The impact of psychosocial factors on the risk of erectile dysfunction and inhibition of sexual desire in a sample of the Brazilian population

Sexual Dysfunction and Related Factors in Patients With Parkinson's Disease

The current cross-sectional study investigated sexual dysfunction and related factors in patients with Parkinson's disease (PD). The sample comprised 76 patients with PD in the neurology clinic of a training and research hospital. Data were collected using the Hospital Anxiety and Depression Scale and Arizona Sexual Experiences Scale. Approximately nine (88.2%) in 10 participants had sexual dysfunction. Sexual dysfunction depended on sex, educational background, employment status, side effects, body image, difficulty falling asleep, self-care, and walking dependence. Sexual dysfunction was positively correlated with age and symptoms of depression and anxiety. Sexual dysfunction was more prevalent in females than males. Advanced age and high risk of depression resulted in increased prevalence of sexual dysfunction. Health care professionals should evaluate the causes of sexual dysfunction and plan and implement appropriate interventions for patients with PD. [Journal of Psychosocial Nursing and Mental Health Services, 61(3), 45-55.].

Erectile Dysfunction and Depression: A Systematic Review and Meta-Analysis

BACKGROUND

Some studies have reported that exposure to depression increases the risk of erectile dysfunction (ED), whereas others have observed no association. Moreover, additional studies have reported that exposure to ED increases the risk of depression.

AIM

To identify and quantitatively synthesize all studies evaluating the association between ED and depression and to explore factors that may explain differences in the observed association.

METHODS

We conducted a systematic review and meta-analysis. We searched Medline, Ovid Embase, and the Cochrane Library through October 2017 for studies that had evaluated the association between ED and depression. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting (PICOS) inclusion criteria.

OUTCOMES

The odds ratio (OR) was regarded as the effect size, and the heterogeneity across studies was assessed using the I² statistic.

RESULTS

We identified 49 eligible publications. The pooled OR for studies evaluating depression exposure and risk of ED was 1.39 (95% CI: 1.35-1.42; n = 46 publications with 48 studies). Although we observed large heterogeneity (I² = 93.6%), subgroup analysis indicated that it may have been as a result of variations in study design, comorbidities, ED assessment, depression assessment, the source of the original effect size, etc. No significant publication bias was observed (P = .315), and the overall effect size did not change by excluding any single study. The pooled OR for studies evaluating ED exposure and risk of depression was 2.92 (95% CI: 2.37-3.60; n = 5 publications with 6 studies). No significant heterogeneity (P < .257, I² = 23.5%) or publication bias (P = .260) was observed.

CLINICAL IMPLICATIONS

Patients reporting ED should be routinely screened for depression, whereas patients presenting with symptoms of depression should be routinely assessed for ED.

STRENGTHS AND LIMITATIONS

There are several strengths to this study. First, evaluations of the association between ED and depression are timely and relevant for clinicians, policymakers, and patients. Second, we intentionally conducted 2 meta-analyses on the association, allowing us to include all potentially relevant studies. However, our study also possesses some limitations. First, the OR is a measure of association that only reveals whether an association is present. Thus, this study was unable to determine the direction of causality between ED and depression. Second, the high heterogeneity among studies makes it difficult to generalize the conclusions.

CONCLUSION

This study demonstrates an association between depression and ED. Policymakers, clinicians and patients should attend to the association between depression and ED. Liu Q, Zhang Y, Wang J, et al. Erectile dysfunction and depression: A systematic review and meta-analysis. J Sex Med 2018;15:1073-1082.

Demographic and clinical correlates of sexual dysfunction among Nigerian male outpatients on conventional antipsychotic medications

BACKGROUND

In psychotic disorders, early intervention with antipsychotic medications increases the likelihood of favourable long-term course. However, the pharmacologic management especially with conventional antipsychotic medications is complicated by a high rate of adverse effects including sexual dysfunction. This study aims to determine the demographic and clinical factors associated with sexual dysfunction among male psychiatric outpatients on conventional antipsychotic medications in South-western Nigeria.

