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Special Issue "Novel Research in Sexuality and Mental Health"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pathergasiology & Psychology".

Deadline for manuscript submissions: 31 May 2019

Special Issue Editor

Guest Editor
Prof. Dr. Angel L. Montejo

Professor of Psychiatry, University of Salamanca, Institute of Research in Biomedicine IBSAL, Salamanca, Spain
Website | E-Mail
Interests: sexuality and mental health; psychotropic-related sexual dysfunction

Special Issue Information

Dear Colleagues,

Sexuality is considered as a great human value related to happiness and satisfaction, but unfortunately, when affecting mental disorders, they tend to be associated with second level human functions. Nevertheless, sexual dysfunction often accompanies psychiatric disorder, intensely influencing compliance, quality of life and human relationships. Sexuality could be influenced either by a mental disorder itself, difficulties to get and maintain couple relationships or by the use of psychotropic treatments. Treatment-related adverse events are unfortunately under-recognized by clinicians, scarcely spontaneously communicated by patients, and rarely investigated in clinical trials. The most frequent psychotropic compounds that could deteriorate sexuality and quality of life include antidepressants, antipsychotics and mood regulators. There are important differences between them related to some variations in mechanisms of action including serotonin, dopamine and prolactin levels. Little is known about the relevance of sexuality and its dysfunctions in chronic and frequent mental and neurological disorders, such as psychosis, mood disorders, anxiety, phobias, eating disorders, alcohol or drug dependencies, epilepsy and childhood pathology. Poor sexual life, low satisfaction and more frequent risky sex behavior than in the general population are associated with severe mental diseases. There is a need for increasing research in this field, including epidemiological, psychological, neurophysiological, neuroanatomical and genetic variables related to sexual life to get a better understanding of the implicated mechanisms. To increase the sensibility of clinicians, the identification and management of sexual disturbances after the onset of any mental disorder should be highlighted. This would avoid unnecessary suffering and deterioration of quality of life.

Prof. Angel L. Montejo
Guest Editor

Manuscript Submission Information

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Keywords

  • sexuality
  • mental health
  • mental disorder
  • sexual dysfunction
  • psychotropic (antidepressant, antipsychotic, antiepileptic)
  • mechanism of action
  • clinical management

Published Papers (14 papers)

