Turkish women's perception of low sexual desire, its causes and consequences: an online qualitative survey.

Background The nature of sexual desire is complex, and little phenomenological consensus exists about its meaning. Low sexual desire (LSD) is a commonly reported sexual difficulty among women, but it is less frequently associated with sexual distress. The aim of this qualitative study is to explore women's understanding of sexual desire, and their perceptions of factors that may contribute to LSD, its effects and their methods of seeking help. Methods The research employed a questionnaire with 12 open-ended questions, developed by the researchers based on sexual script theory. Data were collected from 165 heterosexual Turkish women who reported LSD, recruited through social media platforms between August and October 2021. The data were analysed using a contextual form of thematic analysis to identify and explore patterns. Results The ages of the participants ranged from 20 to 63years. The majority of participants held a Bachelor's degree (81.2%) and in a relationship (78.8%). Three main themes emerged from the study: (1) gendered messages concerning sex, (2) multi-level sexual desire, and (3) minimisation. The research revealed that women's sexual desire is often ignored and repressed, and has negative consequences if not expressed in socially acceptable contexts. The causes of LSD in women go beyond personal factors, and include relational and social influences. Women experiencing LSD report distressing effects on their relationships and general wellbeing, yet they tend not to seek help. Conclusions Our findings contribute to a deeper understanding of the factors impacting women's sexual desire and the barriers to seeking help.

Women and men with distressing low sexual desire exhibit sexually dimorphic brain processing.

Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects approximately 10% of women and 8% of men. In women, the 'top-down' theory of HSDD describes hyperactivity in higher-level cognitive brain regions, suppressing lower-level emotional/sexual brain areas. However, it is unknown how this neurofunctional disturbance compares to HSDD in men. To investigate this, we employed task-based functional MRI in 32 women and 32 men with HSDD to measure sexual-brain processing during sexual versus non-sexual videos, as well as psychometric questionnaires to assess sexual desire/arousal. We demonstrate that women had greater activation in higher-level and lower-level brain regions, compared to men. Indeed, women who had greater hypothalamic activation in response to sexual videos, reported higher psychometric scores in the evaluative (r = 0.55, P = 0.001), motivational (r = 0.56, P = 0.003), and physiological (r = 0.57, P = 0.0006) domains of sexual desire and arousal after watching the sexual videos in the scanner. By contrast, no similar correlations were observed in men. Taken together, this is the first direct comparison of the neural correlates of distressing low sexual desire between women and men. The data supports the 'top-down' theory of HSDD in women, whereas in men HSDD appears to be associated with different neurofunctional processes.

Sexual Desire and Pharmacologic Management.

Female sexual desire is a complex interplay of neurotransmitters and hormones. Diagnosis is based on clinical features and sexual distress. Treatments that affect neurotransmitters and hormones that may be out of balance can help improve sexual desire in women with hypoactive sexual desire disorder.

Mindfulness and Management of Low Desire and Vulvovaginal Pain.

Mindfulness is defined as present-moment, nonjudgmental awareness. By reducing self-criticism, and depression, and increasing self-compassion, attention, and interoceptive awareness, mindfulness has been found across a variety of systematic reviews and meta-analyses to significantly improve sexual desire, sexual pain, and sex-related distress. It helps individuals connect with their bodies, fostering a deeper understanding of sensations and desires while reducing the focus on negative, judgmental, and catastrophic sex-related and pain-related thoughts. By teaching individuals to focus on bare sensations, mindfulness has also been found to significantly reduce vulvovaginal pain intensity with improvements retained a year later.

Correlation of sexual desire with sexual hormone binding globulin and free androgen index in women using combined contraceptives.

