Journal of Clinical Medicine

Editorial

Jump to: Research, Review

4 pages, 197 KiB

Open AccessEditorial

New Challenges in Sexuality and Sexual Dysfunction

by Angel L. Montejo

J. Clin. Med. 2023, 12(1), 203; https://doi.org/10.3390/jcm12010203 - 27 Dec 2022

Cited by 3 | Viewed by 2365

Abstract

Human sexuality constitutes not only a basic need but also a right that significantly enriches interpersonal relationships, providing mutual satisfaction and pleasure [...] Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

Research

Jump to: Editorial, Review

13 pages, 321 KiB

Open AccessArticle

The Associations of Mental Health Disturbances, Self-Esteem, and Partner Violence Victimization with Condom Use in Spanish Adolescents

by Miriam Sánchez-SanSegundo, Raquel Alarcó-Rosales, Ana Zaragoza-Martí, José A. Quesada-Rico, Eva Gabaldón-Bravo and José A. Hurtado-Sánchez

J. Clin. Med. 2022, 11(9), 2467; https://doi.org/10.3390/jcm11092467 - 27 Apr 2022

Cited by 6 | Viewed by 2907

Abstract

Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization [...] Read more.

Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization are also at increased risk of engaging in sexual risk behaviors. In this study, we examined the associations between mental health disturbances and partner violence victimization and the non-use of condoms among young people in Spain. We also examined self-esteem as a mediator of mental health problems and unprotected sexual relationships. A cross-sectional study was conducted on a sample of 831 adolescents randomly selected from 25 high schools in Spain. From the initial sample, 285 students (144 men and 141 women) from high schools in Alicante (Spain) who reported having experienced sexual activity with at least one partner were approached. The results showed that one in three adolescents between 14 and 19 years old did not use condoms during sexual intercourse. The factors associated with the non-use of condoms in the estimated models of Poisson robust variance were having a history of physical, psychological, or sexual violence; having been expelled from school because of behavioral problems; and having higher levels of depression, anxiety, and stress and lower levels of self-esteem. Self-esteem was independently associated with the non-use of condoms. Having lower levels of self-esteem increased the risk of not using a condom during participants’ last sexual intercourse. These findings suggest the importance of developing public health strategies for mental health promotion to increase condom use among adolescents. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

11 pages, 274 KiB

Open AccessArticle

Sexual Habits and Sexual Dysfunctions in a Sample of Patients with Psychotic Disorders Compared to a Group of Healthy Adults

by Benedetta Barchielli, Tommaso Accinni, Stefano Ferracuti, Luca Carlone, Federica Petrini, Massimo Biondi and Massimo Pasquini

J. Clin. Med. 2022, 11(3), 505; https://doi.org/10.3390/jcm11030505 - 19 Jan 2022

Cited by 2 | Viewed by 2528

Abstract

Background: There is a growing body of literature on the association between psychosis and sexual dysfunction. However, most studies have focused on sexual dysfunction and have not investigated the sexual lives of patients with psychosis across a broader range. Material and Methods: Consecutive [...] Read more.

Background: There is a growing body of literature on the association between psychosis and sexual dysfunction. However, most studies have focused on sexual dysfunction and have not investigated the sexual lives of patients with psychosis across a broader range. Material and Methods: Consecutive patients with a diagnosis of acute psychosis or schizophrenia were recruited to the study after obtaining informed consent (n = 46). In addition, healthy control subjects were recruited (n = 52). Sociodemographic and clinical data, psychopathology, and sexual functioning were assessed. Independent sample t-test to determine group differences was obtained. Results: In both the male and female groups, there are significant differences between psychotic individuals and healthy controls in several areas of their sexual functioning: the control group seemed to better perceive Couple sexuality, Self-eroticism, and overall appeared to have a higher Quality of sexual life; on the other hand, the group of patients with psychosis displayed higher scores in Sexual dysfunction. Conclusions: A poor sexual quality of life may be found in patients with psychotic disorders. Assessment of sexual function in these patients is necessary to identify and manage issues and provide support and help to patients in this important area of life. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

15 pages, 477 KiB

Open AccessArticle

Women and Men’s Perspectives on the Factors Related to Women’s Dyadic Sexual Desire, and on the Treatment of Hypoactive Sexual Desire Disorder

by Enav Friedmann and Julie Cwikel

J. Clin. Med. 2021, 10(22), 5321; https://doi.org/10.3390/jcm10225321 - 15 Nov 2021

Cited by 5 | Viewed by 3008

Abstract

Sexuality is a basic human need, which is expressed in the context of intimate personal relations. However, in studies of women’s sexuality, men’s attitudes are often overlooked. Health care providers can benefit from the examination of how both women and men perceive women’s [...] Read more.

