satisfaction (estimate: -0.12; 95% CI: [-0.014, -0.007]) and higher depression (estimate: -0.08, 95% CI: [-0.012, -0.002]). The association of PTSD severity with lubrication was also indirect, but only through lower relationship satisfaction (estimate: -0.10, 95% CI: [-0.013, -0.006]). PTSD symptom clusters were not uniquely associated with arousal and lubrication through mediated pathways. LIMITATIONS Data were from a cross-sectional study using a convenience sample. Criterion A exposure could not be confirmed. CONCLUSIONS PTSD may lead to arousal and lubrication dysfunction by contributing to higher depression severity and strained romantic relationships. Interventions targeting reductions in depressive symptoms and bolstering relationship satisfaction may minimize the burden of PTSD on sexual arousal concerns.
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Bird ER, Piccirillo M, Garcia N, Blais R, Campbell S. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021; 18:1398-1426. [PMID: 37057456 DOI: 10.1016/j.jsxm.2021.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015. AIM This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel. METHODS A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review. RESULTS PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type. CLINICAL IMPLICATIONS Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate. STRENGTHS & LIMITATIONS This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs. CONCLUSION PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.
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Affiliation(s)
- Elizabeth R Bird
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA.
| | - Marilyn Piccirillo
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA; University of Washington, Department of Psychology, Seattle, WA
| | - Natalia Garcia
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA
| | - Rebecca Blais
- Utah State University, Department of Psychology, Logan, UT
| | - Sarah Campbell
- Seattle-Denver Center of Innovation in Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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10
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Wang Z, Li J, Wu W, Qi T, Huang Z, Wang B, Li S, Li C, Ding J, Zeng Y, Huang P, Zhou Z, Huang Y, Huang J, Wang X, Huang Q, Zhang G, Qiu P, Chen J. Saikosaponin D Rescues Deficits in Sexual Behavior and Ameliorates Neurological Dysfunction in Mice Exposed to Chronic Mild Stress. Front Pharmacol 2021; 12:625074. [PMID: 33776766 PMCID: PMC7990100 DOI: 10.3389/fphar.2021.625074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/06/2021] [Indexed: 01/17/2023] Open
Abstract
Often associated with sexual dysfunction (SD), chronic stress is the main contributing risk factor for the pathogenesis of depression. Radix bupleuri had been widely used in traditional Chinese medicine formulation for the regulation of emotion and sexual activity. As the main active component of Radix bupleuri, saikosaponin D (SSD) has a demonstrated antidepressant effect in preclinical studies. Herein, we sought to investigate the effect of SSD to restore sexual functions in chronically stressed mice and elucidate the potential brain mechanisms that might underly these effects. SSD was gavage administered for three weeks during the induction of chronic mild stress (CMS), and its effects on emotional and sexual behaviors in CMS mice were observed. The medial posterodorsal amygdala (MePD) was speculated to be involved in the manifestation of sexual dysfunctions in CMS mice. Our results revealed that SSD not only alleviated CMS-induced depressive-like behaviors but also rescued CMS-induced low sexual motivation and poor sexual performance. CMS destroyed astrocytes and activated microglia in the MePD. SSD treatment reversed the changes in glial pathology and inhibited neuroinflammatory and oxidative stress in the MePD of CMS mice. The neuronal morphological and functional deficits in the MePD were also alleviated by SSD administration. Our results provide insights into the central mechanisms involving the brain associated with sexual dysfunction. These findings deepen our understanding of SSD in light of the psychopharmacology of stress and sexual disorders, providing a theoretical basis for its potential clinical application.
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Affiliation(s)
- Zhuo Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianwei Li
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Wu
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tao Qi
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhansen Huang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Wang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shixiong Li
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Li
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Jiuyang Ding
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Yuanning Zeng
- Research Center for Good Practice in TCM Proessing Technology, Guangdong Pharmaceutical University, Guangzhou, China
| | - Peng Huang
- Foshan Maternal and Child Health Hospital, Affiliated Hospital of Southern Medical University, Foshan, China
| | - Zhihua Zhou
- Department of Neurology, The First Affiliated Hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanjun Huang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Huang
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Xiaohan Wang
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Qiyuan Huang
- School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, China
| | - Guanghuan Zhang
- Department of Nutrition, Hospital of Integrated Traditional Chinese Medical and Western Medicine, Southern Medical University, Guangzhou, China
| | - Pingming Qiu
- School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Jun Chen
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Bulut EC, Ertaş K, Bulut D, Koparal MY, Çetin S. The effect of COVID-19 epidemic on the sexual function of healthcare professionals. Andrologia 2021; 53:e13971. [PMID: 33438223 PMCID: PMC7995045 DOI: 10.1111/and.13971] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 01/19/2023] Open
Abstract
Studies have shown that healthcare professionals struggling with epidemics develop symptoms of post‐traumatic stress disorder. The aim of this study is to show how often and severely erectile dysfunction, one of the components of post‐traumatic stress disorder, is seen among healthcare professionals during COVID‐19 outbreak. The Impact of Event Scale‐Revised (IES‐R) and the Index of Erectile Function‐5 (IIEF‐5) were applied to 159 male healthcare professionals working in COVID‐19 units and a control group of 200 people. Healthcare professional group was divided into subgroups according to occupation (physician, nurse), age‐group (18–25, 26–30, >30), marital status and unit of work (Suspected Patient Area, Diagnosed Patient Area). Both stress disorder and erectile dysfunction were seen at higher rates in healthcare professionals group (p < .001). The median IIEF‐5 scores of nurses, married subjects and those working in the Diagnosed Patient Area, were found to be higher (p < .001, p = .014, p = .011 respectively). During the COVID‐19 outbreak, healthcare professionals are exposed to psychological trauma and their sexual function may be negatively affected. The measures to be taken are important to estimate which groups are more affected.