PURPOSE: To correlate the sexual desire levels with sexual hormone binding globulin and free androgen index in women taking different types of hormonal contraceptives (HCs) containing ethinylestradiol (EE), oestradiol valerate (E2V), 17ß-oestradiol (E2), or estetrol (E4), combined or in phasic formulation with different progestogens having antiandrogenic properties. METHODS: Three hundred and sixty-seven women (age range 18-46) participated in the study. SHBG and total testosterone (TT) were measured, and the Free Androgen Index (FAI) was calculated. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires were used to assess sexual function and distress, respectively. RESULTS: The highest SHBG values and the lowest FAIs were obtained of women on HCs containing EE than those of women on HCs containing E2V/17ß E2 or E4 (p < 0.001). Desire scores and FSFI total scores were lower in women on HCs with EE than in those using HCs containing E2V, 17ß E2, or E4 (p ≤ 0.001). The women who were on HCs containing EE reported FSDS levels higher than those containing all the other types of oestrogen. Finally, sexual desire and FSFI total scores had a negative correlation with the SHBG values and a positive correlation with FAI percentage (p ≤ 0.0001). CONCLUSIONS: A minority of women using HCs with EE might experience a decreased sexual desire. This was not observed in women on HCs containing E2V, 17 E2, or E4. To avoid HC discontinuation, due to sexual desire reduction, HCs having minor antiandrogenic effects could be taken into consideration.

Ovulatory cycle shifts in human motivational prioritisation of sex and food.

Previous research on the endogenous effects of ovarian hormones on motivational states in women has focused on sexual motivation. The Motivational Priority Shifts Hypothesis has a broader scope. It predicts a shift from somatic to reproductive motivation when fertile. In a highly powered preregistered online diary study across 40 days, we tested whether 390 women report such an ovulatory shift in sexual and eating motivation and behaviour. We compared 209 naturally cycling women to 181 women taking hormonal contraceptives (HC) to rule out non-ovulatory changes across the cycle as confounders. We found robust ovulatory decreases in food intake and increases in general sexual desire, in-pair sexual desire and initiation of dyadic sexual behaviour. Extra-pair sexual desire increased mid-cycle, but the effect did not differ significantly in HC women, questioning an ovulatory effect. Descriptively, solitary sexual desire and behaviour, dyadic sexual behaviour, appetite, and satiety showed expected mid-cycle changes that were diminished in HC women, but these failed to reach our strict preregistered significance level. Our results provide insight into current theoretical debates about ovulatory cycle shifts while calling for future research to determine motivational mechanisms behind ovulatory changes in food intake and considering romantic partners' motivational states to explain the occurrence of dyadic sexual behaviour.

Longitudinal changes in sexual desire and attraction among women who started using the Natural Cycles app.

Many women experience sexual side effects, such as decreased libido, when taking hormonal contraceptives (HCs). However, little is known about the extent to which libido recovers after discontinuing HCs, nor about the timeframe in which recovery is expected to occur. Given that HCs suppress the activities of multiple endogenous hormones that regulate both the ovulatory cycle and women's sexual function, resumption of cycles should predict libido recovery. Here, using a combination of repeated and retrospective measures, we examined changes in sexual desire and partner attraction (among partnered women) across a three-month period in a sample of Natural Cycles users (Survey 1: n = 1596; Survey 2: n = 550) who recently discontinued HCs. We also tested whether changes in these outcomes coincided with resumption of the ovulatory cycle and whether they were associated with additional factors related to HC use (e.g., duration of HC use) or relationship characteristics (e.g., relationship length). Results revealed that both sexual desire and partner attraction, on average, increased across three months after beginning to use Natural Cycles. While the prediction that changes in sexual desire would co-occur with cycle resumption was supported, there was also evidence that libido continued to increase even after cycles resumed. Together, these results offer new insights into relationships between HC discontinuation and women's sexual psychology and lay the groundwork for future research exploring the mechanisms underlying these effects.

Genital arousal and responsive desire among women with and without sexual interest/arousal disorder symptoms.