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Research

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Open AccessArticle
Frequency of Sexual Dysfunction in Patients Treated with Desvenlafaxine: A Prospective Naturalistic Study
J. Clin. Med. 2019, 8(5), 719; https://doi.org/10.3390/jcm8050719
Received: 29 March 2019 / Revised: 15 May 2019 / Accepted: 16 May 2019 / Published: 21 May 2019
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Abstract
Despite being clinically underestimated, sexual dysfunction (SD) is one of the most frequent and lasting adverse effects associated with antidepressants. Desvenlafaxine is an antidepressant (AD) with noradrenergic and serotonergic action that can cause a lower SD than other serotonergic ADs although there are [...] Read more.
Despite being clinically underestimated, sexual dysfunction (SD) is one of the most frequent and lasting adverse effects associated with antidepressants. Desvenlafaxine is an antidepressant (AD) with noradrenergic and serotonergic action that can cause a lower SD than other serotonergic ADs although there are still few studies on this subject. Objective: To check the frequency of SD in two groups of depressive patients: one group was desvenlafaxine-naïve; the other was made up of patients switched to desvenlafaxine from another AD due to iatrogenic sexual dysfunction. A naturalistic, multicenter, and prospective study of patients receiving desvenlafaxine (50–100 mg/day) was carried out on 72 patients who met the inclusion criteria (>18 years old and sexually active), who had received desvenlafaxine for the first time (n = 27) or had switched to desvenlafaxine due to SD with another AD (n = 45). Patients with previous SD, receiving either drugs or presenting a concomitant pathology that interfered with their sexual life and/or patients who abused alcohol and/or drugs were excluded. We used the validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) to measure AD-related sexual dysfunction and the Clinical Global Impression Scale for psychiatric disease (CGI-S) and for sexual dysfunction (CGI-SD) at two points in time: baseline and three months after the commencement of desvenlafaxine treatment. Results: In desvenlafaxine-naïve patients, 59.2% of the sample showed moderate/severe sexual dysfunction at baseline, which was reduced to 44% at follow-up. The PSexDQ-SALSEX questionnaire total score showed a significant improvement in sexual desire and sexual arousal without changes in orgasmic function at follow-up (p < 0.01). In the group switched to desvenlafaxine, the frequency of moderate/severe SD at baseline (93.3%) was reduced to 75.6% at follow-up visit. Additionally, SD significantly improved in three out of four items of the SALSEX: low desire, delayed orgasm, and anorgasmia at follow-up (p < 0.01), but there was no significant improvement in arousal difficulties. The frequency of severe SD was reduced from 73% at baseline to 35% at follow-up. The CGI for psychiatric disease and for sexual dysfunction improved significantly in both groups (p < 0.01). There was a poor tolerability with risk of treatment noncompliance in 26.7% of patients with sexual dysfunction due to another AD, this significantly reduced to 11.1% in those who switched to desvenlafaxine (p = 0.004). Conclusion: Sexual dysfunction improved significantly in depressed patients who initiated treatment with desvenlafaxine and in those who switched from another AD to desvenlafaxine, despite this, desvenlafaxine treatment is not completely devoid of sexual adverse effects. This switching strategy could be highly relevant in clinical practice due to the significant improvement in moderate/severe and poorly tolerated SD, while maintaining the AD efficacy. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
(Don’t) Look at Me! How the Assumed Consensual or Non-Consensual Distribution Affects Perception and Evaluation of Sexting Images
J. Clin. Med. 2019, 8(5), 706; https://doi.org/10.3390/jcm8050706
Received: 8 April 2019 / Revised: 10 May 2019 / Accepted: 13 May 2019 / Published: 17 May 2019
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Abstract
The non-consensual sharing of an intimate image is a serious breach of a person’s right to privacy and can lead to severe psychosocial consequences. However, little research has been conducted on the reasons for consuming intimate pictures that have been shared non-consensually. This [...] Read more.
The non-consensual sharing of an intimate image is a serious breach of a person’s right to privacy and can lead to severe psychosocial consequences. However, little research has been conducted on the reasons for consuming intimate pictures that have been shared non-consensually. This study aims to investigate how the supposed consensual or non-consensual distribution of sexting images affects the perception and evaluation of these images. Participants were randomly assigned to one of two groups. The same intimate images were shown to all participants. However, one group assumed that the photos were shared voluntarily, whereas the other group were told that the photos were distributed non-consensually. While the participants completed several tasks such as rating the sexual attractiveness of the depicted person, their eye-movements were being tracked. The results from this study show that viewing behavior and the evaluation of sexting images are influenced by the supposed way of distribution. In line with objectification theory men who assumed that the pictures were distributed non-consensually spent more time looking at the body of the depicted person. This so-called ‘objectifying gaze’ was also more pronounced in participants with higher tendencies to accept myths about sexual aggression or general tendencies to objectify others. In conclusion, these results suggest that prevention campaigns promoting ‘sexting abstinence’ and thus attributing responsibility for non-consensual distribution of such images to the depicted persons are insufficient. Rather, it is necessary to emphasize the illegitimacy of the non-consensual distribution of sexting images, especially among male consumers of the material. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Sexual Satisfaction and Mental Health in Prison Inmates
J. Clin. Med. 2019, 8(5), 705; https://doi.org/10.3390/jcm8050705
Received: 30 April 2019 / Revised: 12 May 2019 / Accepted: 14 May 2019 / Published: 17 May 2019
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Abstract
The main goal of this study was to investigate the association between sexual satisfaction and mental health, and the combined effect of two previously found, statistically significant moderators: partner status and sexual abstinence. In-person interviews were conducted with 223 participants (49.327% males and [...] Read more.