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Affiliation(s)
- Ender Cem Bulut
- Department of Urology, Van Training and Research Hospital, Van, Turkey
| | - Kasım Ertaş
- Department of Urology, School of Medicine, Yüzüncü Yıl University, Van, Turkey
| | - Dilek Bulut
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Murat Yavuz Koparal
- Department of Urology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Serhat Çetin
- Department of Urology, School of Medicine, Gazi University, Ankara, Turkey
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12
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Vyas N, Shah K, Gamit K, Raval M. Male infertility: A scoping review of prevalence, causes and treatments. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2021. [DOI: 10.4103/2305-0500.326717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Frueh BC, Madan A, Fowler JC, Stomberg S, Bradshaw M, Kelly K, Weinstein B, Luttrell M, Danner SG, Beidel DC. "Operator syndrome": A unique constellation of medical and behavioral health-care needs of military special operation forces. Int J Psychiatry Med 2020; 55:281-295. [PMID: 32052666 DOI: 10.1177/0091217420906659] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE U.S. military special operation forces represent the most elite units of the U.S. Armed Forces. Their selection is highly competitive, and over the course of their service careers, they experience intensive operational training and combat deployment cycles. Yet, little is known about the health-care needs of this unique population. METHOD Professional consultations with over 50 special operation forces operators (and many spouses or girlfriends) over the past 6 years created a naturalistic, observational base of knowledge that allowed our team to identify a unique pattern of interrelated medical and behavioral health-care needs. RESULTS We identified a consistent pattern of health-care difficulties within the special operation forces community that we and other special operation forces health-care providers have termed "Operator Syndrome." This includes interrelated health and functional impairments including traumatic brain injury effects; endocrine dysfunction; sleep disturbance; obstructive sleep apnea; chronic joint/back pain, orthopedic problems, and headaches; substance abuse; depression and suicide; anger; worry, rumination, and stress reactivity; marital, family, and community dysfunction; problems with sexual health and intimacy; being "on guard" or hypervigilant; memory, concentration, and cognitive impairments; vestibular and vision impairments; challenges of the transition from military to civilian life; and common existential issues. CONCLUSIONS "Operator Syndrome" may be understood as the natural consequences of an extraordinarily high allostatic load; the accumulation of physiological, neural, and neuroendocrine responses resulting from the prolonged chronic stress; and physical demands of a career with the military special forces. Clinical research and comprehensive, intensive immersion programs are needed to meet the unique needs of this community.
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Affiliation(s)
- B Christopher Frueh
- Department of Psychology, University of Hawaii, Hilo, HI, USA.,Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Alok Madan
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - J Christopher Fowler
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Sasha Stomberg
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Major Bradshaw
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Karen Kelly
- Department of Warfighter Performance, Naval Health Research Center, San Diego, CA, USA
| | - Benjamin Weinstein
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA.,Department of Behavioral Health, Houston Methodist Hospital, Houston, TX, USA
| | - Morgan Luttrell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - Summer G Danner
- Trauma and Resilience Center, Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, TX, USA
| | - Deborah C Beidel
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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14
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Utility of dynamic MRA in the evaluation of male erectile dysfunction. Abdom Radiol (NY) 2020; 45:1990-2000. [PMID: 31784778 DOI: 10.1007/s00261-019-02339-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the efficacy of time-resolved MR angiography (MRA) in evaluating penile vasculature in patients with clinically suspected vascular anomalies contributing to their erectile dysfunction correlating with penile doppler ultrasound (PDUS) findings and clinical outcomes after surgical intervention. METHODS Men (n = 26) with signs of early vascular shunting on PDUS underwent time-resolved, contrast-enhanced (0.1 mMol/kg gadobutrol at 1 ml/s followed by saline flush) 3-dimensional spoiled gradient echo T1-weighted MRA sequence performed over 3 min with 4.6 s frame rate after intracavernosal injection of an erectogenic agent. Additional T1- and T2-weighted sequences were performed for anatomic co-localization and tissue characterization. MRA images were evaluated for early filling of draining veins as well as arteriovenous malformations and fistulas and correlated with findings at surgery. RESULTS 29 MRA examinations on 26 patients (mean age 39 years) demonstrated abnormal early venous drainage (n = 22) as well as diminutive/delayed cavernosal enhancement (n = 3), incomplete tumescence (n = 2), and combined arterial inflow/venous outflow disease (n = 1). The MRA had a concordance of 85.2% at determining the presence, or lack thereof of a shunt/AVM when compared to PDUS. CONCLUSIONS Time-resolved MRA allows for both temporal and spatial resolution with visualization of both arterial and venous abnormalities which may be suggested with a screening PDUS examination. This technique allows us to provide detailed anatomic information prior to any surgical intervention.
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15
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Gaidos JKJ, Naik K, Dave J, Yao M, Hou JK, Cipher DJ, Smith AD, Feagins LA. High Prevalence of Male Sexual Dysfunction in a Prospective Multicenter VA Inflammatory Bowel Disease Population. CROHN'S & COLITIS 360 2020; 2:otaa004. [PMID: 36777954 PMCID: PMC9801960 DOI: 10.1093/crocol/otaa004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
Background Aims of this study were to assess the prevalence of and risk factors for sexual dysfunction (SD) in male veterans with inflammatory bowel disease (IBD). Methods We collected IBD history, quality of life (QOL), and sexual function surveys. Results One hundred seventy-one men enrolled, mean age 50 years, 85% had SD, 92% had erectile dysfunction (ED). More severe ED (P = 0.0001), decreased sexual desire (P = 0.004), and decreased satisfaction (P = 0.001) were associated with poorer QOL. Biologic use was associated with increased SD; hypertension with a decrease in sexual desire. Conclusions SD and ED are highly prevalent and associated with poorer QOL.
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Affiliation(s)
- Jill K J Gaidos
- Division of Gastroenterology and Hepatology, McGuire VA Medical Center and Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, Virginia, USA,Address correspondence to: Jill K. J. Gaidos, MD, 1201 Broad Rock Boulevard, Richmond, VA 23249 ()
| | - Katrina Naik
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jenny Dave
- School of Medicine, George Washington University, Washington, District of Columbia, USA
| | - Michael Yao
- Division of Gastroenterology, Washington DC VA Medical Center, Washington, District of Columbia, USA
| | - Jason K Hou
- Division of Gastroenterology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Daisha J Cipher
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA
| | - Andrew D Smith
- Division of Gastroenterology, VA North Texas Health Care System, Dallas, Texas, USA
| | - Linda A Feagins
- Division of Gastroenterology and Hepatology, VA North Texas Health Care System and Dell Medical School, University of Texas at Austin, Austin, Texas, USA
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16
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Richardson JD, Ketcheson F, King L, Forchuk CA, Hunt R, St Cyr K, Nazarov A, Shnaider P, McIntyre-Smith A, Elhai JD. Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment. Mil Med 2020; 185:68-74. [PMID: 31268528 DOI: 10.1093/milmed/usz163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/07/2019] [Accepted: 06/13/2019] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage. MATERIALS AND METHODS Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction. RESULTS Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse. CONCLUSIONS Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.