Sexuality is a basic human need, which is expressed in the context of intimate personal relations. However, in studies of women’s sexuality, men’s attitudes are often overlooked. Health care providers can benefit from the examination of how both women and men perceive women’s sexual desire and what are the most acceptable avenues for treatment for women’s hypoactive sexual desire disorder (HSDD). This research aimed to explore differences between women and men on the factors affecting women’s sexual desire and the appropriate avenues for treatment. Data were collected using an online questionnaire from 233 heterosexual adults who had a dyadic, steady intimate relationship over most of the previous year. A theory-based questionnaire of 28 items was developed to explore the factors associated with women’s sexual desire. One quarter (7/28) of the items affecting women’s sexual desire were ranked significantly differently between women and men. Among women, interpersonal issues and physical attraction, and among men, physical attraction and daily hassles were the significant predictors of women’s sexual desire. Women more than men endorsed psychological help such as a sex therapist or psychologist as a more appropriate treatment for HSDD, while both men and women viewed the internet as a reasonable way to gain treatment information. Both women and men viewed gynecologists as a more acceptable source of treatment than a family doctor. Religious authorities were the least likely source of treatment advice for both women and men. The results support a multi-dimensional model of women’s sexual desire and suggest that psychological interventions to treat HSDD may be preferred by women more than men. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

14 pages, 568 KiB

Open AccessArticle

Frequency of Iatrogenic Sexual Dysfunction Associated with Antihypertensive Compounds

by Bárbara Buch-Vicente, José Mª. Acosta, José-Angel Martín-Oterino, Nieves Prieto, María Elena Sánchez-Sánchez, Purificación Galindo-Villardón and Angel L. Montejo

J. Clin. Med. 2021, 10(22), 5214; https://doi.org/10.3390/jcm10225214 - 9 Nov 2021

Cited by 7 | Viewed by 3999

Abstract

Iatrogenic sexual dysfunction (SD) caused by antihypertensive (AH) compounds, provoking sexual desire, orgasm or arousal dysfunction, is a common clinical adverse event. Unfortunately, it is often underestimated and underreported by clinicians and prescribers in clinical practice, deteriorating the adherence and patient quality of [...] Read more.

Iatrogenic sexual dysfunction (SD) caused by antihypertensive (AH) compounds, provoking sexual desire, orgasm or arousal dysfunction, is a common clinical adverse event. Unfortunately, it is often underestimated and underreported by clinicians and prescribers in clinical practice, deteriorating the adherence and patient quality of life. The objective of this study was to investigate the frequency of SD in patients treated with different antihypertensive compounds; a real-life naturalistic and cross-sectional study in patients receiving AH treatment was carried out. Method: A total of 256 patients were included in the study (188 males and 68 females who met the inclusion and exclusion criteria). The validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) was transversally applied once at least every two months following the onset of the treatment in order to measure possible AH-related SD. Although the spontaneous reporting of SD was very low (6.81% females/24.8% males), 66.40% of the patients reported impaired sexual function through the SALSEX questionnaire after the treatment onset, as follows: decreased desire (55.8% females/54.2% males), delayed orgasm (42.6%/45.7%), anorgasmia (42.6%/43.6%) and arousal difficulties (53%/59.6%). The average frequency of moderate to severe iatrogenic SD was 66.4% with AH in monotherapy as follows: angiotensin II receptor antagonists (ARBs), 29.8%; calcium antagonists, 40%; diuretics, 42.9%; beta blockers, 43.8%; and angiotensin-converting enzyme (ACE) inhibitors, 77.8%. Combined treatments showed a higher percentage of main SD (70.3%): diuretic + ACE inhibitor, 42.3%; ARB + calcium antagonist, 55.6%; diuretic + calcium antagonist, 68.8%; and diuretic + ARB, 74.2%. The greatest risk factors associated with SD were poor general health, age over 60 with a comorbid coronary or musculoskeletal disease, mood disorder and diuretic +ARB combined therapy. Conclusion: SD is common in patients treated with antihypertensive drugs, and it is still underreported. The most harmful treatment deteriorating sexual function was the combination of diuretic +ARB, while the least harmful was monotherapy with ARBs. More research is needed on the clinical management of this problem to preserve the quality of life of patients and their partners. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

13 pages, 450 KiB

Open AccessArticle

Correlates of Sexual Function in a Sample of Spanish Women with Endometriosis

by Ernesto González-Mesa, Davinia Moya-Bejarano, Carmen Aisha Butrón-Hinojo, Pilar Marín-Sánchez, Marta Blasco-Alonso, Jesús Salvador Jimenez-López, Emilia Villegas-Muñoz and Daniel María Lubián-López

J. Clin. Med. 2021, 10(21), 4957; https://doi.org/10.3390/jcm10214957 - 26 Oct 2021

Cited by 4 | Viewed by 2769

Abstract

Background: In the present study, we aim to report on the sexual function of women experiencing symptoms of endometriosis, analysing the clinical and psychosocial factors that may be associated. Methods: A multicentre cross-sectional study was performed to analyse the sexual function in a [...] Read more.

