Prevalence and correlates of sexual health disorders among adult men in a rural area of North India: An observational study

Sexual dysfunction in men with young onset Parkinson's disease

Sexual dysfunction (SD) is a common, yet under-reported non-motor symptom of PD. Common sexual symptoms among male PD patients include erectile dysfunction, premature ejaculation, and decreased sexual desire. Few research papers have examined sexual dysfunction in PD, especially in YOPD male patients, and there is no Indian research study on sexual dysfunction in YOPD. In this study, we determined the frequency of sexual dysfunction in men with YOPD, and its correlation with other motor and NMS. This prospective cross-sectional study was conducted on YOPD males who presented to the Department of Neurology, NIMHANS, Bangalore, India, from May 2021 to April 2023. The diagnosis of YOPD was made based on MDS criteria for IPD 2015. Sexual functions were evaluated by ASEX, PEDT, QUIP-RS, and sex hormone assay. The patients also underwent other motor and non-motor assessments. Statistical analysis was done using SPSS version 22.0. The study was funded by the PDMD fund. This study included 62 male YOPD patients. The mean age of cases was 44.74 ± 8.54 years. The mean duration of symptoms was 8.45 ± 6.23 years. 43.5% of the cases of PD were Akinetic rigid type. By ASEX Score grading, 46.8% of the cases had erectile dysfunction and 71% of the cases of YOPD had premature ejaculation by PEDT Score grading. 9.7% of the cases had hypersexuality by QUIP-RS. Duration of YOPD was a better predictor of Erectile Dysfunction and premature ejaculation when compared with other variables. SD was related to anxiety and depression and it had a negative impact on the patient's health-related quality of life (HR-QoL). SD should be investigated and treated as an integral part of the neurological assessment in YOPD.

Emergency obstetric referrals in public health facilities: A descriptive study from urban Maharashtra, India

Background

An effective referral system is key to access timely emergency obstetric care. The criticality of referrals makes it necessary to understand its pattern at the health system level. This study aims to document the patterns and primary reasons of obstetric case referral and the maternal and perinatal outcome of the cases in public health institutions in select areas of urban Maharashtra, India.

Methods

The study is based on the health records of public health facilities in Mumbai and its adjoining three municipal corporations. The information on pregnant women referred for obstetric emergencies was collected from patient referral forms of municipal maternity homes and peripheral health facilities between 2016 and 2019. Maternal and child outcome data was obtained from "Received-In" peripheral and tertiary health facilities to track whether the referred woman reached the referral facility for delivery. Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes.

Results

14% (28,020) women were referred to higher health facilities. The most common reasons for referral were pregnancy-induced hypertension or eclampsia (17%), previous caesarean section (12%), fetal distress (11%) and Oligohydramnios (11%). 19% of all referrals were entirely due to unavailability of human resources or health infrastructure. Non-availability of emergency Operation Theatre (47%) and Neonatal Intensive Care Unit (45%) were the major non-medical reasons for referrals. Absence of health personnel such as anaesthetist (24%), paediatrician (22%), physician (20%) or obstetrician (12%) was another non-medical reason for referrals. Referring facility had a phone-based communication about the referral with the receiving facility in less than half of the cases (47%). 60% of the referred women could be tracked in higher health facilities. Of the tracked cases, 45% women delivered via caesarean section. Most of the deliveries (96%) resulted in live birth outcomes. 34% of the newborns weighed less than 2,500 grams.

Conclusion

Improving referral processes are critical to enhance the overall performance of emergency obstetric care. Our findings emphasize the need for a formal communication and feedback system between referring and receiving facilities. Simultaneously, ensuring EmOC at different levels of health facilities by upgradation of health infrastructure is recommended.

Incorporating and Emphasizing Sexual Health in Medical Curriculum of Nepal: Need of the Hour

Sexual health requires a positive and respectful approach to sexuality and sexual relationships. It is one of the most neglected parts of an individual's health. Sexual health is not adequately covered in the medical education curriculum of Nepal. There is a lack of clinicians practising sexual medicine, which provides a fertile field for quacks in this arena. Sexual health needs to be included and incorporated into medical education. The policymakers and stakeholders need to address this need in sexual health urgently and effeciently. Comprehensive sexual education should be included for children, adolescents and young adults.

Keywords

medical education; Nepal; sexual health.

Sociodemographic and Clinical Profile of Patients Presenting With Erectile Dysfunction: Experience From a Tertiary Care Centre of North India

Background:

Erectile dysfunction (ED) is one of the most common psychosexual disorders in clinical practice, and it results in significant distress, interpersonal impairments, poor quality of life, and marital disharmony. However, there is limited research on ED in India. Therefore, this study aimed to assess the sociodemographic and clinical profile of patients presenting with ED.

Method:

Cross-sectional evaluation of patients with ED presenting to the psychosexual outpatient department (OPD) of psychiatry department in a tertiary care hospital was done on structured clinical pro forma, Mini-International Neuropsychiatric Interview, International Index of Erectile Function-5, Arizona Sexual Experience, Hamilton rating scale for depression, and Hamilton rating scale for anxiety.