METHODS

Two hundred and seventy five consecutive male outpatients with psychotic disorders on conventional antipsychotic medications were interviewed. Data was collected on demographic characteristics, illness-related and medication-related variables. Illness severity was assessed with the Brief psychiatric rating scale. The International Index of Erectile Function questionnaire was used to assess for sexual dysfunctions.

RESULTS

A total of 111 (40.4%) respondents had one or more forms of sexual dysfunction. Sexual desire dysfunction was present in 47 (17.1%) of respondents, erectile dysfunction in 95 (34.5%), orgasmic dysfunctions in 51 (18.5%), intercourse dissatisfaction in 72 (26.2%) and overall dissatisfaction in 64 (23.3%). Sexual dysfunction was significantly associated with employment status, age, marital status, haloperidol use, medication dosage, and presence of psychopathology. Unemployment was the only significant independent correlate of sexual dysfunction, with unemployed respondents twice more likely to have sexual dysfunction compared with those employed (Wald = 3.865, Odds Ratio = 2.033, 95% confidence interval = 1.002 - 4.124, p = 0.049).

CONCLUSIONS

The high prevalence of sexual dysfunction found in this study suggests a need among clinicians for increased awareness and recognition of the sexual side effects in patients taking conventional antipsychotic medications. This knowledge should guide conventional antipsychotic medication prescription in the at-risk population to improve treatment adherence.

Estudo psicométrico da escala de inibição/excitação sexual masculina

O presente trabalho pretende desenvolver um estudo psicométrico com base na escala de inibição/excitação masculina. A amostra é constituída por 252 indivíduos do sexo masculino, com idades compreendidas entre os 19 e os 86 anos e os instrumentos utilizados foram o Questionário Introdutório (Nobre, 2007), a Sexual Inhibition / Sexual Excitation Scales - SIS/SES (JANSSEN et al., 2002a) e o Índice Internacional de Função Eréctil - IIEF (ROSEN et al., 1999). Assim, os dados obtidos vão ao encontro daquilo que é referido na literatura, sendo que também neste estudo foi possível agrupar os itens em 3 factores, tal como os autores agruparam numa segunda análise. Além disto, apenas no SIS1 se registam diferenças significativas ao nível do funcionamento sexual, ou seja, os homens com dificuldades de erecção não se diferenciam na predisposição para se excitarem, nem para se inibirem, sendo que as preocupações são referentes ao nível do desempenho.

Monophasic Estrogen-Progestogen Therapy and Sexuality in Postmenopausal Women

OBJECTIVE

This study aimed to evaluate the effects of monophasic estrogen-progestogen therapy on the sexuality and climacteric symptoms of postmenopausal women.

PATIENTS AND METHODS

A prospective, randomised, double-blind, crossover, placebo-controlled, single-centre study was carried out over a total of 12 consecutive months in 40 postmenopausal women with an intact uterus who had no contraindications to hormone therapy. Patients received 17beta-estradiol 2mg in combination with norethisterone acetate 1mg (Cliane) daily for 6 months or one placebo tablet daily for 6 months. The tablets were identical in appearance. After 6 months, the groups were crossed over and the patients were followed up for another 6 months. The groups were homogenous with respect to age, height, bodyweight, body mass index and race. For the statistical analysis, the group receiving hormone therapy was referred to as group A and the placebo group was designated group B, irrespective of the placebo/hormone therapy sequence.

RESULTS

In group A there were fewer hot flashes (F=22.85, p<0.01) and an improvement in sexual interest (F=5.55, p<0.05). The sequence in which the medication was received resulted in a statistically significant difference with respect to dyspareunia (F=9.65, p<0.01) and satisfaction with the duration of penetration (F=6.58, p<0.05). In the intrapatient analysis of variation with respect to orgasmic capability and the presence of dialogue with partner regarding the couple's sexual life, whether the placebo was taken prior to or following hormone therapy was significant (F=17.12, p<0.001 and F=7.10, p<0.05, respectively).

CONCLUSIONS

Monophasic estrogen-progestogen therapy has a beneficial effect on sexuality and on hot flashes in postmenopausal women.