Background: In the present study, we aim to report on the sexual function of women experiencing symptoms of endometriosis, analysing the clinical and psychosocial factors that may be associated. Methods: A multicentre cross-sectional study was performed to analyse the sexual function in a sample of 196 Spanish women with endometriosis, using the Female Sexual Function Inventory. Results: The Female Sexual Function Inventory (FSFI) was validated in our endometriosis study group. The mean FSFI score for the sample was 22.5 (SD 6.6), with 20.9 and 26.9 being in the 25th and 75th percentiles, respectively. Although physical sexual pain and dyspareunia were factors that influenced the sexual function of women with endometriosis, our results show that the impairment was multifactorial. Conclusions: We found impaired sexual function in women diagnosed with endometriosis. The final model included deep endometriosis, depression, age, and unemployment as strongest predictive factors for poor (deteriorated) sexual function. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

19 pages, 354 KiB

Open AccessArticle

Sexuality, Quality of Life, Anxiety, Depression, and Anger in Patients with Anal Fissure. A Case–Control Study

by Antonio Navarro-Sánchez, Paloma Luri-Prieto, Antonio Compañ-Rosique, Ramón Navarro-Ortiz, María Berenguer-Soler, Vicente F. Gil-Guillén, Ernesto Cortés-Castell, Felipe Navarro-Cremades, Luis Gómez-Pérez, Carla Pérez-Tomás, Antonio Palazón-Bru, Angel L. Montejo and Virtudes Pérez-Jover

J. Clin. Med. 2021, 10(19), 4401; https://doi.org/10.3390/jcm10194401 - 26 Sep 2021

Cited by 12 | Viewed by 5928

Abstract

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) [...] Read more.

Anal fissures (AFs) are lesions located in the lower anal canal. They can be primary (chronic or acute) or secondary to a basic disease. There is high comorbidity of depression and anxiety in patients with chronic AF, with poorer quality of life (QoL) and sexual function. This is a case–control study carried out in the San Juan Hospital (Alicante, Spain). Sixty-seven participants were included in the study, including 35 cases and 32 controls: 36 males and 31 females. This study aims to investigate the association of presenting AFs with sexuality, quality of life, anxiety, depression, and anger. The instruments used were the Spanish validated versions of the validated original selected questionnaires. These instruments were used to assess health-related quality of life, anxiety, anger, depression, and sexual function. Results show higher values in cases than in controls with statistical significance in anxiety state and trait; anxiety and depression; bodily pain, general health, and vitality; and 10 of the 12 anger factors. Higher values in controls than in cases with statistical significance in sexuality and many of the QoL factors were found. Addressing these issues in AF surgical patients would be beneficial for their clinical assessment and intervention. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

9 pages, 1337 KiB

Open AccessArticle

Female Sexual Dysfunction in Primary Adrenal Insufficiency

by Virginia Zamponi, Pina Lardo, Roberta Maggio, Chiara Simonini, Rossella Mazzilli, Antongiulio Faggiano, Giuseppe Pugliese and Antonio Stigliano

J. Clin. Med. 2021, 10(13), 2767; https://doi.org/10.3390/jcm10132767 - 24 Jun 2021

Cited by 6 | Viewed by 2674

Abstract

Purpose. No data are currently available on female sexual dysfunction (FSD) in primary adrenal insufficiency (PAI) and the possible impact of replacement therapy. The aim of this study was to evaluate the prevalence of FSD and sexual distress (SD), and to evaluate the [...] Read more.

Purpose. No data are currently available on female sexual dysfunction (FSD) in primary adrenal insufficiency (PAI) and the possible impact of replacement therapy. The aim of this study was to evaluate the prevalence of FSD and sexual distress (SD), and to evaluate the possible impact of replacement therapy on sexuality in women with PAI. Methods. Female Sexual Function Index-6 (FSFI-6) and Sexual Distress Scale (SDS) questionnaires were administered to 22 women with PAI and 23 healthy women matched for age as controls. Results. The prevalence of sexual symptoms measured by FSFI-6 (total score < 19) was significantly higher in women with PAI (15/22; 68.2%) compared to the controls (2/23; 8.7%; p = 0.001). Regarding the questionnaire items, significantly different scores were found for desire (p < 0.001), arousal (p = 0.0006), lubrication (p = 0.046) and overall sexual satisfaction (p < 0.0001) in women with PAI compared to the controls. The rate of FSD (FSFI < 19 with SDS >15) was 60% in patients with PAI. A significant inverse correlation was found between FSFI-6 total scores and SD (r = −0.65; p = 0.0011), while a significant direct correlation was found between FSFI-6 total scores and serum cortisol levels (r = 0.55; p = 0.035). Conclusions. A higher prevalence of FSD was found in women affected by PAI compared to healthy women. Desire seems to be the most impaired aspect of sexual function. Moreover, sexual dysfunction in this population seems to be related to sexual distress and cortisol levels. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

18 pages, 739 KiB

Open AccessArticle

Validation of the Center of Applied Psychology Female Sexuality Questionnaire (CAPFS-Q)

by Sonia Tirado-González, Antonio Navarro-Sánchez, Antonio Compañ-Rosique, Paloma Luri-Prieto, Jesús Rodríguez-Marín, Carlos J. Van-der Hofstadt-Román, María Berenguer Soler, Felipe Navarro-Cremades, Vicente F. Gil-Guillén, Ramón Navarro Ortiz, Angel L. Montejo and Virtudes Pérez-Jover

J. Clin. Med. 2021, 10(12), 2686; https://doi.org/10.3390/jcm10122686 - 18 Jun 2021

Cited by 5 | Viewed by 2741

Abstract

Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for [...] Read more.