Results:

The sample included 102 patients. The mean age was 33.38 years. The majority of the patients were married (81.4%), Hindu (82.4%), residing in a rural area (60.8%), and belonging to a nuclear family (62.7%). The majority of the patients had a moderate level of ED (50%) followed by mild-to-moderate ED (26.5%) and severe ED (23.5%). Premature ejaculation (46.1%) and depression (28.4%) were the most common sexual and psychiatric comorbidities. Obesity was common (62.7%), and only a minority had other metabolic dysfunction, namely dyslipidemia (7.8%), diabetes (5.9%), and hypertension (4.9%). Tobacco dependence and alcohol dependence were present in 37.3% and 6.9% cases, respectively.

Conclusion:

Young adults with moderate-to-severe ED were present for treatment at a tertiary center. Comorbidities of other sexual disorders, psychiatric disorders, and substance use are commonly encountered in such patients. Promotion of early help-seeking should be encouraged. Clinicians should thoroughly assess even the young patients for other sexual, psychiatric, and medical comorbidities.

Demographic Profile and Presenting Complaints of Patients of Psychosexual Disorders: A Study in a Specialized Psychosexual Clinic of a Tertiary Care Centre

Introduction:

Sexual disorders are practically not addressed in community and primary care settings in India. Understanding the profile of patients visiting tertiary care centers’ psychosexual clinics (PSC) may be of value, to map some critical gaps in the service utilization.

Aim:

To understand the demographic profile and presenting complaints of patients with psychosexual disorders visiting a PSC.

Methods:

An audit of patients’ case records, diagnosis based on ICD-10 classification system, in a PSC over last 1 month was done, noting demographic factors and their frequency distributions.

Results:

Out of 55 patients visiting the clinic, most common age group was 21 to 30 years (49.09%) and only 2 were females. Maximum patients had education up to higher-secondary level (69.09%), were married (65.4%), and had a sexual partner during past 3 months (70.09%). Premature ejaculation (occurring singly or along with other sexual disorders) was diagnosed in 45.28% patients.

Conclusion:

Further exploration is needed into the services provided by the PSC. There is scope for sensitizing female patients, customizing psychoeducation suitable to the educational status and work holistically in the PSC.

A Comparative Study of Yoga with Paroxetine for the Treatment of Premature Ejaculation: A Pilot Study

Context:

Premature ejaculation (PME) is a common sexual disorder. Drugs used commonly used for its treatment have various side effects and disadvantages. Yoga is being increasingly studied in a variety of medical disorders with positive results. However, its evidence for patients with PME is very limited.

Aims:

The aims of this study were to investigate the effect of yoga on ejaculation time in patients with PME and to compare it with paroxetine.

Settings and Design:

This was a nonrandomized nonblinded comparative study in a tertiary care center.

Materials and Methods:

Among patients with PME, 40 selected paroxetine and 28 yoga. Intravaginal ejaculation latency time (IELT) was measured in seconds once before and three times after intervention.

Statistical Analysis Used:

Mean, standard deviation, paired and unpaired t-tests, and repeated measures ANOVA were used for statistical analysis.

Results:

IELT was significantly increased in both groups – paroxetine (from 29.85 ± 11.9 to 82.19 ± 32.9) and yoga (from 25.88 ± 16.1 to 88697 + 26.9). Although the effect of yoga was slightly delayed in onset, its effect size (η² = 0.87, P < 0.05) was more than paroxetine (η² = 0.73, P < 0.05). One-fifth of the patients in the paroxetine group (19.5%) and 8% in the yoga group continued to have the problem of PME at the end of the trial.

Conclusions:

Yoga caused improvement in both intravaginal ejaculation latency time and subjective sexual experience with minimal side effect. Therefore, yoga could be an easily accessible economical nonpharmacological treatment option for the patient with PME.

Association of sociodemographic factors with various domains of alcohol-induced sexual dysfunction - An Indian perspective

BACKGROUND

Sexual dysfunction is frequently seen in alcohol-use disorders. The available research on this topic has studied erectile dysfunction and premature ejaculation using nonvalidated scales. This study was undertaken to study the other major domains of sexual dysfunction, namely sexual desire, orgasmic dysfunction and satisfaction, and their association with sociodemographic factors.

MATERIALS AND METHODS

A cross-sectional descriptive study design was used and 78 male patients were recruited. The assessment was conducted using a specially designed intake pro forma, International Index of Erectile Function (IIEF-15) Scale, DSM-5 and International Classification of Disease, 10^th revision, diagnostic criteria for research. A correlation between the amount of alcohol consumed and its effect on various domains of sexual dysfunction was also carried out using Pearson's correlation coefficient.

RESULTS

The sociodemographic profile was studied in association with the overall (total) IIEF-15 subscale using analysis of variance (ANOVA). Statistically significant differences were observed among age groups, education subgroups, marital disharmony, years of alcohol use, and lifetime alcohol use. Further, since the values of ANOVA were significant, Tukey's post hoc analysis was carried out which showed a statistically significant difference among the groups. Various domains of sexual dysfunction showed a strongly negative correlation for overall IIEF subscale followed by intercourse satisfaction, sexual desire, and orgasmic function with years of alcohol use and lifetime alcohol use.

CONCLUSION

Sexual dysfunction in alcohol dependence patients was significantly associated with a family history of paternal alcohol abuse, lower educational background, increasing age, and marital disharmony. This study also found a strongly negative correlation between various domains of sexual functioning and years of alcohol use/lifetime alcohol use.