French validation of the sexual complaints screener (SCS) for patients with multiple sclerosis

BACKGROUND

Sexual dysfunctions are frequent in the general population and even more frequent in individuals with chronic neurological disorders like multiple sclerosis (MS). Several studies indicate that patients would like healthcare workers to address sexual problems. Indeed, such complaints are not currently sufficiently detected and treated. In clinical practice, a screening tool is lacking to help French-speaking patients and healthcare professionals address this issue.

OBJECTIVE

The main aim of this study was to evaluate the reliability and validity of the French adaptation of the self-assessment Sexual Complaints Screener scale for Women (SCS-W) and Men (SCS-M).

METHOD

A prospective study was conducted among patients with MS in two centers. The SCS-W was adapted into French (QPS-F: questionnaire de plaintes sexuelles - Femmes) and compared to the reference questionnaire Female Sexual Function Index-19 (FSFI-19). The SCS-M was adapted into French (QPS-H: questionnaire de plaintes sexuelles - Hommes) and compared to the reference International Index of Erectile Function-15 (IIEF-15).

RESULTS

Included were 101 women and 35 men with MS. Median age was 40.5 (range: 20-68) years. Based on the Cronbach alpha coefficient, the internal coherence of the QPS in French was 0.89 for women (QPS-F) and 0.71 for men (QPS-H), indicating high reliability. For QPS-F, the bivariate Pearson correlation coefficient indicated good convergence for desire and satisfaction, and average convergence for orgasm, pain, and arousal excitability. For QPS-H, the convergence was good for desire, pleasure, and ejaculation.

CONCLUSION

The French versions of the SCS-W/M scales, namely QPS-F and QPS-H, are reliable and validated tools compared with the reference questionnaires, FSFI and IIEF-15, respectively. The QPS-F/H are useful tools for brief, simple, and accurate screening and assessment of sexual complaints. They provide supportive information for clinicians who are less familiar with the clinical significance of sexual complaints and hence can be helpful to achieve more adapted care. These scales are adapted, but not specific, to MS. They could be used in other pathologies and the general population.

Psychological and interpersonal dimensions of sexual function and dysfunction: recommendations from the fifth international consultation on sexual medicine (ICSM 2024)

INTRODUCTION

Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.

OBJECTIVES

This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.

METHODS

A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.

RESULTS

Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.

CONCLUSIONS

This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.

Sexual dysfunction following retinoid treatment: a systematic review

Despite product monograph warnings of post-retinoid sexual dysfunction (PRSD) for isotretinoin and recent policy decisions regarding the safety of isotretinoin, this study demonstrates that there remains conflicting and low-quality evidence on this topic and it is not possible to ascertain causation between retinoids and PRSD. Dermatologists and patients should be aware of the conflicting data regarding sexual dysfunction associated with systemic retinoid therapy. Routine screening for sexual side-effects during systemic retinoid treatment may be reasonable, as patients are less likely to self-disclose sexual health concerns.

Analysis of the International Index of Erectile Function: psychometric evidence and measurement invariance across relationship status and age generations in a Chilean sample

Background

The International Index of Erectile Function (IIEF) stands out for its utility and widespread use to measure sexual function in men. However, it lacks consistency in its internal latent structure across studies, has not been evaluated for measurement invariance, and has not undergone psychometric validation for its 15-item form in Spanish among South American countries.

Aim

To examine the IIEF's psychometric evidence (ie, structural/criterion validity and reliability) in a sample of adult men and determine its measurement invariance across relationship status (single vs in a relationship) and age generations (generations Z, Y/millennials, and X).

Methods

A sample of 650 sexually active males was derived from a broader Chilean study (Chilean Sex and Sexuality Study). We used a confirmatory factor analysis to determine the IIEF's structural validity, sexual satisfaction dimensions to establish its criterion-related validity, and Cronbach alpha and McDonald omega to assess the reliability of its scores.

Outcomes

Measures of goodness of fit.

Results

The evidence supported the 5-factor latent solution. Meanwhile, criterion-related validity revealed subtle yet significant differences in sexual satisfaction, with younger men displaying higher satisfaction in various sexual domains. In contrast, middle-aged men and those in a relationship showed better sexual function. Finally, the IIEF was invariant across age groups and relationship status at the factor covariance level.