Instruments for the measurement of human sexuality include self-report measures used to assess sexual functioning, but many of them have not yet been validated. The Center of Applied Psychology Female Sexual Questionnaire (CAPFS-Q) is an original self-report instrument. It has been developed for the study of sexuality in specific non-clinical populations, such as female university students of Medicine and other Health Sciences. The CAPFS-Q includes 26 items, organized as follows: sociodemographic and relevant data (four items); aspects of sexual relations with partner (five items); sexual practices (12 from 13 items); and dysfunctional aspects of sexual relations (four items). CAPFS-Q validity and reliability were examined in a sample of Spanish female university students of Health Sciences. Exploratory and confirmatory factor analysis (FA) showed a four-factor structure which explained 71.6% of the variance. This initial version of the CAPFS-Q is a reliable measure of women’s sexual behavior, with a dimensionality that replicates the initial theoretical content and with adequate indicators of internal consistency, validity, and test–retest reliability. It is easy to administer and to complete. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure A1

15 pages, 951 KiB

Open AccessArticle

Reduced Quality of Life and Sexual Satisfaction in Isolated Hypogonadotropic Hypogonadism

by Małgorzata Kałużna, Pola Kompf, Michał Rabijewski, Jerzy Moczko, Jarosław Kałużny, Katarzyna Ziemnicka and Marek Ruchała

J. Clin. Med. 2021, 10(12), 2622; https://doi.org/10.3390/jcm10122622 - 14 Jun 2021

Cited by 11 | Viewed by 4007

Abstract

(1) Background: Isolated hypogonadotropic hypogonadism (IHH) is a genetic condition characterized by impaired puberty and fertility. IHH can significantly impact patient health-related quality of life (HRQoL), sexual satisfaction (SS) and mood. (2) Methods: Participants included 132 IHH subjects (89 men and 43 women) [...] Read more.

(1) Background: Isolated hypogonadotropic hypogonadism (IHH) is a genetic condition characterized by impaired puberty and fertility. IHH can significantly impact patient health-related quality of life (HRQoL), sexual satisfaction (SS) and mood. (2) Methods: Participants included 132 IHH subjects (89 men and 43 women) and 132 sex- and age-matched controls. HRQoL, depressive symptoms, erectile dysfunction (ED), and SS were assessed in an online survey using the Zung Self-Rating Depression Scale (SDS), 15D instrument of HRQoL (15D), Sexual Satisfaction Questionnaire (SSQ), and 5-item International Index of Erectile Function (IIEF-5). (3) Results: QoL and SS were significantly lower in the IHH group vs. controls. There was a high rate of ED (53.2% vs. 33%, p = 0.008) and depressive symptoms (45.00 ± 17.00 vs. 32.00 ± 12.00, p < 0.001) in patients vs. controls. The age of patients at IHH diagnosis inversely correlated with their overall 15D scores. An alarming non-compliance rate was seen (51.6%). No differences were found between scores of patients receiving hormone replacement therapy (HRT) and untreated subjects in any of the scales. (4) Conclusions: The HRQoL, SS, ED, and depression levels observed in IHH patients, despite HRT, are alarming. Late IHH diagnosis may have a particularly negative impact on HRQoL. More attention should be devoted to HRT adherence and various HRQoL aspects of IHH patients. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

16 pages, 1094 KiB

Open AccessArticle

Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men

by Nicolás Ruiz-Robledillo, Rosario Ferrer-Cascales, Irene Portilla-Tamarit, Cristian Alcocer-Bruno, Violeta Clement-Carbonell and Joaquín Portilla

J. Clin. Med. 2021, 10(8), 1662; https://doi.org/10.3390/jcm10081662 - 13 Apr 2021

Cited by 21 | Viewed by 4307

Abstract

Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV [...] Read more.

Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

9 pages, 408 KiB

Open AccessArticle

Differences in Penile Hemodynamic Profiles in Patients with Erectile Dysfunction and Anxiety

by Rossella Cannarella, Aldo E. Calogero, Antonio Aversa, Rosita A. Condorelli and Sandro La Vignera

J. Clin. Med. 2021, 10(3), 402; https://doi.org/10.3390/jcm10030402 - 21 Jan 2021

Cited by 10 | Viewed by 3148

Abstract

Background: Penile echo-color Doppler ultrasound (PCDU) is the gold standard for the diagnosis of arterial erectile dysfunction (ED). Its reliability in patients with anxiety was questioned, due to false-positive results. Aim: To assess the penile hemodynamic response to intracavernous injection (ICI) of alprostadil [...] Read more.