BACKGROUND: Models depicting sexual desire as responsive to sexual arousal may be particularly apt for women experiencing arousal or desire difficulties, and the degree to which arousal triggers desire may depend on the relationship context and desire target and timing-yet, these associations have not been directly tested among women with and without sexual interest/arousal disorder (SIAD). AIM: To assess the role of SIAD status and relationship satisfaction in the associations between genital arousal and 4 types of responsive desire. METHODS: One hundred women (n = 27 meeting diagnostic criteria for SIAD) in romantic relationships with men viewed a sexual film (pleasurable intimate depiction of oral sex and penile-vaginal intercourse) while their genital arousal was recorded via vaginal photoplethysmography (n = 63) or thermal imaging of the labia (n = 37). Partner and solitary desire was assessed immediately before and after the film (immediate desire) and 3 days later (delayed desire). OUTCOMES: Outcomes consisted of genital response (z scored by method) and associations between genital response and responsive sexual desire. RESULTS: The key difference between women with and without SIAD was not in their ability to experience genital arousal but in how their genital responses translated to responsive sexual desire. Women with SIAD actually exhibited greater genital arousal than unaffected women. Associations between genital arousal and desire were significant only for women with SIAD and depended on relationship satisfaction and desire type. For women with SIAD with low relationship satisfaction, higher arousal predicted lower immediate desire for a partner; for those with high relationship satisfaction, arousal was either positively related (vaginal photoplethysmography) or unrelated (thermal imaging of the labia) to immediate desire for a partner. Associations with other desire types were not significant. CLINICAL IMPLICATIONS: Patterns of genital arousal and partner-specific responsive desire among women affected with SIAD were indicative of an avoidance model in response to heightened genital arousal, unless relationship satisfaction was high; attending to genital arousal sensations could be a means of triggering sexual desire for women with SIAD who are satisfied in their relationships. STRENGTHS AND LIMITATIONS: This is one of the first sexual psychophysiologic studies to connect relationship factors to patterns of sexual response. The differing arousal assessment procedures and lack of official diagnosis may have attenuated results. The homogeneous sample and in-person session requirement limit generalizability. CONCLUSION: When compared with unaffected women, women affected by SIAD may exhibit stronger arousal responses with sufficiently incentivized sexual stimuli, and the connection between their genital arousal and responsive desire for their partners may be stronger and more dependent on relationship context.

Characteristics of systemic testosterone therapy for female hypoactive sexual desire disorder-a claims database analysis.

BACKGROUND: Testosterone therapy (TTh) is recommended for postmenopausal women with hypoactive sexual desire disorder (HSDD); however, there remain insufficient data to support use of TTh in premenopausal women with sexual dysfunction. AIM: In this study, we used a large national database to evaluate prescribing trends of TTh for women with HSDD. METHODS: We conducted a cohort analysis of information from electronic health records acquired from the data network TriNetX Diamond. The study cohort consisted of women 18-70 years of age with a diagnosis of HSDD. We analyzed trends of testosterone prescriptions, routes of testosterone administration, and coadministration of testosterone with estrogen. OUTCOMES: Despite an increase in rates of testosterone prescriptions for HSDD, there remains a high degree of variability in the duration of treatment, route of administration, and coadministration of estrogen with significant underprescription of testosterone. RESULTS: Our query of the TriNetX database led to the identification of 33 418 women diagnosed with HSDD at a mean age of 44.2 ± 10.8 years, among whom 850 (2.54%) women received a testosterone prescription. The testosterone prescriptions were highly variable with regard to duration and route of administration and coadministration with estrogen. For all patients until 2015, the prevalence of testosterone prescriptions for HSDD showed a positive quadratic relation was observed. Since 2015 a linear increase in prevalence was observed, with the highest rate of increase for patients aged 41-55 years. CLINICAL IMPLICATIONS: The findings of this study reveal a significant need for further research investigating the optimal use of TTh to enhance the sexual health of women with HSDD, and further studies on the long-term effects of testosterone use must be undertaken to ensure that patients have access to safe and effective treatment. STRENGTHS AND LIMITATIONS: Limitations to this study include patient de-identification and lack of availability of testosterone dosage data. However, this study also has many strengths, including being the first, to our knowledge, to characterize the prescribing trends of testosterone for women with HSDD. CONCLUSION: Testosterone therapy should be considered as a potential therapy for premenopausal female patients with HSDD. Further studies on the long-term effects of testosterone use must be undertaken to address disparities in the management of HSDD and to ensure patients can access treatment.

Management of hypoactive sexual desire dysfunction at a specialized service in women's sexual health.