The main goal of this study was to investigate the association between sexual satisfaction and mental health, and the combined effect of two previously found, statistically significant moderators: partner status and sexual abstinence. In-person interviews were conducted with 223 participants (49.327% males and 50.673% females). The effect of sexual satisfaction on mental health and the interactions of sexual satisfaction × partner status, sexual satisfaction × sexual abstinence, and sexual satisfaction × partner status × sexual abstinence were examined using simple moderation and moderated moderation tests after controlling for a set of sociodemographic, penitentiary, and interpersonal variables. Results revealed a direct relationship between sexual satisfaction and mental health only for the sexually abstinent group. Partner status was not significant as a moderator. It seems that the lack of sexual relationships is more powerful as a moderator than the lack of a romantic relationship. Additionally, the sexually abstinent group showed lower levels of sexual satisfaction in those with a partner outside or inside prison, and lower mental health independently of the current romantic status, than sexually active inmates. These findings point to the importance of sexual satisfaction to mental health in sexual situations of extreme disadvantage. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Sexual Distress in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study
J. Clin. Med. 2019, 8(4), 532; https://doi.org/10.3390/jcm8040532
Received: 7 April 2019 / Revised: 14 April 2019 / Accepted: 16 April 2019 / Published: 18 April 2019
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Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress [...] Read more.
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress (SD) in patients with HS and to explore potentially associated epidemiological and clinical factors. We conducted a cross-sectional study by means of a crowd-sourced online questionnaire hosted by the Spanish hidradenitis suppurativa patients’ association (ASENDHI). Sexual distress (SD) was evaluated with a Numeric Rating Scale (NRS) for HS impact on sex life. A total of 393 participants answered the questionnaire. The mean NRS for HS impact on sex life was 7.24 (2.77) in women and 6.39 (3.44) in men (p < 0.05). Variables significantly associated (p < 0.05) with SD in the multiple linear regression model were sex, with a higher risk in females, the presence of active lesions in the groin and genitals and NRS for pain and unpleasant odor; being in a stable relationship was an important protector factor. Regarding these results, it seems that SD in HS patients is due, at least in part, to disease symptoms and active lesions in specific locations, emphasizing the importance of disease control with a proper treatment according to management guidelines. Women and single patients are more likely to suffer from sexual distress. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Predictors of Sexual Dysfunction in Veterans with Post-Traumatic Stress Disorder
J. Clin. Med. 2019, 8(4), 432; https://doi.org/10.3390/jcm8040432
Received: 18 February 2019 / Revised: 25 March 2019 / Accepted: 27 March 2019 / Published: 29 March 2019
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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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
Open AccessFeature PaperArticle
Sexual Dysfunctions and Their Association with the Dual Control Model of Sexual Response in Men and Women with High-Functioning Autism
J. Clin. Med. 2019, 8(4), 425; https://doi.org/10.3390/jcm8040425
Received: 20 February 2019 / Revised: 20 March 2019 / Accepted: 22 March 2019 / Published: 28 March 2019
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Abstract
Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual [...] Read more.
Adults with an Autism Spectrum Disorder (ASD) are characterized by impairments in social interaction and communication, repetitive and stereotyped interests and behaviours as well as hyper- and/or hyposensitivities. These disorder specific symptoms could be associated with the development of sexual disorders. The Dual Control Model of Sexual Response presents one approach that is frequently used to explain the emergence of sexual dysfunctions. The aim of the present study was to assess the extent of symptoms of sexual dysfunctions in men and women with ASD and to evaluate their association with the individual propensity of sexual excitation and inhibition as defined by the Dual Control Model. Both men and women with ASD were more likely to report about sexual dysfunctions than individuals from the control group. In men with ASD, sexual inhibition was significantly correlated with the emergence of sexual dysfunctions, while there was no association between sexual functioning and sexual excitation. In women, the opposite pattern was found. Especially the peculiarities in sensitive perception could be responsible for the observed problems with sexual functioning in individuals with ASD. The present findings highlight the great need for specialized treatment programs addressing the frequently observed sexuality-related problems in individuals with ASD. However, up to now such treatment programs are lacking. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
Open AccessArticle
Mental Health and Proximal Stressors in Transgender Men and Women
J. Clin. Med. 2019, 8(3), 413; https://doi.org/10.3390/jcm8030413
Received: 1 March 2019 / Revised: 9 March 2019 / Accepted: 20 March 2019 / Published: 25 March 2019
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Abstract
This paper explores the subjective perception of some personal and interpersonal aspects of the lives of transgender people and the relationship they have with their mental health. One hundred and twenty transgender people (60 men and 60 women) participated in semi-structured interviews. Following [...] Read more.
This paper explores the subjective perception of some personal and interpersonal aspects of the lives of transgender people and the relationship they have with their mental health. One hundred and twenty transgender people (60 men and 60 women) participated in semi-structured interviews. Following quantitative methodology, analysis highlighted that social loneliness is the main predictor of lower levels of mental health (anxiety and depression) for both genders and recognized romantic loneliness as the strongest factor among transgender men. In both cases, higher levels of loneliness were associated with lower levels of mental health. The results have guided us to improve institutional and social responses and have provided an opportunity to promote the mental health of transgender people. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Couple Relationship and Parent-Child Relationship Quality: Factors Relevant to Parent-Child Communication on Sexuality in Romania
J. Clin. Med. 2019, 8(3), 386; https://doi.org/10.3390/jcm8030386
Received: 5 February 2019 / Revised: 4 March 2019 / Accepted: 14 March 2019 / Published: 19 March 2019
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Abstract
This study of parents in Romania explores how perceptions of their couple relationship quality and of factors associated with it (such as sexual communication anxiety and sexual perfectionism) were related to their perception of aspects describing parenting dimensions relevant to the sexual education [...] Read more.