Background: Penile echo-color Doppler ultrasound (PCDU) is the gold standard for the diagnosis of arterial erectile dysfunction (ED). Its reliability in patients with anxiety was questioned, due to false-positive results. Aim: To assess the penile hemodynamic response to intracavernous injection (ICI) of alprostadil in patients with anxiety-related ED. Methods: Patients with non-organic ED and a 5-item International Index of Erectile Function (IIEF-5) score ranging between 5 and 7 were enrolled. They were asked to compile the 7-item Generalized Anxiety Disorder (GAD-7) questionnaire to assess the degree of anxiety and were divided according to the GAD-7 score in Group 1 with minimal level of anxiety (n = 20), Group 2 with mild anxiety (n = 20), Group 3 with moderate anxiety (n = 20), and Group 4 with severe anxiety (n = 20). Peak systolic velocity (PSV) and the end-diastolic velocity (EDV) were sampled in all patients, through PCDU in the flaccid state, and 5, 10, 15, and 20 min after ICI of alprostadil at the standard dose of 10 μg. Results: In penile flaccidity, the patients showed a mean PSV of 8.0 ± 4.0 cm/s. The degree of anxiety was found to significantly influence both PSV and EDV at all assessed time-points. Particularly, it was negatively associated with the PSV at time 5 (r = −0.9, p < 0.01), 10 (r = −0.9, p < 0.01), 15 (r = −0.9, p < 0.01), and 20 (r = −0.7, p < 0.01) minutes, and positively with the EDV at time 5 (r = 0.7, p < 0.01), 10 (r = 0.6, p < 0.01), 15 (r = 0.5, p < 0.01), and 20 (r = 0.3, p < 0.01) minutes. Although all patients showed a mean dynamic PSV > 25 cm/s (which excluded an arterial ED according to the current guidelines), a peculiar hemodynamic pattern was found in patients with severe anxiety. In these patients, normal PSV values were reached only after 20 min from ICI, suggesting a “late-responder” profile. Conclusion: If further studies confirm the existence of a distinct hemodynamic profile in patients with severe anxiety, sampling the PSV and the EDV values could be proposed, for detecting patients with severe anxiety-related ED. Dynamic PCDU could be considered an accurate diagnostic test in patients with non-organic ED, since zero false-positive results were found in the present study. PSV in the flaccid state is not able to discriminate between arterial- or non-organic ED. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

14 pages, 708 KiB

Open AccessArticle

Thyroid Autoimmune Disease—Impact on Sexual Function in Young Women

by Ana-Maria Cristina Bortun, Viviana Ivan, Dan-Bogdan Navolan, Liana Dehelean, Andreea Borlea and Dana Stoian

J. Clin. Med. 2021, 10(2), 369; https://doi.org/10.3390/jcm10020369 - 19 Jan 2021

Cited by 16 | Viewed by 3984

Abstract

The important prevalence of autoimmune thyroid disease (AITD) in the general population was the main motivation for conducting the present study. The present paper aims to estimate the possible comorbidities related to female sexual dysfunction (FSD) and depression related to AITD. The study [...] Read more.

The important prevalence of autoimmune thyroid disease (AITD) in the general population was the main motivation for conducting the present study. The present paper aims to estimate the possible comorbidities related to female sexual dysfunction (FSD) and depression related to AITD. The study group consisted of 320 patients: 250 cases known with untreated AITD, divided into subgroups (euthyroid subgroup, subclinical hypothyroidism subgroup and clinical hypothyroidism subgroup); respectively 70 healthy females in the control group. Patients underwent thyroid evaluation, ovarian evaluation and laboratory assays. At the time of the diagnosis of autoimmune thyroid disease, psychometric scales were filled in by the patients: the Female Sexual Function Index 6 (FSFI-6) and the Beck’s Depression Inventory-II (BDI-II). It was observed that healthy patients had significantly higher FSFI scores than patients with AITD (28 vs. 27; p = 0.006). In the AITD group, the risk of FSD increases with the severity of thyroid disease. The most affected areas were: sexual desire (p < 0.001), lubrication (p = 0.001) and orgasm (p = 0.008), followed by excitability and sexual satisfaction. The severity of hypothyroidism influences the degree of decrease in libido, central and peripheral excitability. Sexual satisfaction and orgasm were less influenced. The field related to pain seems uninfluenced by the presence of thyroid disease. The concomitant presence of depression and the value of thyroid-stimulating hormone (TSH) are risk factors in the development of FSD. Higher TSH value and BDI-II score increase the risk of female sexual dysfunction by 1.083 and 1.295 times, respectively. Our findings are significant and promising; they may help professionals dealing with sexual and reproductive health. Despite the importance of female sexual dysfunction and its prevalence, clinicians and patients often ignore it. In fact, only a small percentage of patients consult their doctors about sexual health, and their doctors do not often ask them questions related to this aspect. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

19 pages, 677 KiB

Open AccessArticle

Pornography Use in Adolescents and Its Clinical Implications

by Josep M. Farré, Angel L. Montejo, Miquel Agulló, Roser Granero, Carlos Chiclana Actis, Alejandro Villena, Eudald Maideu, Marta Sánchez, Fernando Fernández-Aranda, Susana Jiménez-Murcia and Gemma Mestre-Bach

J. Clin. Med. 2020, 9(11), 3625; https://doi.org/10.3390/jcm9113625 - 11 Nov 2020

Cited by 47 | Viewed by 17076

Abstract

(1) Background: The Differential Susceptibility to Media Effects Model (DSMM) suggests that pornography use effects are conditional and they depend on dispositional, developmental, and social differential susceptibility variables. This framework also highlights that the differential susceptibility variables act as predictors of pornography use [...] Read more.