Hypoactive sexual desire dysfunction (HSDD) is prevalent among women. This retrospective cohort study aimed to verify the results of the strategies used by Gynecologists and Obstetricians (Ob-gyn) residents in the management of female HSDD. For this, we conducted a data collection of patient medical records of women with HSDD from the Human Sexuality Studies outpatient clinic of the Human Reproduction Center, Department of Gynecology and Obstetrics of FMRP-USP, from 2005 to 2019. Among the 437 women included, 361 (82.6%) answered the question concerning the effect of the protocol to which they were submitted, whereas 234 (64.8%) reported improvements in sexual desire. The univariate model showed that patients without chronic pelvic pain were 19.0% less likely to report improvements in HSDD than those with chronic pelvic pain (p = 0.03). Patients without depression and without orgasmic dysfunction were, respectively 32% and 23% more likely to show improvements in their HSDD than those who had depression or orgasmic dysfunction (respectively p = 0.001, p = 0.008). However, the multivariate model did not identify any associations. The assistance regarding HSDD by the Ob-gyn resident in training to deal with female sexual complaints may be effective in improving sexual complaints.

Age-related changes in testicular histological structure, testosterone level, libido and semen traits in male Coturnix quail.

To investigate the effect of age in male quail on testicular weight and histology, sexual libido and semen characteristics, a study was performed on 100 quails at 10, 16, 22, 28 and 34 weeks of age. The body and testicular weights were significantly (p < .05) higher at 16 and 22 than at 28 weeks of age. The circumference and diameter of the seminiferous tubules were significantly (p < .05) higher at 28 and 34 than at 10 and 16 weeks of age. Histological evaluation of testicular slices revealed advanced and effective seminiferous tubes as early as 10 weeks, while spermatogenic activity peaked at 16 weeks of age. The highest semen volume, sperm motility and sperm concentration were observed at weeks of age and then decreased gradually with age. At the same time, the testosterone level and libido were significantly (p < .05) higher at 22 than at 10 weeks of age. Furthermore, the age was positive (p < .05), correlated to seminiferous tubule circumference and diameter, and negative (p < .05), correlated to sperm concentration. In conclusion, the age of quail markedly affected the testicular histological structure, libido, testosterone level and semen characteristics.

Rights or Obligations: The Extent to Which Sexual Desire and Gender Roles Determine Sexual Intimacy in Romantic Relationships.

The present study aims to investigate the relationship between traditional gender roles and the frequency of sexual intimacy within romantic relationships, considering sexual desire and societal norms and expectations. The study was conducted among a convenience sample of men and women in Israel. The survey included measures of sociodemographic information, traditional gender roles, sexual desire, perceived partner's sexual desire, and frequency of engaging in sex. Findings suggest that men who embraced less traditional gender roles exhibit a greater synchronization between their own sexual desire and their perceived partner's sexual desire, whereas women who embraced more traditional gender roles tend to rely more on their partners' sexual desire in their frequency of sex. These results imply that men's sexual desire plays a significant role in determining the frequency of sexual activity in romantic relationships, especially in relationships where traditional gender roles are more strongly embraced. Findings from the current study underscore the idea that the decision to engage in intimate acts may not solely hinge on individual sexual desire; rather, it operates within a broader context influenced by societal and cultural expectations. It is important to challenge societal norms to promote more balanced and equitable sexual dynamics in committed relationships.

Auditory Cues Alter the Magnitude and Valence of Subjective Sexual Arousal and Desire Induced by an Erotic Video.

Although women and men rate their subjective arousal similarly in response to "female-centric" erotic videos, women rate their subjective arousal lower than men in response to "male-centric" videos, which often end with the male's ejaculation. This study asked whether ratings of subjective sexual arousal and desire using the Sexual Arousal and Desire Inventory (SADI) would be altered if this ending was present or absent, and whether including or excluding the accompanying soundtrack would influence the magnitude and direction of the responses. A total of 119 cis-gendered heterosexual undergraduates (59 women and 60 men) viewed an 11-min sexually explicit heterosexual video that ended with a 15-s ejaculation scene. Two versions of the video were created, one with the ejaculatory ending (E+) and one without (E-). Participants were assigned randomly to view one of the two versions with (S+) or without (S-) the accompanying soundtrack, after which they completed the state version of the SADI. Women and men found both sequences without sound less arousing on the Evaluative, Motivational, and Physiological subscales of the SADI relative to the S+ sequences. However, on the Negative/Aversive subscale, women found the E + S- sequence more negative than did men, whereas this difference was not found with sound. Thus, women and men were sensitive to the auditory content of sexually explicit videos, and scenes of sexual intercourse ending with explicit ejaculation increased the Evaluative and Motivational properties of subjective sexual arousal and desire. However, this occurred in women only when the auditory cues signaled a clear and gratifying sexual interaction.

Testosterone replacement therapy: clinical considerations.

INTRODUCTION: As an increasingly popular therapeutic option, testosterone replacement therapy (TRT) has gained significant notoriety for its health benefits in indicated populations, such as those suffering from hypogonadism. AREAS COVERED: Benefits such as improved libido, muscle mass, cognition, and quality of life have led to widened public interest in testosterone as a health supplement. No therapy exists without side effects; testosterone replacement therapy has been associated with side effects such as an increased risk of polycythemia, benign prostate hypertrophy (BPH), prostate cancer, gynecomastia, testicular atrophy, and infertility. Testosterone replacement therapy is often accompanied by several prophylactic co-therapies aimed at reducing the prevalence of these side effects. Literature searches for sections on the clinical benefits and risks associated with TRT were performed to include clinical trials, meta-analyses, and systematic reviews from the last 10 years. EXPERT OPINION: Data from clinical studies over the last decade suggest that the benefits of this therapy outweigh the risks and result in overall increased quality of life and remission of symptoms related to hypogonadism. With this in mind, the authors of this review suggest that carefully designed clinical trials are warranted for the investigation of TRT in symptomatic age-related hypogonadism.

Sexual counseling for female sexual interest/arousal disorders: a randomized controlled trial based on the "good enough sex" model.

BACKGROUND: Female sexual interest/arousal disorder (FSIAD) is the most common female sexual disorder with adverse effects on women's health and interpersonal relationships. AIM: This survey evaluated the effects of sexual counseling based on the "good enough sex" (GES) model on the sexual health variables of women with FSIAD. METHODS: A randomized clinical trial with a 1:1 allocation ratio was conducted among 80 women with FSIAD in Iran in 2021. Eligible participants were randomly assigned to group A (women) and group B (couples). Women attended 4 weekly online group sexual counseling sessions based on the GES model, each lasting 120 minutes. In group B, husbands participated in sessions 2 and 3. OUTCOMES: Women's sexual health parameters-including sexual desire, sexual satisfaction, sexual function, sexual distress, sexual communication, frequency of sexual intercourse, and dysfunctional beliefs-were evaluated before and 3 months after counseling. The significance threshold considered P < .007 due to Bonferroni correction. RESULTS: After the intervention, all sexual parameters except sexual dysfunctional beliefs showed significant improvement (P < .001) in both groups. During the follow-up period, the average scores for all sexual variables were slightly higher in group B vs group A. The between-group difference was significant only for frequency of sexual intercourse (P < .01). CLINICAL IMPLICATIONS: This study reaffirms the impact of the GES model as biopsychosocial therapy in managing female sexual problems. Considering men's reluctance to accompany their wives to sex clinics, counseling for women alone can play a significant role in solving sexual problems, especially in the case of FSIAD. Online sexual consultation offers cost and time savings, provides a secure space for discussing sensitive topics, and facilitates group program coordination. It ensures universal access to counseling, thereby addressing gender incompatibility issues. It is a powerful, interactive, and acceptable alternative to in-person visits, providing convenience and confidentiality for clients seeking sexual health support. STRENGTHS AND LIMITATIONS: The following were among the survey strengths: conducting a randomized controlled trial on women with FSIAD by applying an appropriate model and scales, involving spouses, and evaluating online group sexual counseling. However, the results of this study may not be generalizable to women without partners. CONCLUSION: The GES model, emphasizing intimacy and sexual dialogue, reduces unrealistic sexual expectations and improves women's sexual desire and overall health. Our results showed that instead of insisting on the physical presence of husbands in counseling sessions, clinicians should emphasize their emotional support and companionship during the treatment process.

Deepening Sexual Desire and Erotic Fantasies Research in the ACE Spectrum: Comparing the Experiences of Asexual, Demisexual, Gray-Asexual, and Questioning People.

Over the past 30 years, an increasing number of people have identified within the asexual (ACE) spectrum recognizing an absence/low/situational sexual attraction to individuals of any gender. The current study aims to deepen the knowledge of sexual desire, erotic fantasies, and related emotions within the ACE spectrum. A total of 1072 Italian volunteers were recruited to take part to the present study via social media. Data were collected from October 2021 to January 2022 using the Sexual Desire and Erotic Fantasies questionnaire and the Sexual Desire Inventory-2. Participants were divided into four groups: asexual, demisexual, gray-asexual, and questioning. Focusing on sexual desire, asexual people reported significantly lower scores than the other groups in all the dimensions except for "negative feelings to sexual desire," while demisexual participants showed the higher scores in all the domains except for "negative feelings to sexual desire." The questioning group reported the highest scores in the "negative feelings toward sexual desire" compared to the asexual and demisexual ones. The asexual group reported significantly lower scores than the other groups in fantasies frequency, fantasies importance, negative emotions, and sharing and experiencing. The demisexual group showed higher frequency of romantic fantasies than the asexual and gray-asexual ones. The results showed some specific patterns of desire and fantasies among the asexual, gray-asexual, demisexual, and questioning groups. These data may provide relevant material to clinicians working with asexual patients who need greater awareness about the diversity and heterogeneity of the sexual experience within the ACE spectrum.

Rose Colored Glasses: An Exploration of the Relationship between Sexual Nostalgia and Sexual Satisfaction.

Sexual satisfaction contributes significantly to one's quality of life and offers a variety of mental and physical health benefits. Consequently, numerous studies have examined ways to improve sexual satisfaction. However, no research has investigated how sexual nostalgia (i.e., "the sentimental longing for or wistful reflection on past sexual memories," p. 1539) with one's current partner impacts sexual satisfaction. Thus, this program of research was designed to develop the Sexual Nostalgia Inventory, assess the relationship between sexual nostalgia and sexual satisfaction, and to examine the moderating role of romantic attachment. The results of Study One (N = 227) indicated that the content of sexual memories can be conceptualized into one factor. The results from Study Two (N = 619) revealed that sexual nostalgia was positively related to sexual satisfaction and that romantic attachment moderated these relationships. In particular, the positive association between sexual nostalgia and satisfaction was greatest for those insecurely attached (i.e., those high in anxious and avoidant attachment). These findings have important implications for researchers looking to establish the causal link between nostalgia and satisfaction and clinicians working with couples experiencing low sexual desire and/or unmet sexual needs.

The Role of Dyadic Sexual Desire Similarity in Predicting Sexual Behaviors in Cohabitating Couples: An Ecological Momentary Assessment Study.

Although researchers are increasingly paying attention to the dyadic nature of sexual desire and its relevance to sexual and relational outcomes, our understanding of how sexual desire operates on a couple level and how it may influence the occurrence of sexual activity in relationships remains limited. This study used ecological momentary assessments to explore to what extent similarity in levels of desire for sex with one's sexual partner, or dyadic sexual desire, was associated with sexual initiations, receptivity to one's partner's initiations, and partnered sexual activity, and how these associations were moderated by perceived partner support. Ninety-four cohabitating couples (M age = 26.30, SD = 7.60) provided six reports a day for 10 consecutive days. We used response surface analysis to examine the associations among both the degree and direction of (dis)similarity in partners' dyadic desire and each of the three outcome variables. Our results revealed that although partners tended to experience similar levels of desire on a moment-to-moment basis, similarity in desire levels was not associated with the three outcome variables. Rather, higher desire within couples predicted each partner's behavioral outcomes. At lower levels of perceived partner support, dyadic sexual desire was negatively associated with women's receptivity to sexual initiations by their partners, indicating high context-sensitivity of women's sexual responding. These findings offer new insights into the links between the similarity in partners' levels of dyadic desire and sexual behaviors in couples, suggesting the need for increased focus on maintaining desire and promoting perceived partner support in clinical practice.

Sexual Compliance in Finnish Committed Relationships: Sexual Self-Control, Relationship Power, and Experienced Consequences.

We studied sexual compliance (i.e., consensual engagement in partnered sexual activity despite lack of sexual desire) in committed relationships using a large Finnish sample. First, we tested if previous theories on sexual self-control and partner sexual relationship power could be extended to a Finnish setting. As little is known about the personal and relational consequences of compliance, we also explored the experienced consequences and their association with the aforementioned aspects. The convenience survey sample (n = 1,496) included individuals who were or had recently been in committed intimate relationships. As 93% of the participants were women, our analyses focused on these (64.3% heterosexual, 24.5% bisexual, 11.3% other). Sixty-five percent of women reported having complied at least once in their current or most recent relationship. Women with lower sexual self-control and higher partner sexual relationship power reported more compliance, corroborating previous research. Lower age was uniquely associated with more compliance, whereas the association between more compliance and lower education diminished when including sexual self-control and partner sexual relationship power in the regression model. Experienced consequences of compliance varied greatly among women. However, roughly two-fifths reported only negative consequences for their well-being and relationships. Fewer approach motives, more avoidance motives, lower sexual self-control, and higher partner relationship control were associated with experiencing fewer positive consequences. Our results corroborate previous studies conducted in North America, suggesting that sexual compliance is common among women in committed relationships. We suggest careful consideration in instances of compliance, considering possible negative consequences.

Prevalence, lifestyle, and risk factors of erectile dysfunction, premature ejaculation, and low libido in middle-aged men: first results of the Bavarian Men's Health-Study.

BACKGROUND: Erectile dysfunction (ED), premature ejaculation (PE), and low libido (LL) are reported as the most common male sexual dysfunctions. OBJECTIVE: To evaluate the prevalence of ED, PE, and LL and associations with lifestyle risk factors and comorbidities in middle-aged men. MATERIALS AND METHODS: This study included a population-based random sample of 2500 50-year-old men who completed validated questionnaires, including the International Index of Erectile Function, the Erection Hardness Score, the Sexual Complaints Screener, and further questionnaires. Multiple logistic regression of outcomes ED, PE, and LL was used to model the association with explanatory factors. RESULTS: The prevalence of at least one sexual dysfunction was 30%. 21%, 5.2%, and 7.2% of men had ED, PE, and LL, respectively. The risk of ED increased with PE (odds ratio [OR]: 1.94, 95% confidence interval [95%CI]: 1.22-3.08), LL (OR: 2.04, 95%CI: 1.26-3.29), higher waist circumference (OR: 2.23, 95%CI: 1.67-2.96), and lower urinary tract symptoms (LUTS) (OR: 1.88, 95%CI: 1.39-2.55), partnership was associated with a lower risk (OR: 0.57, 95%CI: 0.39-0.85). The risk of PE increased with ED (OR: 1.94, 95%CI: 1.23-3.07), partnership (OR:5.42, 95%CI: 1.30-22.60), depression (OR: 2.37, 95%CI: 1.09-5.14), and LUTS (OR: 2.42, 95%CI: 1.52-3.87), and decreased with physical activity (OR: 0.44, 95%CI: 0.21-0.93). The risk of LL increased with ED (OR: 2.09, 95%CI: 1.31-3.34) and poorer self-rated health (OR: 2.97, 95%CI: 1.54-5.71). DISCUSSION AND CONCLUSIONS: Roughly one in three 50-year-old men experience some form of sexual dysfunction and risk factors identified in this study underline the multifactorial nature of ED, PE, and LL. Many risk factors are modifiable which underlines the role of patient education. Modifiable risk factors should be addressed in patient education and men should take active measures to remove the risk posed by these factors.