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Affiliation(s)
- J Don Richardson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Felicia Ketcheson
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Lisa King
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada
| | - Callista A Forchuk
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada
| | - Renée Hunt
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Kate St Cyr
- Operational Stress Injury Clinic, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1 Canada.,MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St. Rm 500, Toronto, ON, M5T 3M7, Canada
| | - Anthony Nazarov
- MacDonald/Franklin OSI Research Centre, Parkwood Institute, 550 Wellington Rd, London, ON, N6C 5J1, Canada.,Department of Psychiatry, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada.,Department of Psychiatry, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8 Canada
| | - Philippe Shnaider
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | | | - Jon D Elhai
- Department of Psychology, and Department of Psychiatry, University of Toledo, 2801 Bancroft St, Toledo, OH, 43606
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Blais RK, Livingston WS, Fargo JD. Higher depression severity mediates the association of assault military sexual trauma and sexual function in partnered female service members/veterans. J Affect Disord 2020; 261:238-244. [PMID: 31655379 DOI: 10.1016/j.jad.2019.09.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/16/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Military sexual trauma (MST), and assault as opposed to harassment-only MST in particular, is associated with lower sexual function among female service members/veterans (SM/Vs). Recent research revealed that higher posttraumatic stress disorder (PTSD) symptom clusters of anhedonia and dysphoric arousal mediated the association of assault MST and sexual function. Such clusters represent the depressive symptoms of PTSD, and theories of sexual function suggest that depression worsens sexual function. The impact of depression on the association of MST and sexual function has yet to be tested. METHOD Using path analysis, the study examined whether depression severity mediated the association of MST and sexual function after accounting for demographics and mediators of PTSD-related anhedonia and dysphoric arousal. Female SM/Vs (N = 697) completed measures of MST (history, severity), depression, PTSD-related anhedonia and dysphoric arousal, sexual function, and a demographic inventory. RESULTS One hundred twenty-two (17.50%) indicated that they did not experience MST, 336 (48.21%) reported that they experienced harassment-only MST, and 239 (34.29%) reported assault MST. Fit indices evidenced strong model fit, χ2(12, N = 697)=18.85, p=.09, CFI=1.00, TLI=0.99, SRMR=0.02, and RMSEA=0.03. The indirect effect of depression severity was significant (p<.001). LIMITATIONS Use of cross-sectional data in a convenience sample of female SM/Vs. CONCLUSIONS Even after accounting for established covariates and mediators of assault MST and sexual function, depression accounted for a significant amount of variance in this association. Treatment of poor sexual function must address depressive symptoms. As medications for depression can exacerbate sexual issues, psychotherapy may be the most effective treatment strategy.
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18
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Letica-Crepulja M, Stevanović A, Protuđer M, Popović B, Salopek-Žiha D, Vondraček S. Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Clin Med 2019; 8:jcm8040432. [PMID: 30934864 PMCID: PMC6518171 DOI: 10.3390/jcm8040432] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 01/02/2023] Open
Abstract
Background: The problems in sexual functioning among patients with post-traumatic stress disorder (PTSD) are often overlooked, although scientific research confirms high rates of sexual dysfunctions (SD) particularly among veterans with PTSD. The main objective of this study was to systematically identify predictors of SD among veterans with PTSD. Methods: Three hundred veterans with PTSD were included in the cross-sectional study. The subjects were assessed by the Mini-International Neuropsychiatric Interview (MINI) and self-report questionnaires: PCL-5, i.e., PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) with Criterion A, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT), and Relationship Assessment Scale (RAS). Several hierarchical multiple regressions were performed to test for the best prediction models for outcome variables of different types of SD. Results: 65% of participants received a provisional diagnosis of SD. All tested prediction models showed a good model fit. The significant individual predictors were cluster D (Trauma-Related Negative Alterations in Cognition and Mood) symptoms (for all types of SD) and in a relationship status/relationship satisfaction (all, except for premature ejaculation (PE)). Conclusions: The most salient implication of this study is the importance of sexual health assessment in veterans with PTSD. Therapeutic interventions should be focused on D symptoms and intended to improve relationship functioning with the aim to lessen the rates of SD. Psychotropic treatment with fewer adverse sexual effects is of utmost importance if pharmacotherapy is applied. Appropriate prevention, screening, and treatment of medical conditions could improve sexual functioning in veterans with PTSD.
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Affiliation(s)
- Marina Letica-Crepulja
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia.
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia.
| | - Aleksandra Stevanović
- Department of Psychiatry and Psychological Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia.
- Department of Psychiatry, Clinical Hospital Center Rijeka, Referral Center of the Ministry of Health of the Republic of Croatia, 51000 Rijeka, Croatia.
- Department of Basic Medical Sciences, Faculty of Health Studies, University of rijeka, 51000 Rijeka, Croatia.
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19
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Rusiecki L, Zdrojowy R, Gebala J, Sobieszczańska M, Smoliński R, Pilecki W, Piestrak P, Janocha A, Kawałko W, Womperski M, Kałka D. The Influence of Socioeconomic Status on the Presence and Degree of Erectile Dysfunction in Men With Coronary Artery Disease—A Cross-Sectional Study. Am J Mens Health 2019. [PMCID: PMC6872924 DOI: 10.1177/1557988319834378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Impairment of social functioning and low economic status may lead to the development of cardiovascular disease (CVD). This study aimed to evaluate the relationship between socioeconomic status (SES) and erectile dysfunction (ED) in patients with clinically significant CVD. A total of 808 male patients with ischemic heart disease (IHD) were recruited. Socioeconomic and demographic data as well as occupational data and the presence of modifiable risk factors were collected. Erection quality was assessed using the International Index of Erectile Function 5 (IIEF-5), while physical activity was evaluated using a modified Framingham questionnaire. Relationships among the presence of socioeconomic factors (marital status, education, income, occupational status, nature of work conducted, and demographic data), intensity of ED, and time from diagnosis of IHD were assessed. ED was diagnosed in 618 men (76.49% overall; severe in 23.14%, moderate to severe in 13.11%, moderate in 32.20%, mild in 31.55%). Patients with ED were older (61 ± 8.6 vs. 53 ± 9.1 years; p < .0001), were less active (6.97 ± 2.18 vs. 8.31 ± 2.34 Metabolic Equivalent [METs]; p < .0001), and had more modifiable risk factors (3.4 ± 1.1 vs. 3.2 ± 1.0; p < .0300). Higher education was associated with a lower probability of the occurrence of ED (OR = 0.7546; 95% CI [0.6221, 0.9153]). In patients with newly diagnosed IHD, SES correlated significantly with the presence of ED (p = .009). Education in patients suffering from CVD has a significant relationship with both the occurrence and degree of ED. Economic status was significantly linked to the presence and degree of ED only in patients with IHD diagnosed less than 2 months before entering the study.