(1) Background: The Differential Susceptibility to Media Effects Model (DSMM) suggests that pornography use effects are conditional and they depend on dispositional, developmental, and social differential susceptibility variables. This framework also highlights that the differential susceptibility variables act as predictors of pornography use and as moderators of the effect of pornography on criterion variables. (2) Methods: By administering a survey to n = 1500 adolescents, we tested whether these assumptions were met. (3) Results: Pornography use was related to being male and older, having a bisexual or undefined sexual orientation, higher substance use, being non-Muslim, and reporting sexual interest and the use of the media to obtain sexual information. Structural Equation Modeling (SEM) showed that higher levels in the criterion variables were directly related to pornography use, older age, substance use, and being women. Some mediational links also emerged. Pornography use mediated between the age and criterion variables. Moreover, substance use mediated the association between age and gender with the criterion variables. (4) Conclusions: Our findings support the clinical applicability of the theoretical DSMM framework. Knowing adolescent pornography consumers’ profiles and the impact of pornography on this population would allow for the designing of more effective prevention and regulation proposals. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

12 pages, 643 KiB

Open AccessArticle

Clinical Features Associated with Female Genital Mutilation/Cutting: A Pilot Longitudinal Study

by Georgios Paslakis, Josep M. Farré, Iris Tolosa-Sola, Alba Palazón-Llecha, Helena Domínguez-Cagnon, Maria Jiménez, Berta Martínez Rosselló, Pere Barri-Soldevila and Gemma Mestre-Bach

J. Clin. Med. 2020, 9(8), 2340; https://doi.org/10.3390/jcm9082340 - 22 Jul 2020

Cited by 16 | Viewed by 3514

Abstract

(1) Background: Female genital mutilation/cutting (FGM/C) is associated with physical and psychological complications. However, there is scarce literature on how women with FGM/C respond to treatment interventions. (2) Methods: In the present pilot longitudinal study, we assessed changes in general psychopathology (Symptom Check [...] Read more.

(1) Background: Female genital mutilation/cutting (FGM/C) is associated with physical and psychological complications. However, there is scarce literature on how women with FGM/C respond to treatment interventions. (2) Methods: In the present pilot longitudinal study, we assessed changes in general psychopathology (Symptom Check List-90-R), sexual functioning and distress (Female Sexual Function Index, Female Sexual Distress Scale-Revised, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) female sexual dysfunction criteria), body image (Body Shape Questionnaire), and sexual body image (Female Genital Self-Image Scale) in a sample of n = 15 women with FGM/C before and after reconstructive surgery. (3) Results: Sexual distress was significantly improved following surgery. We also observed an improvement in general psychopathology and genital self-image. However, sexual function was not improved. (4) Conclusions: These results provide evidence for the benefits of reconstructive surgery on sexual distress in women with FGM/C. The impact of surgery on sexual function cannot be conclusively evaluated. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

14 pages, 584 KiB

Open AccessArticle

Creating and Validating the DESEA Questionnaire for Men and Women

by Francisco Cabello-Santamaría, Marina A. Cabello-García, Jerónimo Aragón-Vela and F. Javier del Río

J. Clin. Med. 2020, 9(7), 2301; https://doi.org/10.3390/jcm9072301 - 20 Jul 2020

Cited by 6 | Viewed by 3801

Abstract

In clinical practice, it is essential to be able to identify hypoactive sexual desire disorder (HSDD), with its different severity levels and assess the influence the subject’s relationship has on the issue. In order to do this, questionnaires are needed that comprise appropriate [...] Read more.

In clinical practice, it is essential to be able to identify hypoactive sexual desire disorder (HSDD), with its different severity levels and assess the influence the subject’s relationship has on the issue. In order to do this, questionnaires are needed that comprise appropriate psychometric properties. We analyzed the psychometric properties and factorial structure of the Sexual Desire and Aversion (DESEA) questionnaire that evaluates sexual desire and interpersonal stress (relationship problems) in male and female couples. A pilot study was conducted with a group of 1583 people. Finally, it included 20,424 Spanish speakers who answered the questionnaire via an online link. The requirements for factor analysis were verified followed by the exploratory and confirmatory factor analysis. The Cronbach’s alpha coefficient calculated the reliability of the test scores at 0.834 in the pilot group and 0.889 in the final group. A 3-factor factorial design explains the 62.08% variance. The KMO (Kaiser-Meyer-Olkin) test (p = 0.904), Bartlett’s test of sphericity (126,115.3; p = 0.000010) and the matrix determinant (0.0020770) verified the appropriateness of the factor analysis. The results show that the DESEA questionnaire is a reliable and valid instrument for evaluating desire and interpersonal stress, both in women and men, in clinical and research contexts. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