This study of parents in Romania explores how perceptions of their couple relationship quality and of factors associated with it (such as sexual communication anxiety and sexual perfectionism) were related to their perception of aspects describing parenting dimensions relevant to the sexual education and sexual health of their children. The hypotheses tested in this study were supported by the data collected from 106 participants (aged 25 to 51 years), parents of 1 to 3 children: (1) sexual communication anxiety with one’s partner (but not sexual perfectionism) is a significant predictor for parents’ self-efficacy, outcome expectancy and communication and parenting behavior related to sexuality education; (2) parents’ self-efficacy and outcome expectancy about parent-child communication on sexual topics (including involvement in risky sexual behaviors) predict the level of parenting behavior in this respect; (3) parents’ sexual communication anxiety (but not their sexual perfectionism) together with their self-efficacy and outcome expectancy regarding parent-child communication about sexuality predict the level of parental sexuality-communication-and-education behavior. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Sexual Dysfunction and Quality of Life in Chronic Heroin-Dependent Individuals on Methadone Maintenance Treatment
J. Clin. Med. 2019, 8(3), 321; https://doi.org/10.3390/jcm8030321
Received: 31 January 2019 / Revised: 23 February 2019 / Accepted: 1 March 2019 / Published: 7 March 2019
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Abstract
This study examined whether methadone (hereinafter referred to as MTD) maintenance treatment (MMT) is correlated with sexual dysfunction (SD) in heroin-dependent men. This was conducted to determine the prevalence of sexual dysfunction and if there is a relationship between duration and dose among [...] Read more.
This study examined whether methadone (hereinafter referred to as MTD) maintenance treatment (MMT) is correlated with sexual dysfunction (SD) in heroin-dependent men. This was conducted to determine the prevalence of sexual dysfunction and if there is a relationship between duration and dose among men on MMT and its impact on the quality of life. The study combined a retrospective and a cross-sectional survey based on the Kinsey Scale, TECVASP, and PRSexDQ-SALSEX clinical interviews of 85 patients who are currently engaged in MMT. Sexual dysfunction in all five PRSexDQ-SALSEX domains (lack of libido, delay in orgasm, inability to orgasm, erectile dysfunction, and tolerance or acceptance of changes in sexual function) was associated with dose and long-term use of heroin. All dimensions of SD were affected by the MTD intake. From the analysis of our sample, we may conclude that dose of MTD and overall score of SD were directly associated. However, no evidence was found to prove that treatment duration and severity of SD were linked. It is notable that only one tenth of the patients spontaneously reported their symptoms of the sexual sphere, but up to a third considered leaving the MMT for this reason. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the [email protected] Study
J. Clin. Med. 2019, 8(2), 157; https://doi.org/10.3390/jcm8020157
Received: 19 December 2018 / Revised: 23 January 2019 / Accepted: 28 January 2019 / Published: 30 January 2019
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Abstract
Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n [...] Read more.
Problems arising from hypersexual behavior are often seen in clinical settings. We aimed to extend the knowledge about the clinical characteristics of individuals with hypersexual disorder (HD). A group of people who fulfilled the proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group of healthy controls (n = 40). We investigated differences in sociodemographic, neurodevelopmental, and family factors based on self-report questionnaires and clinical interviews. Men with HD reported elevated rates of sexual activity, paraphilias, consumption of child abusive images, and sexual coercive behavior compared to healthy controls. Moreover, rates of affective disorders, attachment difficulties, impulsivity, and dysfunctional emotion regulation strategies were higher in men with HD. Men with HD seem to have experienced various forms of adverse childhood experiences, but there were no further differences in sociodemographic, neurodevelopmental factors, and family factors. Regression analyses indicated that attachment-related avoidance and early onset of masturbation differentiated between men with HD and healthy controls. In conclusion, men with HD appear to have the same neurodevelopment, intelligence levels, sociodemographic background, and family factors compared to healthy controls, but they report different and adverse experiences in childhood, problematic sexual behavior, and psychological difficulties. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessArticle
Understanding the Mechanism of Antidepressant-Related Sexual Dysfunction: Inhibition of Tyrosine Hydroxylase in Dopaminergic Neurons after Treatment with Paroxetine but Not with Agomelatine in Male Rats
J. Clin. Med. 2019, 8(2), 133; https://doi.org/10.3390/jcm8020133
Received: 16 November 2018 / Revised: 13 January 2019 / Accepted: 21 January 2019 / Published: 23 January 2019
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Abstract
Antidepressant-related sexual dysfunction is a frequent adverse event caused by serotonergic activation that intensely affects quality of life and adherence in depressed patients. The dopamine system has multiple effects promoting sexual behavior, but no studies have been carried out to confirm dopaminergic changes [...] Read more.
Antidepressant-related sexual dysfunction is a frequent adverse event caused by serotonergic activation that intensely affects quality of life and adherence in depressed patients. The dopamine system has multiple effects promoting sexual behavior, but no studies have been carried out to confirm dopaminergic changes involved in animal models after antidepressant use. Methods: The sexual behavior-related dopaminergic system in the rat was studied by comparing two different antidepressants and placebo for 28 days. The antidepressants used were paroxetine (a serotonergic antidepressant that causes highly frequent sexual dysfunction in humans) and agomelatine (a non-serotonergic antidepressant without associated sexual dysfunction). The tyrosine hydroxylase immunoreactivity (THI) in the substantia nigra pars compacta, the ventral tegmental area, the zona incerta, and the hypothalamic arcuate nucleus, as well as the dopaminergic projections to the striatum, hippocampus, cortex, and median eminence were analyzed. Results: The THI decreased significantly in the substantia nigra and ventral tegmental area after treatment with paroxetine, and the labeling was reduced drastically in the zona incerta and mediobasal hypothalamus. The immunoreactive axons in the target regions (striatum, cortex, hippocampus, and median eminence) almost disappeared only in the paroxetine-treated rats. Conversely, after treatment with agomelatine, a moderate reduction in immunoreactivity in the substantia nigra was found without appreciable modifications in the ventral tegmental area, zona incerta, and mediobasal hypothalamus. Nevertheless, no sexual or copulatory behavior was observed in any of the experimental or control groups. Conclusion: Paroxetine but not agomelatine was associated with important decreased activity in dopaminergic areas such as the substantia nigra and ventral tegmental areas that could be associated with sexual performance impairment in humans after antidepressant treatment. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Review