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Affiliation(s)
- Lesław Rusiecki
- Department of Pathophysiology, Wrocław Medical University, Poland
| | - Romuald Zdrojowy
- Department and Clinic of Urology, Wrocław Medical University, Poland
| | - Jana Gebala
- Cardiosexology Students’ Scientific Club, Wrocław Medical University, Poland
| | | | | | - Witold Pilecki
- Department of Pathophysiology, Wrocław Medical University, Poland
| | - Piotr Piestrak
- Department of Track and Field, University School of Physical Education, Wroclaw, Poland
| | - Anna Janocha
- Department of Pathophysiology, Wrocław Medical University, Poland
| | - Wiktor Kawałko
- Department of Geriatrics, Wrocław Medical University, Poland
| | | | - Dariusz Kałka
- Department of Pathophysiology, Wrocław Medical University, Poland
- Centre for Men’s Health in Wroclaw, Poland
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20
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Blais RK, Geiser C, Cruz RA. Specific PTSD symptom clusters mediate the association of military sexual trauma severity and sexual function and satisfaction in female service members/veterans. J Affect Disord 2018; 238:680-688. [PMID: 30029163 DOI: 10.1016/j.jad.2018.05.052] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/04/2018] [Accepted: 05/27/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Sexual satisfaction and function are vastly understudied in female service members/veterans (SM/Vs). Military sexual trauma (MST) is associated with poorer sexual satisfaction and function, but the mechanism through which MST relates to sexual satisfaction and function is unknown. Posttraumatic stress disorder (PTSD) is one of the most frequent diagnoses following MST, and those with poorer sexual satisfaction and function experience higher PTSD symptoms, particularly numbing and anhedonia symptom clusters. In this study, we examined which symptom clusters (re-experiencing, avoidance, negative alterations in cognition and mood [NACM], anhedonia, dysphoric and anxious arousal) mediated the relationship between MST and sexual satisfaction and function. METHOD Female SM/Vs (N = 1,189) completed self-report measures of MST severity (none, harassment only, assault), PTSD, sexual satisfaction, and sexual function, as well as a demographic inventory. RESULTS Anhedonia and dysphoric arousal fully mediated the association between assault MST and sexual satisfaction and function. NACM fully mediated the association between harassment and assault MST and sexual satisfaction. Finally, dysphoric arousal significantly mediated the association of harassment MST with sexual satisfaction and function. LIMITATIONS Data was cross-sectional and based on self-report. CONCLUSIONS The relationship between MST and sexual satisfaction and function may be mediated through specific PTSD symptom clusters. As there are no evidenced-based treatments to improve sexual satisfaction and function in female SM/Vs, additional research is needed to develop and pilot interventions. Among those with a history of MST, targeting NACM, anhedonia, and dysphoric arousal may be most effective in addressing sexual concerns.
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Affiliation(s)
- Rebecca K Blais
- Department of Psychology, Utah State University, 2810 Old Main St, Logan, UT 84322, USA.
| | - Christian Geiser
- Department of Psychology, Utah State University, 2810 Old Main St, Logan, UT 84322, USA
| | - Rick A Cruz
- Department of Psychology, Utah State University, 2810 Old Main St, Logan, UT 84322, USA
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21
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Nnamani NS, Pugh MJ, Amuan ME, Eapen BC, Hudak SJ, Liss MA, Orman JA. Outcomes of Genitourinary Injury in U.S. Iraq and Afghanistan War Veterans Receiving Care from the Veterans Health Administration. Mil Med 2018; 184:e297-e301. [DOI: 10.1093/milmed/usy196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nina S Nnamani
- US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX
| | - Mary Jo Pugh
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX
- South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
| | - Megan E Amuan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, MA
| | - Blessen C Eapen
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
- Department of Rehabilitation Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX
| | - Steven J Hudak
- Urology Clinic, Department of Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
| | - Michael A Liss
- South Texas Veterans Health Care System, 7400 Merton Minter St., San Antonio, TX
- Department of Urology, University of Texas Health San Antonio, 7703 Floyd Curl Drive San Antonio, TX
| | - Jean A Orman
- Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD
- Joint Trauma System, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX
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22
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Slyper M, Strunk A, Garg A. Incidence of sexual dysfunction among patients with hidradenitis suppurativa: a population-based retrospective analysis. Br J Dermatol 2018; 179:502-503. [PMID: 29478285 DOI: 10.1111/bjd.16483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- M Slyper
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, U.S.A
| | - A Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, U.S.A
| | - A Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, U.S.A
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23
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Thandi G, Oram S, Verey A, Greenberg N, Fear NT. Informal caregiving and intimate relationships: the experiences of spouses of UK military personnel. J ROY ARMY MED CORPS 2016; 163:266-272. [PMID: 27909070 DOI: 10.1136/jramc-2016-000679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 11/06/2016] [Indexed: 11/04/2022]
Abstract
AIM Currently, there is no research available on the experiences of spouses providing informal care to wounded, injured or sick (WIS) UK military personnel. The aim of this study was to fill this gap by investigating the relationship experiences of non-military partners caring for WIS UK military personnel. METHODS Spouses of WIS military personnel (n=25) completed telephone interviews with the research team. The data were transcribed and analysed using thematic analysis. The transcripts were cross-coded and checked for inter-rater reliability. RESULTS Six major themes were identified: (1) communication between couples, (2) adverse family environment, (3) reintegration, (4) intimacy, (5) financial uncertainty and (6) transition from partner to caregiver. CONCLUSIONS Partners caring for injured/ill military personnel appear to be at risk of experiencing personal distress caused by impaired relationship functioning, which may lead to diminished physical and mental well-being. Partners of WIS military personnel experience significant levels of distress and burden associated with caregiving in the form of arguments with the military partner, problems in reintegration and a lack of physical and emotional intimacy.
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Affiliation(s)
- Gursimran Thandi
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Oram
- Health Services and Population Research, King's College London, London, UK
| | - A Verey
- King's Centre for Military Health Research, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
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Prevalence of use of erectile dysfunction medication by Dutch military personnel between 2003 and 2012. Int J Impot Res 2016; 29:54-56. [PMID: 27853169 DOI: 10.1038/ijir.2016.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/09/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
Use of ED medication can be seen as a marker for ED. ED is associated with increasing age, exposure to traumatic events and physical injuries in military veterans. The objective of this study was to assess the prevalence of use of ED medication in Dutch military personnel in the period 2003-2012 and to assess its association with age and psychotropic medication use. Data on dispensing of ED medication, age and co-medication with psychotropic medication of all Dutch military personnel between 2003 and 2012 were collected. The prevalence of ED medication use in each year was estimated, stratified for age and use of psychotropic medication. The number of ED medication users increased a hundredfold from 0.09 to 9.29 per 1000 per year between 2003 and 2012. ED medication was more often used by men over 40 than under 40 (prevalence in 2012: 2.4% vs 0.2%, OR (2003-2012, adjusted for calendar year) 15.6, 95% CI 13.5-17.9) and by men using psychotropic medication (prevalence in 2012: 3.8% vs 0.9%, OR (2003-2012, adjusted for calendar year) 3.13, 95% CI 2.66-3.67). This study shows a strong increase between 2003 and 2012 in a number of ED medication users in male Dutch military personnel. ED medication use increases with age and with psychotropic medication use.
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Associations between sexual health concerns and mental health symptoms among African American and European American women veterans who have experienced interpersonal trauma. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Correlates of CVD and discussing sexual issues with physicians among male military veterans. Maturitas 2016; 92:168-175. [PMID: 27621256 DOI: 10.1016/j.maturitas.2016.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/01/2016] [Accepted: 07/29/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE This study aims to identify socio-demographic and health behavior factors associated with cardiovascular disease (CVD) diagnosis and patient-physician communication concerning sexual issues among older Veterans. METHODS Cross-sectional data were collected from 635 male Veterans over age 55 years as part of the 2010 National Social Life, Health and Aging Project, a nationally-representative, population-based study of community-dwelling older Americans. Two independent logistic regression analyses were performed. RESULTS Over 33% of Veterans were aged 75 years or older. Over one-half of participants reported having a CVD diagnosis (58%) and sexual intercourse within the previous year (58%); over one-third (37%) reported having one or more sexual dysfunctions and discussing sexual issues with their physician (42%). Veterans diagnosed with CVD were significantly more likely to self-identify as racial/ethnic minorities (OR=1.89, P=0.021), have more chronic disease comorbidities (OR=1.23, P=0.041), and have more sexual dysfunctions (OR=1.19, P=0.028). Veterans diagnosed with CVD were significantly less likely to report having sex within the previous year (OR=0.53, P=0.005). Veterans who reported discussing sexual issues with a physician were significantly more likely to be ≥75 years (OR=1.79, P=0.010), and report more than a high school education (OR=1.62, P=0.016), CVD diagnosis (OR=1.59, P=0.015), sex within the previous year (OR=1.69, P=0.033), and trouble achieving/maintaining an erection (OR=3.39, P<0.001). IMPLICATIONS These findings suggest older male Veterans, particularly racial/ethnic minorities and those less-educated, may benefit from VA and community-based aging and sexual health/counseling services. These services should promote increased patient-physician communication as well as referrals between physicians and sex health/counseling specialists.
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Breyer BN, Fang SC, Seal KH, Ranganathan G, Marx BP, Keane TM, Rosen RC. Sexual Health in Male and Female Iraq and Afghanistan U. S. War Veterans With and Without PTSD: Findings From the VALOR Cohort. J Trauma Stress 2016; 29:229-36. [PMID: 27128485 PMCID: PMC4899252 DOI: 10.1002/jts.22097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 01/15/2016] [Accepted: 01/27/2016] [Indexed: 01/23/2023]
Abstract
We sought to determine whether posttraumatic stress disorder (PTSD) was associated with sexual health in returned warzone-deployed veterans from the recent Iraq and Afghanistan conflicts. We studied 1,581 males and females from the Veterans After-Discharge Longitudinal Registry, a gender-balanced U.S. Department of Veterans Affairs registry of health care-seeking veterans with and without PTSD. Approximately one quarter (25.1%) of males (n = 198) and 12.7% of females (n = 101) had a sexual dysfunction diagnosis and/or prescription treatment for sexual dysfunction. Both genders were more likely to have a sexual dysfunction diagnosis and/or prescription treatment if they had PTSD compared with those without PTSD (male: 27.3% vs. 21.1%, p = .054; female: 14.9% vs. 9.4%, p = .022). Among the 1,557 subjects analyzed here, males with PTSD had similar levels of sexual activity compared to those without PTSD (71.2% vs. 75.4%, p = .22), whereas females with PTSD were less likely to be sexually active compared to females without PTSD (58.7% vs. 72.1%, p < .001). Participants with PTSD were also less likely to report sex-life satisfaction (male: 27.6% vs. 46.0%, p < .001; female: 23.0% vs. 45.7%, p < .001) compared with those without PTSD. Although PTSD was not associated with sexual dysfunction after adjusting for confounding factors, it was significantly negatively associated with sex-life satisfaction in female veterans with a prevalence ratio of .71, 95% confidence interval [.57, .90].
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Affiliation(s)
- Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Shona C. Fang
- Division of Epidemiology, New England Research Institutes, Watertown, Massachusetts, USA
| | - Karen H. Seal
- Departments of Medicine and Psychiatry, University of California, San Francisco, Veterans Administration Medical Center, San Francisco, California, USA
| | - Gayatri Ranganathan
- Division of Epidemiology, New England Research Institutes, Watertown, Massachusetts, USA
| | - Brian P. Marx
- VA Boston Healthcare System, Boston, Massachusetts, USA
,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Terence M. Keane
- VA Boston Healthcare System, Boston, Massachusetts, USA
,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Raymond C. Rosen
- Division of Epidemiology, New England Research Institutes, Watertown, Massachusetts, USA
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Badour CL, Gros DF, Szafranski DD, Acierno R. Sexual Problems Predict PTSD and Depression Symptom Change Among Male OEF/OIF Veterans Completing Exposure Therapy. Psychiatry 2016; 79:403-417. [PMID: 27997327 PMCID: PMC5538014 DOI: 10.1080/00332747.2016.1142774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A growing literature documents frequent sexual problems among Operations Enduring/Iraqi Freedom (OEF/OIF) veterans with post-traumatic stress disorder (PTSD). However, there has been no examination of how (1) sexual problems may be affected by evidenced-based psychotherapy for PTSD or (2) how the presence of sexual problems might impact effectiveness of evidenced-based psychotherapy for PTSD. As such, the present study investigated associations among symptoms of PTSD, depression, and problems with sexual desire and arousal among 45 male OEF/OIF veterans receiving behavioral activation and therapeutic exposure (BA-TE), an evidence-based behavior therapy targeting co-occurring symptoms of PTSD and depression. METHOD Participants completed clinical interviews and several questionnaires including measures of sexual arousal, sexual desire, PTSD symptoms, and depression symptoms at baseline and after completion of 8 sessions of BA-TE treatment. A records review was also conducted to assess for relevant medication use. RESULTS Overall, sexual desire and sexual arousal problems did not improve during the course of treatment. Moreover, veterans with co-occurring sexual problems at baseline evidenced significantly less improvement in symptoms of PTSD and depression across treatment as compared to veterans without sexual problems. CONCLUSIONS These findings suggest that veterans with co-occurring symptoms of PTSD and sexual problems may require additional assessment and treatment considerations in order to improve their treatment outcomes for both primary psychiatric symptoms as well as sexual problems. Future research on combination treatments of medication for sexual problems and psychotherapy for PTSD is needed.
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Affiliation(s)
- Christal L. Badour
- University of Kentucky, Lexington, KY, USA,Corresponding author: 106B Kastle Hall, University of Kentucky, Lexington, KY 40506, (859) 323-3817,
| | - Daniel F. Gros
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Derek D. Szafranski
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Ron Acierno
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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Beaulieu GR, Latini DM, Helmer DA, Powers-James C, Houlette C, Kauth MR. An Exploration of Returning Veterans' Sexual Health Issues Using a Brief Self-Report Measure. Sex Med 2015; 3:287-94. [PMID: 26797063 PMCID: PMC4721023 DOI: 10.1002/sm2.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Sexual health is an integral aspect of quality of life with important implications for satisfaction with intimate relationships, emotional well‐being, and life as a whole. Veterans returning from Iraq and Afghanistan frequently encounter a wide range of known risk factors for sexual health concerns. Aim This article seeks to examine the overall frequency, important covariates associated with sexual difficulties, and the relevant domains of sexual dysfunction among a group of recent US veterans of Iraq and Afghanistan. Methods This is a retrospective chart review of 247 veterans of conflicts in Iraq and Afghanistan evaluated for an initial visit at the post‐deployment clinic of a large veterans affairs medical center (VAMC). Patient demographic and medical characteristics were calculated using descriptive statistics. The prevalence and burden of sexual health issues in our patient sample were calculated using descriptive statistics from these veterans' responses to a self‐report measure of sexual functioning. Item‐level regression analyses were then conducted between sexual functioning responses and other patient data. Main Outcome Measures The main outcome measures used were the responses to the Arizona Sexual Experience Scale (ASEX). Results Almost 18% of veterans screened positive for sexual functioning difficulties. Self‐reported sexual dysfunction was most strongly associated with depression, posttraumatic stress disorder, female sex, and service connection rating. Co‐occurring characteristics varied with specific areas of sexual functioning. Conclusions Screening using an empirically validated self‐report instrument indicates that there is a high prevalence of reported sexual dysfunction among recently deployed veterans. Analyses indicated that there are specific characteristics associated with both overall self‐reported sexual dysfunction and specific subtypes of sexual dysfunction. Active assessment of specific aspects of sexual dysfunction concerns may allow providers to identify and implement more precise sexual functioning interventions. Beaulieu GR, Latini DM, Helmer DA, Powers‐James C, Houlette C, and Kauth MR. An exploration of returning veterans sexual health issues using a brief self‐report measure. Sex Med 2015;3:287–294.
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Affiliation(s)
- Gregory R Beaulieu
- Psychology ServiceMental Health Care LineMichael E. DeBakey Veterans Affairs Medical CenterHoustonTXUSA; Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTXUSA
| | - David M Latini
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTXUSA; Scott Department of UrologyBaylor College of MedicineHoustonTXUSA
| | - Drew A Helmer
- War Related Illness and Injury Study CenterVA New Jersey Health Care SystemEast OrangeNJUSA; Department of MedicineRutgers University-New Jersey Medical SchoolNewarkNJUSA
| | - Catherine Powers-James
- Department of Palliative, Rehabilitation, and Integrative Medicine The University of Texas MD Anderson Cancer Center
| | - Cheryl Houlette
- Social Work and Transition Care Service Line Michael E. DeBakey Veterans Affairs Medical Center Houston TX USA
| | - Michael R Kauth
- Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTXUSA; VA South Central Mental Illness Research, Education, and Clinical Center (SC-MIRECC)Michael E. DeBakey Veterans Affairs Medical CenterHoustonTXUSA; Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey Veterans Affairs Medical CenterHoustonTXUSA
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Helmer DA, Beaulieu G, Powers C, Houlette C, Latini D, Kauth M. Perspectives on Sexual Health and Function of Recent Male Combat Veterans of Iraq and Afghanistan. Sex Med 2015; 3:137-46. [PMID: 26468377 PMCID: PMC4599551 DOI: 10.1002/sm2.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background U.S. veterans of recent wars in Iraq and Afghanistan may be at greater risk for sexual dysfunction due to injuries, mental health conditions, medications used to treat those conditions, and psychosocial factors. Objective To explore the perceptions of recent Veterans about sexual health and dysfunction, contributing factors, its impact and solutions. Design Qualitative study. Participants Eight men who screened positive for sexual dysfunction at initial presentation to a postdeployment clinic at a Veterans Affairs medical center Approach Patients who screened positive for sexual dysfunction and indicated an interest in participating were contacted and scheduled for an in-person private interview with a researcher. Interviews were semistructured, utilizing open-ended and follow-up probe questions to elicit the individual's perspective about sexual dysfunction and its cause, impact and solutions. Interviews were recorded, transcribed and analyzed for themes. Key Results These heterosexual men discussed a range of sexual dysfunction in their activities including lack of desire, erectile dysfunction, delayed orgasm, premature ejaculation, and distraction. They also discussed the importance of setting or context and changes over time to their sexual health and function. The men shared their ideas about contributory factors, including normal aging, medication side effects, injury and a possible role for combat deployment more generally. Reported solutions for sexual dysfunction included medications, herbal remedies, and new positions and approaches to sexual activity. Participants reported discussing sexual dysfunction with their health-care providers and what was helpful. Finally, the men expressed in their own words the significant impact of sexual dysfunction on their self-perception, their partners, and their relationships. Conclusions Sexual dysfunction in recent combat veterans can have important negative effects on their health and relationships. Our findings elucidate perceived contributory factors and preferred solutions, which can be applied by health-care providers to improve the management of sexual dysfunction in these patients.
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Affiliation(s)
- Drew A Helmer
- War Related Illness and Injury Study Center, VA New Jersey Health Care System East Orange, NJ, USA
| | - Gregory Beaulieu
- Mental Health Care Line, Michael E. DeBakey VA Medical Center Houston, TX, USA ; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine Houston, TX, USA
| | - Catherine Powers
- Integrative Medicine Program, MD Anderson Cancer Center Houston, TX, USA
| | - Cheryl Houlette
- OEF/OIF/OND Program, Michael E. DeBakey VA Medical Center Houston, TX, USA
| | - David Latini
- Mental Health Care Line, Michael E. DeBakey VA Medical Center Houston, TX, USA ; Scott Department of Urology, Baylor College of Medicine Houston, TX, USA
| | - Michael Kauth
- Mental Health Care Line, Michael E. DeBakey VA Medical Center Houston, TX, USA ; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine Houston, TX, USA ; Mental Illness Research, Education & Clinical Center, VA South Central Houston, TX, USA ; Center for Innovations in Quality, Effectiveness, and Safety, Houston VA HSR&D Houston, TX, USA
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Yehuda R, Lehrner A, Rosenbaum TY. PTSD and Sexual Dysfunction in Men and Women. J Sex Med 2015; 12:1107-19. [DOI: 10.1111/jsm.12856] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Fulton JJ, Calhoun PS, Wagner HR, Schry AR, Hair LP, Feeling N, Elbogen E, Beckham JC. The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. J Anxiety Disord 2015; 31:98-107. [PMID: 25768399 DOI: 10.1016/j.janxdis.2015.02.003] [Citation(s) in RCA: 412] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/25/2014] [Accepted: 02/09/2015] [Indexed: 12/20/2022]
Abstract
Literature on posttraumatic stress disorder (PTSD) prevalence among Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans report estimates ranging from 1.4% to 60%. A more precise estimate is necessary for projecting healthcare needs and informing public policy. This meta-analysis examined 33 studies published between 2007 and 2013 involving 4,945,897 OEF/OIF veterans, and PTSD prevalence was estimated at 23%. Publication year and percentage of Caucasian participants and formerly active duty participants explained significant variability in prevalence across studies. PTSD remains a concern for a substantial percentage of OEF/OIF veterans. To date, most studies have estimated prevalence among OEF/OIF veterans using VA medical chart review. Thus, results generalize primarily to the prevalence of PTSD in medical records of OEF/OIF veterans who use VA services. Additional research is needed with randomly selected, representative samples administered diagnostic interviews. Significant financial and mental health resources are needed to promote recovery from PTSD.
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Affiliation(s)
- Jessica J Fulton
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States.
| | - Patrick S Calhoun
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - H Ryan Wagner
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Amie R Schry
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Lauren P Hair
- Durham VA Medical Center, Durham, NC 27705, United States
| | - Nicole Feeling
- Durham VA Medical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Eric Elbogen
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry, UNC-Chapel Hill, Chapel Hill, NC 27516, United States
| | - Jean C Beckham
- Durham VA Medical Center, Durham, NC 27705, United States; VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, NC 27705, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
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Badour CL, Gros DF, Szafranski DD, Acierno R. Problems in sexual functioning among male OEF/OIF veterans seeking treatment for posttraumatic stress. Compr Psychiatry 2015; 58:74-81. [PMID: 25596624 PMCID: PMC4369440 DOI: 10.1016/j.comppsych.2014.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Few studies have examined sexual dysfunction among Operations Enduring/Iraqi Freedom (OEF/OIF) veterans with posttraumatic stress disorder (PTSD). The present study investigated predictors of erectile dysfunction [ED] and self-reported sexual problems among 150 male combat veterans seeking outpatient treatment for PTSD within the Veterans Affairs healthcare system. METHOD Participants completed clinical interviews and several questionnaires including measures of sexual arousal and sexual desire. A medical records review was also conducted to document evidence of an ED diagnosis or associated medication use. RESULTS An ED diagnosis was present for 12% of the sample, and 10% were taking associated medications. Sexual arousal problems were reported by sixty-two percent of partnered veterans. Sexual desire problems were endorsed by 63% of the total sample, and by 72% of partnered veterans. Age was the only significant predictor of ED diagnosis or medication use. Age, race, PTSD diagnosis (versus subclinical symptoms), depression, and social support predicted self-reported sexual arousal problems; while race, combat exposure, social support, and avoidance/numbing symptoms of PTSD predicted self-reported sexual desire problems. CONCLUSIONS Sexual problems are common among male OEF/OIF combat veterans seeking treatment for PTSD. Moreover, avoidance/numbing symptoms robustly predicted sexual desire problems. These findings highlight the importance of expanding assessment of sexual dysfunction and support the need for additional research in this area.
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Affiliation(s)
- Christal L. Badour
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA,Corresponding author. 67 President Street, MSC 861, 2nd Fl. IOP South Building, Charleston, SC 29425, Ph. (843) 792-2945, Fax (843) 792-3388,
| | - Daniel F. Gros
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Derek D. Szafranski
- National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Ron Acierno
- Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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Tran JK, Dunckel G, Teng EJ. Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder. J Sex Med 2015; 12:847-55. [DOI: 10.1111/jsm.12823] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Bentsen IL, Giraldi AG, Kristensen E, Andersen HS. Systematic Review of Sexual Dysfunction Among Veterans with Post‐Traumatic Stress Disorder. Sex Med Rev 2015; 3:78-87. [DOI: 10.1002/smrj.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wilcox SL, Redmond S, Hassan AM. Sexual functioning in military personnel: preliminary estimates and predictors. J Sex Med 2014; 11:2537-45. [PMID: 25042933 DOI: 10.1111/jsm.12643] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Although the military is a young and vigorous force, service members and veterans may experience sexual functioning problems (SFPs) as a result of military service. Sexual functioning can be impaired by physical, psychological, and social factors and can impact quality of life (QOL) and happiness. AIMS This study aims to estimate rates and correlates of SFPs in male military personnel across demographic and psychosocial characteristics, to examine the QOL concomitants, and to evaluate barriers for treatment seeking. METHODS This exploratory cross-sectional study was conducted using data from a larger nationwide study conducted between October 2013 and November 2013. This sample consists of 367 male active duty service members and recent veterans (military personnel) age 40 or younger. MAIN OUTCOME MEASURES Erectile dysfunction (ED) was determined using the five-item International Index of Erectile Function, sexual dysfunction (SD) was determined using the Arizona Sexual Experiences Scale, Male, and QOL was determined using the World Health Organization Quality of Life, Brief. RESULTS SFPs were associated with various demographic, physical, and psychosocial risk factors. The rates of SD and ED were 8.45% and 33.24%, respectively, for male military personnel aged 21-40. Those who were 36-40, nonmarried, nonwhite, and of lower educational attainment reported the highest rates of SFPs. Male military personnel with poor physical and psychosocial health presented the greatest risk for ED and SD. SFPs were associated with reduced QOL and lower happiness, and barriers for treatment were generally related to social barriers. CONCLUSIONS SFPs in young male military personnel are an important public health concern that can severely impact QOL and happiness.
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Affiliation(s)
- Sherrie L Wilcox
- Center for Innovation and Research on Veterans & Military Families (CIR), School of Social Work, University of Southern California, Los Angeles, CA, USA
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Tepper MS. Sexual Healthcare for Wounded Warriors with Serious Combat-Related Injuries and Disabilities. Sex Med Rev 2014; 2:64-74. [PMID: 27784591 DOI: 10.1002/smrj.24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Short of the rich literature on sexuality in men following spinal cord injury, started largely by physicians and mental health professionals within the United States Department of Veterans Affairs (VA) system following earlier wars, little attention has been paid to the sexual healthcare of wounded warriors with other serious combat-related injuries. The recent wars in Iraq and Afghanistan-Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)-resulted in physical injuries including traumatic brain injuries (TBIs), amputations, and serious burns. There are wounded warriors who are left blind or deaf, and a significant percent of OEF/OIF/OND warriors acquire other "invisible" injuries. While the signature injury of the war in Iraq is said to be TBI, there are a substantial number of service members surviving with posttraumatic stress disorder (PTSD). Many with serious injury are struggling with co-occurring depression. Furthermore, many of our wounded warriors are surviving with polytrauma (multiple traumatic injuries, i.e., amputation plus burns). One specific constellation of injuries seen too frequently among our service members in Afghanistan is referred to as a Dismounted Complex Blast Injury (DCBI) sometimes resulting in orchiectomy and/or penile injury. As with other blast injuries, burns, shrapnel injuries, vision loss, hearing loss, TBI, and PTSD often accompany DCBIs. All of the above injuries have significant sexual, endocrine, psychological, and relationship issues that need to be addressed. AIM This article presents an overview of the effects of serious, combat-related injuries on sexual health and provides medical and other health professionals a framework within which to address comprehensive sexual healthcare using a medical rehabilitation model. CONCLUSIONS Sexual healthcare for persons with combat-related disabilities presents a complex array of biopsychosocial and relational issues that call for a coordinated interdisciplinary approach that connects physical health, psychological health, and sexual health. Tepper MS. Sexual healthcare for wounded warriors with serious combat-related injuries and disabilities. Sex Med Rev 2014;2:64-74.
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Hou G, Xiong W, Wang M, Chen X, Yuan T. Chronic Stress Influences Sexual Motivation and Causes Damage to Testicular Cells in Male Rats. J Sex Med 2014; 11:653-63. [DOI: 10.1111/jsm.12416] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Goldstein I. Unfair: Government‐Approved Sexual Medicine Treatments Only Available for Men. J Sex Med 2014; 11:317-20. [DOI: 10.1111/jsm.12431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Wangelin BC, Tuerk PW. PTSD in active combat soldiers: to treat or not to treat. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2014; 42:161-170. [PMID: 25040380 DOI: 10.1111/jlme.12132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as well as the potential difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible.
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Affiliation(s)
- Bethany C Wangelin
- Staff psychologist on the PTSD Clinical Team at the Ralph H. Johnson VA Medical Center in Charleston, SC
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Bray JR. Genitourinary Trauma: A Battle Cry for Integrated Collaborative Veteran-Centric Care. JOURNAL OF MEN'S HEALTH 2013. [DOI: 10.1089/jomh.2013.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, Seal KH. Sexual dysfunction in male Iraq and Afghanistan war veterans: association with posttraumatic stress disorder and other combat-related mental health disorders: a population-based cohort study. J Sex Med 2013; 11:75-83. [PMID: 23679562 DOI: 10.1111/jsm.12201] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Mental health disorders are prevalent in the United States, Iraq, and Afghanistan war veterans. Mental illness, including posttraumatic stress disorder (PTSD) with or without psychiatric medications, can increase the risk for male sexual dysfunction, threatening quality of life. AIMS We sought to determine the prevalence and correlates of sexual dysfunction among male Iraq and Afghanistan veterans. METHODS We performed a retrospective cohort study of 405,275 male Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs healthcare from October 7, 2001 to September 30, 2009 and had 2-year follow-up. MAIN OUTCOME MEASURES We determined the independent association of mental health diagnoses and sexual dysfunction after adjusting for sociodemographic and military service characteristics, comorbidities, and medications. RESULTS Veterans with PTSD were more likely to have a sexual dysfunction diagnosis, be prescribed medications for sexual dysfunction, or both (10.6%), compared with veterans having a mental diagnosis other than PTSD (7.2%), or no mental health diagnosis (2.3%). In a fully adjusted model, PTSD increased the risk of sexual dysfunction by more than threefold (adjusted risk ratio = 3.61, 95% CI = 3.48-3.75). Veterans with mental health disorders, particularly PTSD, were at the highest risk of sexual dysfunction when prescribed psychiatric medications (adjusted risk ratio = 4.59, 95% CI = 4.41-4.77). CONCLUSIONS Among U.S. combat veterans, mental health disorders, particularly PTSD, increased the risk of sexual dysfunction independent of the use of psychiatric medications.
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Affiliation(s)
- Benjamin N Breyer
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
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