12 pages, 249 KiB

Open AccessCommunication

Consensus on Recommendations for Safe Sexual Activity during the COVID-19 Coronavirus Pandemic

by Francisco Cabello, Froilán Sánchez, Josep M. Farré and Angel L. Montejo

J. Clin. Med. 2020, 9(7), 2297; https://doi.org/10.3390/jcm9072297 - 20 Jul 2020

Cited by 30 | Viewed by 7677

Abstract

Sexual activity offers numerous advantages for physical and mental health but maintains inherent risks in a pandemic situation, such as the current one caused by SARS-CoV-2. A group of experts from the Spanish Association of Sexuality and Mental Health (AESexSAME) has reached a [...] Read more.

Sexual activity offers numerous advantages for physical and mental health but maintains inherent risks in a pandemic situation, such as the current one caused by SARS-CoV-2. A group of experts from the Spanish Association of Sexuality and Mental Health (AESexSAME) has reached a consensus on recommendations to maintain lower-risk sexual activity, depending on one’s clinical and partner situations, based on the current knowledge of SARS-CoV-2. Different situations are included in the recommendations: a sexual partner passing quarantine without any symptoms, a sexual partner that has not passed quarantine, a sexual partner with some suspicious symptoms of COVID-19, a positive sexual partner with COVID-19, a pregnant sexual partner, a health professional partner in contact with COVID-19 patients, and people without a sexual partner. The main recommendations include returning to engaging in safe sex after quarantine is over (28 days based on the duration one can carry SARS-CoV-2, or 33 days for those who are >60 years old) and all parties are asymptomatic. In all other cases (for those under quarantine, those with some clinical symptoms, health professionals in contact with COVID-19 patients, and during pregnancy), abstaining from coital/oral/anal sex, substituting it with masturbatory or virtual sexual activity to provide maximum protection from the contagion, and increasing the benefits inherent to sexual activity are recommended. For persons without a partner, not initiating sexual activity with a sporadic partner is strongly recommended. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

15 pages, 1451 KiB

Open AccessArticle

Vestibular Anatomic Localization of Pain Sensitivity in Women with Insertional Dyspareunia: A Different Approach to Address the Variability of Painful Intercourse

by Ahinoam Lev-Sagie, Osnat Wertman, Yoav Lavee and Michal Granot

J. Clin. Med. 2020, 9(7), 2023; https://doi.org/10.3390/jcm9072023 - 27 Jun 2020

Cited by 6 | Viewed by 9389

Abstract

The pathophysiology underlying painful intercourse is challenging due to variability in manifestations of vulvar pain hypersensitivity. This study aimed to address whether the anatomic location of vestibular-provoked pain is associated with specific, possible causes for insertional dyspareunia. Women (n = 113) were [...] Read more.

The pathophysiology underlying painful intercourse is challenging due to variability in manifestations of vulvar pain hypersensitivity. This study aimed to address whether the anatomic location of vestibular-provoked pain is associated with specific, possible causes for insertional dyspareunia. Women (n = 113) were assessed for “anterior” and “posterior” provoked vestibular pain based on vestibular tenderness location evoked by a Q-tip test. Pain evoked during vaginal intercourse, pain evoked by deep muscle palpation, and the severity of pelvic floor muscles hypertonicity were assessed. The role of potential confounders (vestibular atrophy, umbilical pain hypersensitivity, hyper-tonus of pelvic floor muscles and presence of a constricting hymenal-ring) was analyzed to define whether distinctive subgroups exist. Q-tip stimulation provoked posterior vestibular tenderness in all participants (6.20 ± 1.9). However, 41 patients also demonstrated anterior vestibular pain hypersensitivity (5.24 ± 1.5). This group (circumferential vestibular tenderness), presented with either vestibular atrophy associated with hormonal contraception use (n = 21), or augmented tactile umbilical-hypersensitivity (n = 20). The posterior-only vestibular tenderness group included either women with a constricting hymenal-ring (n = 37) or with pelvic floor hypertonicity (n = 35). Interestingly, pain evoked during intercourse did not differ between groups. Linear regression analyses revealed augmented coital pain experience, umbilical-hypersensitivity and vestibular atrophy predicted enhanced pain hypersensitivity evoked at the anterior, but not at the posterior vestibule (R = 0.497, p < 0.001). Distinguishing tactile hypersensitivity in anterior and posterior vestibule and recognition of additional nociceptive markers can lead to clinical subgrouping. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research

13 pages, 573 KiB

Open AccessReview

Is Compulsive Sexual Behavior Different in Women Compared to Men?

by Laura I. Kürbitz and Peer Briken

J. Clin. Med. 2021, 10(15), 3205; https://doi.org/10.3390/jcm10153205 - 21 Jul 2021

Cited by 37 | Viewed by 6611

Abstract

The inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the ICD-11 has sparked research interest on this topic in recent years. This review aims to investigate gender differences in Compulsive Sexual Behavior (CBD) and persons with CSBD. While impulsivity and psychiatric comorbidity play [...] Read more.

The inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the ICD-11 has sparked research interest on this topic in recent years. This review aims to investigate gender differences in Compulsive Sexual Behavior (CBD) and persons with CSBD. While impulsivity and psychiatric comorbidity play a role in persons with CSBD regardless of gender, some gender differences can be identified. CSBD is more prevalent in men, with a higher rate of reported sexual behaviors and higher scores on questionnaires measuring CSBD related symptoms. Neuroticism and stress vulnerability seem to play a more important role in the symptomatology of CSBD in women. While it seems plausible that childhood adversities play a role in the development of CSB, the manner with respect to how these adversities affect men and women differently is still to be explored. More clinical studies including the female CSBD population are required to infer clinical implications. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

7 pages, 262 KiB

Open AccessReview

Impact of Mastectomy on Body Image and Sexuality from a LGBTQ Perspective: A Narrative Review

by Magdalena Skórzewska, Andrzej Kurylcio, Karol Rawicz-Pruszyński, Wachirabhorn Chumpia, Buabongkoj Punnanan, Sasiwan Jirapongvanich, Tianxiao Jiang and Jerzy Mielko

J. Clin. Med. 2021, 10(4), 567; https://doi.org/10.3390/jcm10040567 - 3 Feb 2021

Cited by 12 | Viewed by 4441

Abstract

Although mastectomy could lead to a decrease in sexual performance among patients, only a handful of studies focused on the psychological and sexual behavioral aspects after the surgery. Research on post-mastectomy sexuality has focused mainly on female subjects but barely on lesbian, gay, [...] Read more.

Although mastectomy could lead to a decrease in sexual performance among patients, only a handful of studies focused on the psychological and sexual behavioral aspects after the surgery. Research on post-mastectomy sexuality has focused mainly on female subjects but barely on lesbian, gay, bisexual, transgender, queer (LGBTQ), and male patients. This narrative review aimed to explore the importance of sexuality after mastectomy from a LGBTQ perspective. Each sexual minority group has been addressed individually. In general, sexual and gender minority breast cancer (BC) patients undergoing bilateral mastectomy expect a complex treatment plan in terms of physical and emotional outcomes. Bilateral mastectomy or top surgery for masculinization reasons was reported to be the most popular procedure among transmen, which resulted in a significant improvement in the quality of life. Heterosexual and lesbian female patients are willing to undergo mastectomy after repeated lumpectomies or to avoid radiation, despite potential post-operative somatic and quality-of-life complications. Transwomen would seek gender-affirming surgery to improve physical satisfaction and psychological well-being. There is not enough evidence for non-oncological reasons and consequences of mastectomy in gay men and cisgender heterosexual men. Establishing the awareness of the sexuality impact of mastectomy will allow the implementation of tailored perioperative psychological care. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

18 pages, 558 KiB

Open AccessReview

Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

by Angel L. Montejo, Rubén de Alarcón, Nieves Prieto, José Mª Acosta, Bárbara Buch and Laura Montejo

J. Clin. Med. 2021, 10(2), 308; https://doi.org/10.3390/jcm10020308 - 15 Jan 2021

Cited by 27 | Viewed by 13267

Abstract

Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can [...] Read more.

Antipsychotic medication can be often associated with sexual dysfunction (SD). Given its intimate nature, treatment emergent sexual dysfunction (TESD) remains underestimated in clinical practice. However, psychotic patients consider sexual issues as important as first rank psychotic symptoms, and their disenchantment with TESD can lead to important patient distress and treatment drop-out. In this paper, we detail some management strategies for TESD from a clinical perspective, ranging from prevention (carefully choosing an antipsychotic with a low rate of TESD) to possible pharmacological interventions aimed at improving patients’ tolerability when TESD is present. The suggested recommendations include the following: prescribing either aripiprazole or another dopaminergic agonist as a first option antipsychotic or switching to it whenever possible. Whenever this is not possible, adjunctive treatment with aripiprazole seems to also be beneficial for reducing TESD. Some antipsychotics, like olanzapine, quetiapine, or ziprasidone, have less impact on sexual function than others, so they are an optimal second choice. Finally, a variety of useful strategies (such as the addition of sildenafil) are also described where the previous ones cannot be applied, although they may not yield as optimal results. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

17 pages, 624 KiB

Open AccessReview

Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

by Adrián Jesús Ricoy-Cano, Esteban Obrero-Gaitán, Francisco Caravaca-Sánchez and Yolanda María De La Fuente-Robles

J. Clin. Med. 2020, 9(6), 1716; https://doi.org/10.3390/jcm9061716 - 3 Jun 2020

Cited by 37 | Viewed by 12250

Abstract

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present [...] Read more.

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults. Full article

(This article belongs to the Special Issue Sexuality and Sexual Dysfunctions)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Sexuality and Sexual Dysfunctions

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (22 papers)

Editorial

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI