Psychosocial profile of male patients presenting with sexual dysfunction in a psychiatric outpatient department in Mumbai, India

The negative impact of timed intercourse in infertile couples: A prospective cohort study

Objective:

To study the differences in sexual dysfunction and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI – around the time of ovulation) and regular intercourse (RI – at least twice a week).

Methods:

In this prospective cohort study, we recruited all infertile couples presenting to the regional infertility clinics from January 2016 to December 2018, pursuing TI ( n = 283) or RI ( n = 88), and having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The couples for whom natural conception was possible were followed up to determine TTP using Kaplan–Meier analysis.

Results:

TI significantly increased the risk of sexual dysfunction than RI for both males and females, even after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI increased the risk of erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between them.

Conclusion:

TI increased the risk of sexual dysfunction without accelerating the time to achieve pregnancy, compared with RI.

Level of evidence:

Not applicable

Comorbidities of male patients with sexual dysfunction in a psychiatry clinic: A study on industrial employees

BACKGROUND

Previous studies assessed the association of sexual dysfunction (SD) in cases of specific organic and psychiatric disorders separately as risk factors of SD, but the extent of association of various disorders in cases of SD was rarely evaluated. This study was conducted to assess almost all types of comorbidities to find out their effects on SD in male patients and to make complete diagnoses.

MATERIALS AND METHODS

All male patients aged between 18 and 60 years reporting with sexual problems to the psychiatry outpatient department were evaluated with Arizona sexual experiences scale (ASEX) for males. Their assessment included detailed medical and psychiatric history including medicine intake, physical and mental status examination. Relevant biochemical investigations were done including sex hormone assessment.

RESULTS

Among 104 males diagnosed as cases of SD according to the ASEX scale in 1 year period only 75 patients completed all the biochemical and hormonal assessments. It was observed that 38.67% were diagnosed as SD without any comorbidity, 25.33% had biochemical or hormonal or physical comorbidities, 21.33% had psychiatric comorbidities and 14.67% had psychiatric as well as biochemical or hormonal or physical comorbidities (n = 75). The severity of SD was higher in the patients with comorbidity and the age of the patients predicted its severity.

CONCLUSION

All cases of SD should be assessed in detail for physical, biochemical, hormonal, and psychiatric comorbidities to treat them holistically. Psychiatrists should play a key role in assessing, diagnosing, treating, and referring them to the appropriate treatment provider.

Quality of Marital Relationship and Sexual Interaction in Couples With Sexual Dysfunction: An Exploratory Study From India

Background:

Sexual dysfunction and marital intimacy and quality are found to have a reciprocal relationship. Examining this relationship in couples seeking help for sexual dysfunctions in the cultural context of India is worthwhile.

Aim:

This study aims to explore the nature of sexual functioning, sexual interaction, sexual communication, and marital intimacy and quality in couples with sexual dysfunction. Further, relationship between the above variables is also examined.

Methods:

A cross-sectional, single-group exploratory design was adopted. A sample of 155 married heterosexual individuals, with a clinical diagnosis of sexual dysfunction in either of the spouses, was included in the study. The tools used included MINI neuropsychiatric interview, Marital Quality Scale, Marital Intimacy Questionnaire, Dyadic Sexual Communication Scale, and Sexual Interaction Inventory.

Results:

Erectile dysfunction and premature ejaculation in men and hypoactive sexual desire disorder in women were the most common sexual dysfunctions. Majority of the sample were young adults. About 82% of the sample had moderate-to-severe levels of marital distress. Mood disorder was the most common psychiatric disorder reported in the sample. High levels of intimacy problems were seen with no significant gender differences in the overall marital quality or intimacy. Difficulty in the overall sexual interactions was found; however, higher levels of dissatisfaction with the frequency of sex and lower self-acceptance was reported by men compared to women. Significant interrelationships were found between marital quality and intimacy, sexual interaction, and sexual communication.

Conclusions:

Sexual dysfunctions and marital distress are closely related. Sexual interaction and sexual communication play a significant role in marital quality and intimacy.

Psychosexual Problem in Remitted Psychiatric Patients

Background:

Many patients and health literature, in general, allege that psychotropic agents cause sexual side effects.

Objective:

We intended to investigate this issue in a Nepalese clinical setting by estimating the prevalence of psychosexual problems among remitted psychiatric outpatients (on psychotropic medication) and by comparing it with that of a nonpsychiatric patient group (on nonpsychotropic medication).

Methodology:

In this hospital-based cross-sectional comparison study with purposive sampling, we collected the responses to a self-response questionnaire called “Arizona Sexual Experience Scale” from a total of 400 subjects: 100 male and 100 female consecutive consenting remitted psychiatric and dermatological outpatients, each with sex and marital status matching. We recorded pertinent information in the proforma and screened psychosexual problems with the Arizona Sexual Experience Scale after informed written consent. The problems in psychiatric and dermatological groups were compared.

Results:

We have more subjects of reproductive ages in both the psychiatric and dermatological groups. Depression, anxiety, and bipolar affective disorder were the most common diagnoses in the psychiatric patients, whereas eczema, fungal, immunologic, and allergic skin lesions/diseases were common in the dermatological patients. Both groups had comparable sexual dysfunction rates, both by overall and the criteria of ≥3 items with scores ≥4, whereas dermatological patients had more problems with criteria of ≥1 item with a score ≥5.

Conclusions:

Psychosexual dysfunction was more or less similar in frequency among both the psychiatric patients on psychotropic medication and dermatological patients on topical agents.

Challenges in Taking Sexual History: A Qualitative Study of Indian Postgraduate Psychiatry Trainees

CONTEXT

In India, psychiatrist is an important point of helpseeking for sexual complaints. A detailed sexual history can go a long way in understanding sexual difficulties. In this background, there is inadequate information on the difficulties that psychiatry postgraduate trainees experience while taking a sexual history as part of a routine mental health evaluation.

AIMS

The aim was to study the difficulties experienced by postgraduate psychiatry trainees while taking sexual history as a part of routine mental health evaluation.

SETTING

This study was conducted in an Indian medical college general hospital psychiatry setting.

MATERIALS AND METHODS

This is a qualitative study using focus group discussions and in-depth interviews with postgraduate psychiatry trainees.

STATISTICAL ANALYSIS

Content analysis was used to identify direct and latent themes.

RESULTS

Thematic saturation was achieved with 17 participants. Major themes of difficulties that emerged included trainee-related factors such as gender and sociocultural background of the trainee; patient-related factors such as age, gender, and sexual orientation; setting-related factors; and language-related difficulties.

CONCLUSIONS

Specific and regular training in taking a sexual history is essential in addressing the difficulties faced by postgraduate psychiatry trainees in India.