Clinical Translation

This study provides evidence that the IIEF is a valid, reliable, and invariant tool for the clinical practice in men's sexual health, particularly that associated with their sexual function and dysfunction.

Strengths and Limitations

The study included a comprehensive validity analysis of the IIEF's psychometric properties, demonstrating its reliability and validity across diverse Chilean male subpopulations. The study also offered the IIEF's first assessment of measurement invariance and confirmed its suitability for clinical and research use in the Chilean population. Meanwhile, the study's limitations include a lack of clinical population and a sample predominantly younger, cisgender, and heterosexual.

Conclusion

Our study provides evidence of the IIEF's 5-factor structure and measurement invariance across age generations and relationship status in Chilean men, supporting its validity for clinical use and research and broadening its applicability in global sexual health studies, particularly in the Spanish-speaking South American male population.

Cross-cultural Validation of the Arizona Sexual Experience Scale (ASEX) in 42 Countries and 26 Languages

Introduction

The Arizona Sexual Experiences Scale (ASEX) is a brief questionnaire that evaluates five major aspects of sexual function: sex drive, arousal, erectile function/vaginal lubrication, ability to reach orgasm, and satisfaction with orgasm. An advantage of the ASEX is its simplicity and brevity (five items), making it suitable for the screening of sexual function problems in healthcare contexts and large-scale studies. The main objective of this study was to examine the psychometric properties of the ASEX in a multi-national sample, as well as to explore sexual function according to countries, genders, and sexual orientations.

Methods

The psychometric examination of the ASEX was conducted with a sample of 82,243 participants (women = 57.02%; men = 39.59%; gender-diverse = 3.38%; Mage = 32.39 years; SD = 12.52) from 42 different countries speaking 26 languages.

Results

The CFA supported a one-factor solution. Multigroup CFAs supported configural, metric, partial scalar, and residual invariance across countries, languages, genders, and sexual orientations. Furthermore, the ASEX showed good internal consistency (ω = .85) and convergent validity (e.g., significant negative associations with masturbation and sexual intercourse frequency). Finally, individuals in Eastern countries, women, and asexual participants reported higher levels of sexual function issues.

Conclusions and Policy Implications

The findings supported the use of the ASEX as a tool to screen for sexual function problems across diverse populations in multi-cultural settings. This scale may be used to improve our knowledge on the cross-cultural differences on the expression of sexual function, serving as the basis for the development of culturally tailored interventions for the improvement of this basic aspect of well-being.

Using augmented intelligence to improve long term outcomes

PURPOSE OF REVIEW

For augmented intelligence (AI) tools to realize their potential, critical care clinicians must ensure they are designed to improve long-term outcomes. This overview is intended to align professionals with the state-of-the art of AI.

RECENT FINDINGS

Many AI tools are undergoing preliminary assessment of their ability to support the care of survivors and their caregivers at multiple time points after intensive care unit (ICU) discharge. The domains being studied include early identification of deterioration (physiological, mental), management of impaired physical functioning, pain, sleep and sexual dysfunction, improving nutrition and communication, and screening and treatment of cognitive impairment and mental health disorders.Several technologies are already being marketed and many more are in various stages of development. These technologies mostly still require clinical trials outcome testing. However, lacking a formal regulatory approval process, some are already in use.

SUMMARY

Plans for long-term management of ICU survivors must account for the development of a holistic follow-up system that incorporates AI across multiple platforms. A tiered post-ICU screening program may be established wherein AI tools managed by ICU follow-up clinics provide appropriate assistance without human intervention in cases with less pathology and refer severe cases to expert treatment.

Platelet-rich plasma intracavernosal injections for the treatment of primary organic erectile dysfunction: a systematic review and meta-analysis of contemporary controlled studies

We aim to summarize the latest evidence on platelet-rich plasma (PRP) intracavernosal injections efficacy in men affected by primary organic erectile dysfunction (ED). We reviewed the literature for randomized controlled trials (RCTs) or prospective and retrospective comparative studies evaluating PRP alone or in combination for ED treatment. A comprehensive search in PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed for English language full-text articles or conference abstracts. A qualitative and quantitative data synthesis was provided. Overall, seven records were included: three RCTs evaluated PRP vs. placebo, one study separately tested PRP and low-intensity shock wave therapy (Li-SWT), three studies compared Li-SWT or low-intensity pulsed ultrasound alone with their combination with PRP. Of 641 included patients, 320 received PRP. Despite the heterogeneity among inclusion criteria, dose and protocol of PRP administration, and outcomes measured, most studies independently reported better sexual outcomes in patients who received PRP, without significant severe side effects. In meta-analysis, where only placebo-controlled studies were included, patients treated with PRP showed higher International Index of Erectile Function (erectile function domain) score compared to patients who received placebo: pooled mean difference (95% Confidence Interval) of 2.99 (1.86, 4.13) after 1 month (209 patients) vs. 2.85 (1.61, 4.09) after 3 months (204 patients) vs. 3.21 (1.82, 4.60) after 6 months (199 patients) of follow-up. In men affected by primary organic ED, PRP intracavernosal injections demonstrated an objective improvement or at least a tendency in erectile function recovery. Patient numbers, and the short-term follow-up may limit the generalizability of these observations. High quality, large-scale, and standardized controlled trials are needed before recommending its definitive use in clinical practice.

Sexual dysfunction and marital adjustment in married men with alcohol dependence syndrome

Background

Only a few studies have systematically assessed sexual dysfunction and marital adjustment in married men with alcohol dependence in India.

Aim

To assess the prevalence and pattern of sexual dysfunction and marital adjustment in a clinical sample of married men with alcohol dependence. The association of sexual dysfunction and marital adjustment with the severity of alcohol dependence was also explored.

Materials and Methods

This cross-sectional study included 100 consecutive married men attending psychiatry outpatient department (OPD) with a diagnosis of alcohol dependence syndrome (ADS). A pre-designed study proformawas used for collecting relevant socio-demographic and clinical details of the study participants. Sexual dysfunction, marital adjustment, and alcohol dependence were assessed using the following validated tools: the Arizona Sexual Experiences Scale (ASEX), the Marital Adjustment Questionnaire (MAQ), and the Severity of Alcohol Dependence Questionnaire (SADQ), respectively.

Results

Of 100 patients, about 15% had clinical sexual dysfunction based on ASEX. The most commonly reported sexual dysfunction was difficulty with erection (24.0%), followed by problems in desire (18.0%), sexual arousal (12.0%), ability to reach orgasm (12.0%), and satisfaction with orgasm (9.0%). Sexual dysfunction (ASEX score) showed significant positive correlation (rs = 0.345; P < 0.001) with alcohol dependence severity (SADQ score). Also, the severity of alcohol dependence was negatively correlated (rs = -0.240; P = 0.016) with the overall level of marital adjustment (MAQ score) with spouse.

Conclusion

Sexual dysfunction is common in married men with ADS, with both sexual dysfunction intensity and marital adjustment difficulties being positively associated with the severity of alcohol dependence.

Validity of the Brazilian online version of the Sexual Desire Inventory 2

OBJECTIVE

The Sexual Desire Inventory 2 is a self-report instrument for assessing sexual desire in men and women. In Brazil, there is no validated sexual desire self-report for the adult population. The aim of this study was to determine the evidence of validity for the content and construct of the Brazilian online version of the Sexual Desire Inventory 2.

METHODS

This was a cross-sectional study with Brazilian men and women. The sample size was calculated using the criterion of more than 20 participants per item. The invitation to participate in the study was conducted online by the platform Survey Monkey®. The Sexual Desire Inventory 2 was evaluated for content, construct, reliability, and invariance.

RESULTS

A total of 818 female and male adults participated in the study. The two-dimensional factorial solution represented 71% of the total variance explained by the model, and the factorial loads of the model were ≥0.40; commonalities presented values ≥0.23. Reliability was measured by the coefficients of Cronbach's alpha with a total score of 0.87, McDonald's of 0.87, Omega, and greatest lower bound with a total score of 0.95. The metric invariance was tested for the sex variables ΔCFI (comparative fit index) and ΔRMSEA (root mean square error of approximation) with a total score of 0.01.

CONCLUSION

The analyses indicate evidence of robust validity in the Brazilian online version of the Sexual Desire Inventory 2.

Female sexual dysfunction-knowledge, attitude, practices, and barriers encountered by medical fraternity across the country: A web-based cross-sectional study

Introduction

Sexual dysfunction in women is common yet often remains underdiagnosed due to the lack of adequate training and experience of the doctors to manage female sexual dysfunctions. This study was done to assess the knowledge and attitude of medical professionals toward female sexual dysfunction and the various practices and barriers they encounter while managing women with sexual dysfunction.

Materials and Methods

A web-based cross-sectional study was done using the snowball sampling method. A well-structured, self-administered, and pre-validated questionnaire containing 27 items was administered through social media. Data was collected and evaluated to assess their knowledge, practices they follow, and barriers encountered while managing female sexual dysfunction.

Results

A total of 513 doctors participated in the study. Out of all, only 11.1% of the doctors were often seeing patients with sexual dysfunction. Loss of desire (44%), painful intercourse (33%), lack of lubrication (18%), and anorgasmia (5%) are common symptoms with which women present. The majority of doctors (78.9%) were comfortable in starting a conversation, over half (52.6%) were confident in making a diagnosis, and 51.3% were confident in providing sexual counseling. Yet, only 11.1% were routinely screening women for sexual dysfunctions, and 33.8% were providing counseling regarding sexual issues. Lack of time (31.6%), lack of adequate training (57.3%), unavailability of effective treatment (11.9%), patient discomfort (60.62%), and patient's reluctance to seek treatment (15.8%) were the barriers encountered by doctors. When assessed for knowledge, around 30.9% had excellent knowledge (≥75th percentile) about female sexual dysfunction.

Conclusion

Sexual dysfunction among women is an important health issue that significantly affects the social, mental, and physical well-being of those suffering from it. Screening for sexual dysfunction should be done routinely in day-to-day clinical practice to improve the overall quality of life of a couple.

Sex Differences in Sexual Motivation in Humans and Other Mammals: The Role of Conscious and Unconscious Processes

In self-report questionnaires, men report higher scores than women on variables such as desire for sex, frequency of sexual thoughts, number of sex partners, etc. Based on this, men are considered to have a higher level of sexual motivation than women. However, retrospective self-reports may be unsuitable for estimations of the inherent level of sexual motivation. We review data on automatic (unconsciously controlled) responses and measures of implicit motivation during exposure to sexual stimuli. These responses and measures are inaccessible to willful manipulations and make it possible to determine whether the sex difference in answers to questionnaires is replicated when volitional response manipulations are unlikely. We complement the human data with observations from some rodent and non-human primate species. The attentional resources allotted to stimuli with sexual relevance as well as genital responses to such stimuli are similar in men and women. Measures of implicit motivation also fail to detect any sex difference. Finally, the frequency of masturbation is superior in female infants before the age at which social expectations begin to determine behavior. Neither in rodents nor in non-human primates is there any clear-cut evidence for sex differences in motivation. It seems that males and females are similar with regard to the intensity of sexual motivation. The responses to questionnaires may be affected by social learning of sexual scripts and/or the inferior quality of sexual experiences in women, among other things.

Treatment-emergent sexual dysfunctions due to antidepressants: A primer on assessment and management strategies

Antidepressants (ADs) are among the most commonly prescribed drugs worldwide. Persons with mental illness taking ADs commonly report sexual dysfunction (SD) related to treatment. A brief discussion on the neurobiology of sexual functioning and mechanism of treatment-emergent SD (TESD) was performed. The incidence of prevalence of TESD in various studies has been reviewed. TESD impacts patients as it frequently leads to nonadherence, while psychiatrists have challenges in proceeding forward with treatment in such patients. Assessment of patients with suspected TESD is described with a focus on practical tips for clinicians. Five strategies (watchful waiting, drug holiday, downward titration, switching, and add-on therapy) to manage TESD have been extensively discussed with evidence in the literature. Each strategy comes with its own bag of advantages and drawbacks, which have been pointed out for simplicity. A detailed discussion on individual pharmacological strategies is given, and options for non-pharmacological management that can be tried are enlisted. Common clinical case scenarios have been discussed to incorporate the implementation of this literature.

Restorative therapy clinical trials for erectile dysfunction: a scoping review of endpoint measures

Given the lack of regulatory approval for restorative therapies for the treatment of erectile dysfunction, we hypothesized that clinical trials would vary in methodology and endpoint measurements. Our objective was to analyze methodological approaches and outcome measures of clinical trials evaluating restorative therapies for erectile dysfunction. Data was extracted from clinicaltrials.gov on trials which contained the keywords "erectile dysfunction". We evaluated trials initiated between 2004 and 2021 which listed a restorative therapy intervention. We identified 95 trials investigating energy-based/shockwave therapies (60/95), stem cell therapies (25/95), platelet-based therapies (6/95), and others (4/95). Only 41.1% of the trials evaluated safety. The most common efficacy endpoint was International Index of Erectile Function and Sexual Health Inventory for Men, and only 29.5% utilized penile Doppler. Thirty (31.6%) trials had been completed yet only 3 (3.2%) have published results. We found substantial heterogeneity in methodological approach in the trials. Subjective measures of erectile function were commonly reported, but definitions of inclusion criteria and objective outcome measures were inconsistent. These results provide a basis for the design of future clinical trials to improve the quality of trial data and aid in the development of standardized criteria for erectile dysfunction clinical trials.

Sexual Dysfunction in Female Patients with Type 2 Diabetes Mellitus—Sneak Peek on an Important Quality of Life Determinant

Type 2 diabetes mellitus (T2DM) is a multisystemic disease with a high global burden and chronic complications. Sexual dysfunction (SD) in patients with T2DM is an often-overlooked complication, despite its high impact on quality of life (QoL). Female sexual disorders can affect women of reproductive age as well as menopausal women. Proposed mechanisms are intertwining a variety of physiological, neurological, vascular, hormonal, and psychological variables. The impairment of sexual function has been linked to hyperglycemia, insulin resistance, chronic low-grade inflammation, endothelial dysfunction, neuropathy, and hormonal abnormalities. There are many different manifestations of female sexual dysfunction, such as insufficient sexual desire, diminished arousal, difficulty in eliciting orgasm, and pain during sexual engagement. Numerous studies have shown that the QoL of patients living with diabetes mellitus (DM) is lower than that of those without DM. SD in women with T2DM leads to deteriorated QoL. Treatment must be individualized based on the diagnosis and the sexual dysfunction as well as underlying medical, psychological, and interpersonal issues. The goal of modern medical care for patients living with diabetes is not to delay death but to improve their health and QoL. The present review article aimed to raise awareness about female sexual dysfunction in patients with T2DM and to provide an overview of its impact on QoL.

Psychometric properties of the Romanian version of the female sexual function index (FSFI-RO)

BACKGROUND

Female sexual dysfunction (FSD) is a highly prevalent health disorder and no self-report questionnaire on female sexual function is available in Romanian. Therefore we considered the Female Sexual Function Index (FSFI) to be the most appropriate due to its excellent psychometric properties. The FSFI is a measuring scale with 19 items that assess the six domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction and pain. The paper aims to analyze the psychometric reliability and validity of the FSFI-RO (Romanian Version of the Female Sexual Function Index).

METHODS

385 women (aged 18 to 51) enrolled in the present study. To assess the presence of FSD we used the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for sexual dysfunction. Then we categorized the participants into two groups: the FSD group (41%) and the healthy control group (59%). Women were then asked to fill out a form that included sociodemographic information and the FSFI-RO questionnaire. A sample of 50 women agreed to re-answer FSFI-RO in a 4-week interval in order to evaluate the test-retest validity of the questionnaire. The data were summarized using descriptive statistics: the test-retest reliability was measured by the intraclass correlation coefficient (ICC); Cronbach's alpha was employed to evaluate the internal consistency of the Romanian version of the FSFI, and validity was assessed by the content and construct validity.

RESULTS

The results showed high test-retest reliability, with ICC from 0.942 to 0.991 in the domains and 0.987 in the total score. Regarding the internal consistency of the FSFI-RO, Cronbach's α coefficients were found to be high (α = 0.944). Convergent construct validity proved to be moderate to high in desire, arousal, lubrication, orgasm and, satisfaction domains, and weak correlation in the pain domain. Regarding the discriminant construct validity, the scores for each domain and the total score showed statistically significant differences between the FSD group and the control group.

CONCLUSIONS

The FSFI-RO showed similar psychometric properties to those of the original version, therefore being a reliable and valid instrument that can be used in Romanian-speaking women.

Prevalence and risk factors of erectile dysfunction in cirrhotic patients: An observational study

Background

Erectile dysfunction (ED) is a prevalent complication observed in male patients with liver cirrhosis; however, there is limited understanding of the etiological determinants responsible for its occurrence. The objective of this investigation is to explore potential contributory factors that underlie the development of ED in male patients with liver cirrhosis.

Method

A cross-sectional study was conducted on 200 male patients with liver cirrhosis, who were divided into three groups according to the Child score. ED was studied using the International Index of Erectile Function (IIEF-5) Questionnaire and penile Doppler.

Results

The prevalence of ED among the cirrhotic patients was 80%, and it was more frequent in patients with advanced liver disease (Child C). Penile venous leakage was observed in 20% of cirrhotic patients, which increased to 28.6% in those with advanced liver cirrhosis. Multivariate logistic regression analysis showed that age, low albumin levels, elevated INR, high hemoglobin levels, and Child C were predictors of ED in cirrhotic patients.

Conclusion

Several clinical variables have been identified as potential contributors to the development of erectile dysfunction (ED) in patients with cirrhosis. These variables include advanced age, decreased levels of albumin, elevated INR, increased hemoglobin levels, and Child C classification. Early identification and treatment of these factors could potentially improve the quality of life for cirrhotic patients with ED. Notably, patients with ED in this population were observed to have elevated levels of INR, serum bilirubin, and hemoglobin, as well as reduced levels of serum albumin.

Validation of the Spanish Version of the Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ) with Sexual Arousal Measures in Men

Objective

Provide new validity evidence of the Spanish version of the Massachusetts General Hospital-Sexual Functioning Questionnaire (MGH-SFQ) by associating its scores with measures of sexual arousal.

Method

In a sample of 48 men, using a quasi-experimental design, sexual functioning, propensity for sexual inhibition/excitation, subjective sexual arousal, and genital response (penile plethysmography recorded with Biopac MP150 equipment) were evaluated.

Results

Arousal and erection scores correlated with sexual inhibition due to the threat of performance failure (r = .29; p < .05) and genital response (r = .31; p < .05), respectively. Participants with difficulties in sexual functioning indicated greater sexual inhibition due to the threat of performance failure (p = .04) and lower intensity in their genital response (p = .05).

Conclusions

The validity of the measures obtained with the Spanish version of the MGH-SFQ is supported, showing the erection item to be useful for the detection of possible erectile disorders.

Psychometric Properties of the Translated Spanish Version of the Vaginal Penetration Cognition Questionnaire: A Preliminary Work for Validation

(1) Background: To develop an instrument in Spanish to assess beliefs and feelings about vaginal penetration and assess its psychometric properties. (2) Methods: This study translated and adapted the Vaginal Penetration Cognition Questionnaire into Spanish, and a total of 225 women who suffered from Genito-Pelvic Pain/Penetration Disorder were included in the study. The psychometric properties, including construct, convergent and discriminant validity, test-retest reliability, and internal consistency of the translated version were assessed. (3) Results: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess beliefs and thoughts about vaginal penetration in women suffering from Genito-Pelvic Pain/Penetration Disorder. The exploratory factor analysis yielded four domains that explained 62.5% of the variance. Convergent and discriminant validity was also confirmed. Test-retest reliability was high, with an intraclass correlation coefficient value of 0.90, a standard error of measurement of 4.21, and a minimal detectable change of 11.66 points. Every domain also showed good internal consistency levels, with Cronbach's α values ranging from 0.84 to 0.89. (4) Conclusion: The Spanish version of the Vaginal Penetration Cognition Questionnaire is a valid, reliable, and consistent tool to assess vaginal penetration cognition in women suffering from Genito-Pelvic Pain/Penetration Disorder.

Sexuality, quality of life and psychological well-being in older adults: A correlational study

Objective

This study aimed at analyzing the relationship between general health status, quality of life, and sexual life among older adults.

Study design

This descriptive-correlational design study was conducted with the participation of 323 (169 female and 154 male) older people at the age of 65 + . The participants were clients of the outpatient services in a general hospital in Istanbul. Data were collected with the General Health Questionnaire, Arizona Sexual Experiences Scale, and Quality of Life Scale.

Results

Psychological well-being had no association with sexuality scores whereas quality of life had a significant association. Older people with better quality of life had less sexual dysfunctionality. Participants who were up the 75 years old, who have lower education, lower economic status, unemployed, having chronic diseases seemed to experience higher ASEX scores, meaning that higher sexual dysfunction, lower GHQ scores and lower quality of life level.

Conclusions

Sexuality in older people changes over time and continues to hold its importance. Less sexual dysfunction seemed to relate with higher quality of life in older people. Researchers should consider the importance of the quality of life on sexual satisfaction in older people.

Sexuality after breast cancer, how to provide a global and contemporary approach

Patients' sexuality is one of the major and most neglected impact of breast cancer (BC) and its treatment. Even though research is ongoing on the subject, sexuality issues are rarely taken into account and efficiently dealt with in clinical practice. The objective is to review the impact of BC and its treatment on modern women sexuality. In the literature, a heterogeneous level of advancement is notable in the different publishing countries depending on the cultural background; some countries simply do not publish on the matter, others mainly discuss the male partners and practicians experience, and lastly, the most progressive countries have moved up to studying niches of patients such as sexual and gender minorities. A multidisciplinary approach, including pharmacologic and nonpharmacologic management, appears most efficient. There is a need for greater inclusion of partners and for providing a specific training to first-line health care providers. This review provides a general contemporary worldwide overview of the state of the art in sexuality issues in BC patients and survivors.

Erectile Dysfunction: Pharmacological Pathways with Understudied Potentials

Erectile dysfunction (ED) is a public health concern worldwide. In the past, it was perceived as a phenomenon attributed to age advancement. However, more individuals are affected every year that do not fall under that age criterion. Epidemiological research revealed that this abnormality has an association with endothelial dysfunction connected to several cardiovascular (CV) risk factors. Currently, ED is interpreted as a clinical marker for future adverse events and not only as a present health issue that negatively affects the quality of life. The management of ED involves lifestyle modifications, therapeutic optimization for comorbid conditions, and pharmacological and psychosexual therapy. Phosphodiesterase type 5 (PDE5) inhibitors are the first-line pharmacological agents to be prescribed for such a condition. Nonetheless, other pharmacological pathways and agents remain underinvestigated or were investigated at some stage. This review aimed to present to future researchers interested in this field with some pharmacological agents that showed favorable effects on a limited number of studies on human subjects or experimental models.

Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management

INTRODUCTION

Sexual dysfunction (SD) is a symptom of depression in ≈70% of patients presenting with major depressive disorder (MDD). Antidepressant medications (AD) and adjunctive treatments may further contribute to SD and complicate evaluation and management.

AREAS COVERED

A systematic literature search of PubMed, Ovid MEDLINE and Cochrane databases for MDD, SD, classes of antidepressants, etc. was performed with a focus on 2014 to June 2021. SSRIs are associated with 70% treatment-emergent sexual dysfunction (TESD), SNRIs and tricyclics have rates of TESD of 40 - 45%, and antidepressant medications without SRI effects or with additional unique mechanisms of action have rates similar to placebo (<10%). Appropriate assessment at baseline and throughout treatment, consideration of patient preferences in prescribing, addressing modifiable factors (comorbid medical/psychiatric conditions, substances, relationship difficulties), and utilizing management strategies of switching to an AD with less SD, adding an antidote/adjunctive therapy or lowering the dose are discussed.

EXPERT OPINION

MDD and antidepressant treatment contribute to SD in a high percentage of patients. Treating to remission reduces SD as a symptom of depression. Frequent assessment and targeted management strategies may be effective in preventing or addressing SD. Secondary outcomes like impact on adherence, relationships and self-image should also be considered.

Scales and assessments of sexual dysfunction

Sexual dysfunction is a very frequent non-motor symptom in Parkinson's disease (PD). However, patients are often reluctant to declare their sexual problems and many clinicians do not inquire about them during routine visits. The use of validated rating scales and questionnaires allows overcoming these difficulties, characterizing the nature and causes of the patient's sexual dysfunction, and helping to implement and monitor the most adequate interventions. There is a wide range of instruments available for assessing sexual dysfunction in PD, including generic and specific ones. In this chapter, we review the most used rating scales and questionnaires, with a description of its components, characteristics and psychometric attributes.

Diagnostic work up: Laboratory and biomarkers

This chapter will focus on the diagnostic work around sexual dysfunction in Parkinson's disease, especially laboratory tests and biomarkers. A number of methods to analyze if sexual dysfunction is caused by neural pathology, vascular dysfunction or other mechanisms are now available. Other methods can be used to differentiate between psychogenic/functional reasons behind sexual dysfunction and organic ones. The role of biomarkers for diagnosis, but also for understanding the reason behind and for counteracting sexual dysfunction is becoming more evident. There is also a rich and increasing number of scales and other instruments available for detecting and quantifying sexual hypo- and hyperactivity. When investigating the reason behind sexual dysfunction in patients with Parkinson's disease comorbidities should also be considered. Finally, early and pronounced sexual dysfunction might in some cases be an indication that differential diagnosis, like Multisystem Atrophy, should be thought about. All these aspects of the diagnostic procedures around sexual dysfunction in Parkinson's disease will be covered in this chapter.

Prevalence and risk factors of erectile dysfunction in patients with liver cirrhosis: a systematic review and meta-analysis

BACKGROUND AND AIMS

Liver cirrhosis is associated with an increased risk of developing erectile dysfunction (ED). The aim of this systematic review and meta-analysis was to evaluate the prevalence of ED and its risk factors in male patients with liver cirrhosis.

METHODS

A systematic search of PubMed (Medline), EMBASE, OVID Medline, the Cochrane Library, and other databases was performed for this review. Two investigators reviewed the abstracts obtained from the search and selected manuscripts for full-text review. The event rates were calculated with random-effects model and quality effects model.

RESULTS

Fourteen studies evaluating ED with the International Index of Erectile Function (IIEF) scores were selected. A total of 770 patients with liver cirrhosis were analyzed. The prevalence of ED in cirrhotic patients was 79% [decompensated: 88.4%, CI 35.95-70.84%, I² heterogeneity 85%; compensated: 53.6%, CI 77.64-32%, I² heterogeneity 80%]. Through a meta-regression analysis, we discovered that the presence of decompensation, use of beta-blocker and diuretics were related with ED. In addition, risk factors for ED included high body mass index [odds ratio (OR) 1.13, 95% CI 1.01-1.26], advanced Child-Pugh class (OR 2.29, 95% CI 1.12-4.72), MELD score (OR 1.19, 95% CI 1.05-1.35), diabetes (OR 3.44, 95% CI 1.38-8.57), and hypertension (OR 8.24, 95% CI 1.62-41.99).

CONCLUSION

ED is relatively common in male patients with cirrhosis, and presence of risk factors increases the prevalence of ED.

CLINICAL TRIAL NUMBER

PROSPERO (International Prospective Register of Systematic Reviews), CRD42020220411.

Checkpoint inhibitors, fertility, pregnancy, and sexual life: a systematic review

Immune checkpoint inhibitors (i.e. anti-PD1, anti-PDL1, and anti-CTLA4) have revolutionized the therapeutic approach of several cancer types. In a subset of metastatic patients, the duration of the response is so long that a cure might be hypothesized, and a treatment discontinuation strategy could be proposed. Considering that long-term efficacy, some patients could also plan to have a child. Moreover, immunotherapy is moving to the early setting in several diseases including melanoma and breast cancer that are common cancers in young patients. However, there is a paucity of data about their potential detrimental effect on fertility, pregnancy, or sexuality. Herein, we conducted a systematic review with the aim to comprehensively collect the available evidence about fertility, pregnancy, and sexual adverse effects of checkpoint inhibitors in order to help clinicians in daily practice and trialists to develop future studies.

A Systemic Review on the Association Between Infertility and Sexual Dysfunction Among Women Utilizing Female Sexual Function Index as a Measuring Tool

The Center for Disease Control and Prevention describes infertility as the inability to conceive after one year or longer with adequate unprotected sex. Infertility affects both females and males, interfering with their everyday lives and significantly impacting their mental health. Sexual dysfunction is defined as an alteration of the sexual response cycle phases, preventing satisfaction during sexual activity. The prevalence of sexual dysfunction in the United States is high, with about 10%-52% among men and 25%-63% among women. Different scales can measure sexual satisfaction and double as a tool to diagnose sexual dysfunction. The Female Sexual Function Index (FSFI) is the gold standard for diagnosing sexual dysfunction in women. Overall, fertile women had a higher score on the FSFI than infertile women; however, both groups showed sexual dysfunctions even if the fertile group was classified as a mild disorder. The most common disorders were disorders of desire and lubrication. Desire and arousal dysfunction appeared more common in participants with secondary infertility, while lubrication dysfunctions were more common in older participants. In the future, it will be important to evaluate other factors that affect sexual function and fertility including mental health, male health, and couple factors.