Jump to: Research

Open AccessReview
Uncovering Female Child Sexual Offenders—Needs and Challenges for Practice and Research
J. Clin. Med. 2019, 8(3), 401; https://doi.org/10.3390/jcm8030401
Received: 20 February 2019 / Revised: 20 March 2019 / Accepted: 21 March 2019 / Published: 22 March 2019
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Abstract
This article provides a short literature overview on female child sexual offenders (FCSO) focusing on the discrepancy between prevalence rates from different sources, characteristics of FCSO and their victims, as well as the societal “culture of denial” surrounding these women. FCSO are a [...] Read more.
This article provides a short literature overview on female child sexual offenders (FCSO) focusing on the discrepancy between prevalence rates from different sources, characteristics of FCSO and their victims, as well as the societal “culture of denial” surrounding these women. FCSO are a powerful social taboo. Even professionals in the healthcare or justice system were shown to respond inappropriately in cases of child sexual abuse committed by women. As a result, offences of FCSO may be underreported and therefore difficult to research. The lack of scientific data on FSCO lowers the quality of child protection and treatment services. We therefore deem it particularly necessary for professionals in health care to break the social taboo that is FCSO and to further stimulate research on the topic of FCSO. We provide some general implications for professionals in health care systems as well as specific recommendations for researchers. We end with an overall conclusion. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
Open AccessReview
Serotonergic, Dopaminergic, and Noradrenergic Modulation of Erotic Stimulus Processing in the Male Human Brain
J. Clin. Med. 2019, 8(3), 363; https://doi.org/10.3390/jcm8030363
Received: 8 February 2019 / Revised: 5 March 2019 / Accepted: 12 March 2019 / Published: 14 March 2019
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Abstract
Human sexual behavior is mediated by a complex interplay of cerebral and spinal centers, as well as hormonal, peripheral, and autonomic functions. Neuroimaging studies identified central neural signatures of human sexual responses comprising neural emotional, motivational, autonomic, and cognitive components. However, empirical evidence [...] Read more.
Human sexual behavior is mediated by a complex interplay of cerebral and spinal centers, as well as hormonal, peripheral, and autonomic functions. Neuroimaging studies identified central neural signatures of human sexual responses comprising neural emotional, motivational, autonomic, and cognitive components. However, empirical evidence regarding the neuromodulation of these neural signatures of human sexual responses was scarce for decades. Pharmacological functional magnetic resonance imaging (fMRI) provides a valuable tool to examine the interaction between neuromodulator systems and functional network anatomy relevant for human sexual behavior. In addition, this approach enables the examination of potential neural mechanisms regarding treatment-related sexual dysfunction under psychopharmacological agents. In this article, we introduce common neurobiological concepts regarding cerebral sexual responses based on neuroimaging findings and we discuss challenges and findings regarding investigating the neuromodulation of neural sexual stimulus processing. In particular, we summarize findings from our research program investigating how neural correlates of sexual stimulus processing are modulated by serotonergic, dopaminergic, and noradrenergic antidepressant medication in healthy males. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Open AccessReview
Online Porn Addiction: What We Know and What We Don’t—A Systematic Review
J. Clin. Med. 2019, 8(1), 91; https://doi.org/10.3390/jcm8010091
Received: 27 November 2018 / Revised: 27 December 2018 / Accepted: 10 January 2019 / Published: 15 January 2019
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Abstract
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. [...] Read more.
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the “triple A” influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research. Full article
(This article belongs to the Special Issue Novel Research in Sexuality and Mental Health)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title 1: Sexual Dysfunction and Obsessive-Compulsive Disorder: A Systematic Review
Authors: Javier I. de la Iglesia, Rubén de Alarcón, Nerea M Casado, Angel L Montejo
Abstract: Among the disorders listed in psychiatric diagnostic manuals world-wide, obsesive-compulsive disorder (OCD) is potentially one of the most disabling for the patients in the real life. Such disability tends to distort the patient’s laboral, social and intimate sphere, causing a wide range of dysfunctions among which the sexual are prevalent. The sexual obsessive symptoms tend to be underestimated for physicians and under communicated by patients. In this review we attempt to provide a summary of the existing data about the effect of OCD on sexuality, focusing on areas such as epidemiology, aetiology, neurobiology, clinical features and options for treatment.

Title 2: Predictors of sexual impairment at 6months after a manic episode: A post-hoc analysis of the MANACOR study
Authors:
Laila Al Chaal
Abstract: Bipolar Disorder Type I (BDI) often involve direct or indirect sexual dysfunction, which has an important impact on the patients’ life quality, adherence to treatment and functional outcomes. We offer a post-hoc analysis of the MANACOR study, an observational, open-label study recruiting BDI patients with a recent manic episode who underwent a prospective follow-up for 6 months. We found that almost 25% of bipolar patients showed mild to severe sexual dysfunction, which was related to an older age of onset and to a higher rate of affective episodes and suicidal ideation. Although we acknowledge the possibility of the treatment constituting a bias modifying the clynical presentation of BDI.

Title 3: Sexuality among eating disorder patients. A systematic review
Authors:
Celia González Soria, David González Parra, Laila Al Chaal Marcos, Ángel Luis Montejo González
Abstract: Eating disorders are complex and serious psychiatric diseases, potentially deadly medical conditions, which particularly affect female sex. In most cases, they are chronic illnesses, being anorexia nervosa and bulimia nervosa the most reported ones. Patients with eating disorders have a high rate of comorbidity with other serious diseases as affective disorders and anxiety disorders. Many published studies have analyzed on these issues, suggesting the possibility of a common psychopathological path related to the emotional dysregulation between these syndromes. Nowadays, there are still very few evaluative studies of the high turnout among these disorders and sexual dysfunction, particularly with regard to the evaluation of sexuality, sex drive, sexual activity and sexual satisfaction.

Title 4: Frequency and Severity of Antipsychotic-related Hyperprolactinaemia: Clinical Symptoms and Sexual Dysfunction in 834 patients.
Authors: Hernández, Ana I.; Acosta, José M.; Alvarez, Aida; Bote, Berta; Buch, Bárbara; Calama, Julia; de la Iglesia, Javier; Fernandez, Blanca; Gallego, Maria T; Guerro, Delio; Lorenzo ,Carolina;  Martín, Carmen; Martín-Pinto, Tomás; Matías, Juan;  Matos, Claudia; Pelayo-Terán, José M; Prieto, Nieves; Sánchez-Iglesias, Santiago; Montejo AL
Abstract: Hyperprolactinaemia is a common side effect of some APS, associated to important clinical manifestations (sexual dysfunction, breast disturbances and even increase of certain types of cancer risk). The objective of this study is to evaluate the frequency and levels of severity of prolactin increased associated to different APS, and its association with sexual dysfunction (SD). METHODS: Observational cross-sectional study. Adult patients treated with one APS for at least 4 weeks and with no other prolactin-rising treatment were included. Hyperprolactinaemia was defined as > 20 microgr/L in women, >18 microgr/L in men, although usually is not clinically significant until higher than 30-60 micrograms / L levels are reached, even greater. SD was evaluated with the specific SD questionnaire PRSexDQ-SALSEX (Montejo et al, 2001). RESULTS: 834 adults patients were evaluated with different diagnoses with the following APS treatments distribution: aripiprazole risperidone olanzapine quetiapine long-acting paliperidone long-acting risperidone oral paliperidone oral risperidone and others APS with N<10 were not evaluated). The mean PRL level was 53,94 ng/ml. Paliperidone  was associated  with the higher mean PRL levels (98.28 and 71.48 ng/mL for LAP and OP respectively),  followed by oral risperidone (71.36 ng/mL). Quetiapine, oral olanzapine and aripiprazole showed the lower PRL levels (28.55, 27.10 and 13.25 ng/mL respectively). Antipsychotics were divided according to the degree of hyperprolactinemia in low(<50 ng/mL), moderate (50-100 ng/mL) and severe (>100 ng/mL) grade. Sexual dysfunction was found in 70% of the sexually active patients treated with paliperidone or risperidone an much less frequent in aripiprazole, olanzapine and quetiapine. CONCLUSIONS: SD must be taken in consideration when electing long-term treatment for patients

Title 5: Sexual dysfunction after treatment with methadone
Authors: Carlos Llanes , Ana I. Álvarez, M. Teresa Pastor, M. Ángeles Garzón, Nerea González, Ángel L. Montejo.
Abstract: Methadone maintenance therapy (MMT) is an effective substitute treatment for opium dependency, and has led to a considerable reduction in drug abuse. However, sexual disorder has remained as one of the main adverse effects of this treatment. It is important to monitor sexual problems among these patients because any sexual dysfunction can lead to treatment cessation and relapse to opium re-use. This study aim to estimate the prevalence and clinical relevance of sexual disorders among a sample of opium users during methadone replacement therapy. Using the PRSexDQ-SALSEX questionnaire patients showed frequent sexual dysfunction including decreased libido, erectile and orgasm problems both in males and females but spontaneous communication was very scarce.

Title 6: Sexual dysfunction in patients with alcohol use disorder and its impact on quality of life: a 6-month prospective and controlled study
Authors: R. Fernández Ovejero, A. Ballesteros, P. Galindo Villardón, B. Buch, José J. Avila, Angel L. Montejo
Abstract: Alcohol Consumption Disorder impacts sexuality and quality of life (QOL) of patients. Longitudinal studies show some improvement in QOL and sexual function with abstinence. This 6-months prospective and controlled study assesses the influence of chronic alcohol abuse on sexuality and QOL previously and after the abstinence period in patients treated at the Alcohol Consumption Disorders Unit of Salamanca (Spain). Method: Sexual function using SALSEX, Kinsey and IIEF-5 questionnaires, severity of dependence and quality of life (EQ-5D) in patients with alcohol dependence were studied and compared with a control group. Patients were evaluated at baseline and after 6 months of abstinence. Results: 53 patients and 33 controls were studied. Sexuality was considered "very important" in both groups. The patients showed greater dissatisfaction and sexual dysfunction, less confidence and greater difficulties with the erection than the controls. Abstinence improved sexual functioning but did not significantly change erectile dysfunction(ED). QOL significantly improved personal care, daily activities and health perception. Conclusions: Patients with ED have worse sexual performance and worse QOL. There was no relationship between sexual affectation and severity of consumption and neither reversibility in ED after abstinence. Nevertheless, an improvement in ejaculation, orgasm, sexual desire and QoL was found at six months. All patients showed normal sex hormone values. Alcohol-dependent patients considered sexuality "very important" as much as controls but patients were less sexually satisfied affecting their QoL. Addressing the sexual functioning in the treatment process of these patients would optimize their holistic care.

Title 7: Sexual satisfaction and mental health in prison inmates
Authors: Rodrigo J. Carcedo, Daniel Perlman, Fernando Pérez, Noelia Fernández-Rouco, and Diego Hervalejo
Abstract: The main goal of this study is to investigate the association between sexual satisfaction and mental health, and the combined effect of two significant moderators previously found: partner status and sexual abstinence. In-person interviews were conducted with 227 participants (48.9% males and 51.1% females). The effect of sexual satisfaction on mental health and the interactions sexual satisfaction*partner status, sexual satisfaction*sexual abstinence, and sexual satisfaction*partner status*sexual abstinence were tested using hierarchical linear regression after controlling for a set of sociodemographic, penitentiary, and interpersonal variables. Results revealed a direct relationship between sexual satisfaction and mental health only for the sexually abstinent group. These findings point to the importance of sexual satisfaction as a predictor of mental health in sexual situations of extreme disadvantage.

Title 8: Mental health and personal and interpersonal aspects in transgender people
Authors: Noelia Fernández-Rouco, Rodrigo J. Carcedo, Felix López and M. Begoña Orgaz
Abstract: This paper explores the subjective perception of transgender people in regard to certain personal and interpersonal aspects of their lives and their relationship with mental health. One-hundred and twenty transgender people (60 men and 60 women) participated by way of semi-structured interviews. Following quantitative methodology, analysis highlighted that sexual satisfaction and loneliness are the main predictors of mental health (Anxiety and Depression). The results act as a guide in the improvement of institutional and social responses and provide an opportunity to promote mental health.

Title 9: The role of sexual satisfaction in adolescents and young adults’ mental health
Authors: Rodrigo J. Carcedo and Noelia Fernández-Rouco
Abstract: The purpose of this study was to assess the role of sexual satisfaction and subjective well-being in adolescents and young adults, both men and women, and to determine their effect on mental health (anxiety and depression). One thousand and seven hundred and four participants answered to a questionnaire regarding these variables (43,8% men and 56,2% women; 55,8% from secondary school and 44,2% from university). Results showed the important role of sexual satisfaction in adolescents and young adults’ mental health. Subjective well-being intervened as an important aspect in the relationship between these two variables. The importance of further research about sexual satisfaction, subjective well-being, and mental health in adolescents and young adults is discussed in this work.

Title 10: The Link Between Childhood Physical, Emotional And Sexual Abuse And Adult Mental Disorders
Authors: Alvela Fernández, S.; Mateos Agut, M; Osorio Guzmán, A.; Abadín Vázquez, M.; Blasco Garrido, A.; Sanz Cid, B.; Martín Martínez, E. ; De La Gándara Martín, J.J.
Abstract: Traumatic childhood experiences are frequently described in patients suffering from mental disorders. The aim of this research study is to analyse the link between childhood trauma and mental illness. For that purpose, 128 psychiatric patients and 128 healthy controls were assessed with the Early Trauma Inventory, Spanish version, which assesses general traumatic events, emotional, physical and sexual abuse. When comparing the results between the two groups, significant differences were found in every category (Sig<0.004 for Sexual Abuse, Sig<0.002 for Physical Punishment, Sig<0.000 for General Trauma and Emotional Abuse). In respect of gender, women reported more traumatic events than men (Sig < 0.004). Significant correlations between certain diagnoses and certain kinds of abuse were also found, being the link between sexual abuse and cluster B personality disorders (p<0.02). Physical punishment, emotional abuse and the loss of a family member were found to be more related to affective, neurotic and psychotic disorders whereas sexual abuse was found to be more related to personality disorders. These results suggest that assessing and approaching traumatic experiences in usual clinical practise.

Title 11: Hormonal contraceptives and female sexual function: a systematic review
Authors: Nerea M. Casado-Espada; Rubén de Alarcón; Javier Ignacio de la Iglesia-Larrad; Berta Bote; Ángel Luis Montejo
Abstract: In recent decades, hormonal contraception (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied, however, the influence of these drugs on female sexual function is not so clear, although variations in plasma levels in the medium-long term of sex hormones could be associated with sexual dysfunction, like the one described in hormonal alterations such as those that take place during menopause or some endocrine pathologies. In this review we attempt to provide a summary of the existing data about the impact of Hormonal Contraceptives on sexuality, focusing on areas such as route of administration, hormonal composition and options for treatment.

Title 12: Frequency of Sexual Dysfunction in patients treated with desvenlafaxine. A prospective 6-month switching strategy
Authors: Montejo, Angel L; Acosta, José M.; Becker, Joemir;  Bote, Berta; Buch, Bárbara;  Bueno, Gloria; Fernández, Raquel; Gallego, María T; González, Nerea; Juanes, Adrián; Pérez-Urdániz, Antonio; Prieto, Nieves; Villegas, José L; Armada Beatriz
Abstract: Sexual dysfunction (SD) caused by serotonergic antidepressants (SAD) is one of its most frequent and lasting adverse effects although clinically underestimated. Desvenlafaxine (DVLX) is an antidepressant with noradrenergic and serotonergic action that could cause lower SD than other serotonergic antidepressants although there are still few studies on this subject…

Title 13: Personality characteristics, psychopathology and copying strategies in women sexual interest and arousal disorder
Authors: Domínguez-Cagnon, H. y Farré, J.M.
Abstract: Sexual interest and arousal disorder (SIAD) are the most common female sexual dysfunction. It happens in women of all the ages and has a strong negative impact in their well-being, relationships and quality of life. Given it´s high resistance to treatment, in order to optimize the different therapeutic options a more comprehensive approach to the multiple psychological factors that contribute to its appearance and maintenance is needed. In this descriptive- comparative study, a sample of 10 women with SIED was compared to a control sample group of healthy women using semi-structured interviews and standardized questionnaires. Statistical analysis was performed using SPSS 17.0 software. Results showed significant differences in psychopathological symptoms, personality dimensions and copying strategies.

J. Clin. Med. EISSN 2077-0383 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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