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BACKGROUND: Among the plethora of urogynecological conditions possibly affecting women, some of them, less explored, have significant impacts on sexological and psychological health, with a mutual influence. AIM: The aim of this study was to investigate the sexological and psychological correlates of four urogynecological pathologies in a sample of women of childbearing age: overactive pelvic floor, vulvodynia, postcoital cystitis, and interstitial cystitis. Women cured of these conditions were also included, to assess the same aspects after the remission of physical symptoms. METHODS: We recruited 372 women with an average age of 33.5 years through an online platform shared by a popular forum for women with urogynecological pathologies between March and May 2021. The participants filled out a socio-anamnestic questionnaire and a set of psychometric tests. OUTCOMES: Participant data were collected by use of the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Toronto Alexithymia Scale-20, Female Sexual Function Index, and Orgasmometer-F, and the SPSS (Statistical Package for Social Sciences) v.26 was used for data analysis. RESULTS: Overactive pelvic floor was reported by 66.4% of the women, vulvodynia by 55%, postcoital cystitis by 58.8%, and interstitial cystitis by 8.3%, and these conditions were often comorbid with each other, with 9.4% and 7% of women reporting having suffered psychological and sexual abuse, respectively. The presence of past abuse was correlated with overactive pelvic floor (P < .05), vulvodynia (P < .01), and major depression (P < .01). Significantly more depression occurred in women with vulvodynia than in the other subgroups (P < .05), except for women with only an overactive pelvic floor. There was no difference between the subgroups in the occurrence of alexithymia, sexual function, and orgasm (P < .05). Interestingly, the prevalence of sexual dysfunction increased in cured women. CLINICAL IMPLICATIONS: The lack of significant differences, except for depression, between the pathological subgroups suggests a similar clinical and psychological relevance of the four pathologies studied. The persistence of sexual dysfunctions in cured women may be related to a residual dysfunctional relational modality with the partner. STRENGTHS AND LIMITATIONS: The evaluation of both psychological and sexological variables in a group of less-explored urogynecological conditions represents a strength of this study, while a lack of a face-to-face assessment could represent a limitation. CONCLUSION: The results of the present study should promote psychosexological interventions in women with these diseases, both during the pathological state and after remission.
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Cistite Intersticial , Vulvodinia , Humanos , Feminino , Adulto , Cistite Intersticial/psicologia , Cistite Intersticial/complicações , Vulvodinia/psicologia , Vulvodinia/epidemiologia , Inquéritos e Questionários , Coito/psicologia , Distúrbios do Assoalho Pélvico/psicologia , Distúrbios do Assoalho Pélvico/complicações , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Psicometria , Bexiga Urinária Hiperativa/psicologia , Bexiga Urinária Hiperativa/epidemiologiaRESUMO
BACKGROUND: Limitation to the capacity to love is often a feature of a suffering personality. AIM: We aimed to investigate the role of the capacity to love in hypersexual behavior, considering both distress and defense mechanisms as possible psychological mediators. METHODS: Through an online platform, we recruited a convenience sample of 521 subjects (390 [74.9%] females and 131 [25.1%] males; mean [SD] age, 26.46 [5.89] years). OUTCOMES: Recruited subjects completed a psychometric protocol that included completion of the following measurement tools: (1) the Capacity to Love Inventory (CTL-I), (2) the Hypersexual Behavior Inventory (HBI), (3) the 30-item self-report Defense Mechanisms Rating Scale, and (4) the Brief Symptom Inventory. We then performed correlation and regression analyses and used a mediation model for data analysis. RESULTS: A significant negative relationship between the capacity to love and hypersexual behavior was found. Furthermore, indirect effects were also statistically significant, supporting the hypothesis that limitation to the capacity to love is related to hypersexuality through the paths of psychological distress and immature defense mechanisms. Finally, compared to the other subjects, those with pathological scores for the HBI showed significantly lower scores on the CTL-I, which suggested limitations to the capacity to love. CLINICAL IMPLICATIONS: The relationship between limitation to the capacity to love and hypersexuality is fundamental to the diagnostic process in persons with problematic sexuality and psychopathological distress. STRENGTHS AND LIMITATIONS: This study is the first, to our knowledge, to highlight the role of the capacity to love in sexual behavior, although future studies in specific clinical sample groups would be suitable for further investigation of the relationships among the considered variables. CONCLUSION: The etiology of limitation in the capacity to love is related to dysfunctional aspects of psychological functioning, such as psychological distress and immature defense mechanisms, and these factors together generate problematic sexuality such as hypersexual behavior. Our results highlight the central role in mental and sexual health of the capacity to love. Based on these findings, clinicians should take these aspects into consideration for diagnosis and treatment of patients presenting with problematic sexuality.
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Amor , Transtornos Parafílicos , Adulto , Feminino , Humanos , Masculino , Mecanismos de Defesa , Transtornos Parafílicos/psicologia , Comportamento Sexual/psicologia , Sexualidade , Adulto JovemRESUMO
BACKGROUND: The integrity of the neural pathways that link genital sensitive areas to the brain and the correlation with subjective sensations in transgender women with gender dysphoria after gender affirming surgery (GAS) have not been explored in detail and remain controversial, so far. AIM: To test with electrophysiology the integrity of the nervous paths after GAS, and to explore the relationship between genital sensitivity and self-perceived orgasmic intensity in transgender women after GAS. METHODS: Six patients who underwent GAS between 2016 and 2019 were enrolled in the study, and the evaluation of genital and pelvic neural pathways was performed. OUTCOMES: Genital sensory thresholds (at clitoral, vaginal, and anal sites) investigated by Somatosensory Evoked Potentials (SEP) and the intensity of orgasm (measured by a psychometric tool, the Orgasmometer) were combined to obtain an objective and subjective evaluation. RESULTS: SSEPs confirmed the integrity of the large diameter, dorsal column-lemniscus pathway subserving the genital area after GAS. Perceptual Threshold (PT) values were much lower at the neoclitoris compared to neovagina and anal sites. There was no correlation between Orgasmometer and SEP at anal and neovaginal level, while a trend was found at clitoral level. CLINICAL IMPLICATION: These findings could lead clinicians to a better understanding of postsurgical sexual life in transgender women in order to develop surgical techniques that could focus more on functional aspects of neovagina and neoclitoris. STRENGTHS & LIMITATIONS: Limitations: study very preliminary/exploratory; small number of patients; no long-term follow-up. Strengths: first assessment of sensory pelvic floor innervation in transgender women after GAS; use of objective methods; first attempt at correlating objectives findings to subjective experience of the sexual orgasm. CONCLUSIONS: Our evaluation showed that SSEPs is a good indicator of neural sensitivity, especially in neoclitoris, and that these measurements were consistent with the analysis of self-perceived orgasmic intensity. Canale D, Molinaro A, Marcocci C, et al. Genital Sensitivity and Perceived Orgasmic Intensity in Transgender Women With Gender Dysphoria After Gender-Affirming Surgery: A Pilot Study Comparing Pelvic Floor Evoked Somatosensory Potentials and Patient Subjective Experience. J Sex Med 2022;19:1479-1487.
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Disforia de Gênero , Pessoas Transgênero , Clitóris , Feminino , Humanos , Orgasmo , Diafragma da Pelve , Projetos PilotoRESUMO
BACKGROUND: The COVID-19-related lockdown has profoundly changed human behaviors and habits, impairing general and psychological well-being. Along with psychosocial consequences, it is possible that sexual behavior was also affected. AIMS: With the present study, we evaluated the impact of the community-wide containment and consequent social distancing on the intrapsychic, relational, and sexual health through standardized psychometric tools. METHODS: A case-control study was performed through a web-based survey and comparing subjects of both genders with (group A, N = 2,608) and without (group B, N = 4,213) sexual activity during lockdown. The Welch and chi-square tests were used to assess differences between groups. Univariate analysis of covariance, logistic regression models, and structural equation modeling were performed to measure influence and mediation effects of sexual activity on psychological, relational, and sexual outcomes. OUTCOMES: Main outcome measures were General Anxiety Disorder-7 for anxiety, Patient Health Questionnaire-9 for depression, Dyadic Adjustment Scale for quality of relationship and a set of well-validated sexological inventories (International Index of Erectile Function, Female Sexual Function Index, and male-female versions of the Orgasmometer). RESULTS: Anxiety and depression scores were significantly lower in subjects sexually active during lockdown. Analysis of covariance identified gender, sexual activity, and living without partner during lockdown as significantly affecting anxiety and depression scores (P < .0001). Logistic regression models showed that lack of sexual activity during lockdown was associated with a significantly higher risk of developing anxiety and depression (OR: 1.32 [95% CI: 1.12 - 1.57, P < .001] and 1.34 [95% CI: 1.15 - 1.57, P < .0001], respectively). Structural equation modeling evidenced the protective role of sexual activity toward psychological distress (ßmales = -0.18 and ßfemales = -0.14), relational health (ßmales = 0.26 and ßfemales = 0.29) and sexual health, both directly (ßmales = 0.43 and ßfemales = 0.31), and indirectly (ßmales = 0.13 and ßfemales = 0.13). CLINICAL TRANSLATION: The demonstrated mutual influence of sexual health on psychological and relational health could direct the clinical community toward a reinterpretation of the relationship among these factors. STRENGTHS AND LIMITATIONS: Based on a large number of subjects and well-validated psychometric tools, this study elucidated the protective role of sexual activity for psychological distress, as well for relational and sexual health. Main limitations were the web-based characteristics of the protocol and the retrospective nature of prelockdown data on psychorelational and sexual health of subjects recruited. CONCLUSIONS: COVID-19 lockdown dramatically impacted on psychological, relational, and sexual health of the population. In this scenario, sexual activity played a protective effect, in both genders, on the quarantine-related plague of anxiety and mood disorders. Mollaioli D, Sansone A, Ciocca G, et al. Benefits of Sexual Activity on Psychological, Relational, and Sexual Health During the COVID-19 Breakout. J Sex Med 2021;18:35-49.
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COVID-19 , Saúde Sexual , Ansiedade , Estudos de Casos e Controles , Controle de Doenças Transmissíveis , Depressão , Feminino , Humanos , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Comportamento Sexual , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Vulvo-Vaginal Atrophy (VVA) affects about fifty percent of postmenopausal women, contributing more vulnerable sexual and psycho-relational equilibrium. To date, no psychometric instruments have been designed to assess the impact of coital pain associated with VVA on sexual quality of life. AIM: To validate a new psychometric tool, the Gynogram, able to investigate coital pain and to quantify its impact on sexual well-being in menopause. METHODS: 214 sexually active postmenopausal women were enrolled in the study during clinical consultations in gynecological outpatient clinics in Italy. After gynecological examination and evaluation of the presence of VVA, the study sample was divided in a clinical group (103 women with certified diagnosis of VVA) and in a control group (111 women without certified diagnosis of VVA) according to the Vaginal Health Index (VHI) cut-off. Factor, Reliability and Receiving Operating Characteristics (ROC) analysis were performed in order to validate our newly created Gynogram. OUTCOMES: A structured questionnaire, named Gynogram, to assess coital pain and its impact, and the Female Sexual Function Index (FSFI). RESULTS: The factor analysis performed on the original form (80 items) reduced the Gynogram to 24 items. Reliability analysis conducted with Cronbach's Alpha coefficients showed high values in all the components (ranging from .813 to .972), both in the long and in the short form. The sensitivity analysis demonstrated that the Gynogram, with a cut-off ≤93, is able to recognize a clinically significant coital pain. With respect to the FSFI, statistically significant differences were found for all the domains. In addition, statistically significant differences were found for all the twelve factors of the Gynogram, showing that VVA profoundly affects the sexual quality of life of women in post-menopause. CLINICAL TRANSLATION: The utility of this tool consists in the possibility to improve prognosis, compliance/adherence and treatment outcomes. STRENGTHS AND LIMITATIONS: The Gynogram is able to evaluate and to quantify the impact of coital pain associated with VVA. Moreover, it can also recognize the areas of biopsychosocial functioning being more affected by this clinical condition. The main limit of the study is the impossibility to evaluate both mental health and partner's general and sexual health. CONCLUSIONS: The Gynogram is a new and validated psychometric tool able to detect the impact of symptomatic VVA on sexual quality of life among post-menopausal women, with a specific focus on the different areas of sexual functioning. Nappi RE, Graziottin A, Mollaioli A, et al. The Gynogram: A Multicentric Validation of a New Psychometric Tool to Assess Coital Pain Associated With VVA and Its Impact on Sexual Quality of Life in Menopausal Women. J Sex Med 2021;18:955-965.
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Dispareunia , Qualidade de Vida , Atrofia/patologia , Dispareunia/diagnóstico , Dispareunia/patologia , Feminino , Humanos , Itália , Dor , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Vagina/patologia , Vulva/patologiaRESUMO
Sexual health is strictly related with general health in both genders. In presence of a sexual dysfunction, the expert in sexual medicine aims to discover the specific weight of the physical and psychological factors can cause or con-cause the sexual problem. At the same time, a sexual dysfunction can represent a marker of the future development of a Non-communicable diseases (NCDss) as cardiovascular or metabolic diseases.In the evaluation phase, the sexual health specialist must focus on these aspects, focusing especially on the risk and protective factors that could impact on both male and female sexuality.This article presents a review of researches concerning healthy and unhealthy lifestyles and their contribute in the development of sexual quality of life in a gender-dependent manner.Among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. Tobacco smoking, alcohol - substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapies.
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Exercício Físico/fisiologia , Estilo de Vida , Medicina Reprodutiva/métodos , Disfunções Sexuais Fisiológicas/fisiopatologia , Sexualidade/fisiologia , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Obesidade/fisiopatologia , Comportamento Sexual/fisiologia , Disfunções Sexuais Fisiológicas/epidemiologia , Fumar/epidemiologia , Fumar/fisiopatologiaRESUMO
INTRODUCTION: There is evidence that women's preferences for facial characteristics in men's faces change according to menstrual phase and sexual hormones. Literature indicates that the pregnancy is characterized by a specific sexual hormonal pattern with respect to all other physiological conditions concerning the sexual hormone status during the reproductive age, configuring this physiological condition as an excellent surrogate to study how the sexual hormones may affect many of the aspects concerning the sexual behavior. AIM: The aim of this study was to investigate pregnancy as a model of hormonal influence on women's facial preferences in short-term and long-term relationships and compare the choices of pregnant women with those of nonpregnant women. MAIN OUTCOME MEASURES: Measurement of women's preferences for synthetic men's faces, morphed from hyper-masculine to hypomasculine shape. MATERIALS AND METHODS: Forty-six women in the third trimester of pregnancy, and 70 nonpregnant women took part in the study. All women were shown a composite male face. The sexual dimorphism of the images was enhanced or reduced in a continuous fashion using an open-source morphing program that produced a sequence of 21 pictures of the same face warped from a feminized to a masculinized shape. RESULTS: Pregnant women's choices differed significantly from those of nonpregnant women. In fact, in the context of both a hypothetical short- (M = -0.4 ± 0.11) and long-term relationship (M = -0.4 ± 0.07) pregnant women showed a clear preference for a less masculine man's face than the other group (short-term: M = 0.15 ± 0.13; long-term: M = -0.06 ± 0.15; P < 0.0001). CONCLUSIONS: Women in the third trimester of pregnancy clearly prefer more feminine men's faces, distancing themselves from the choices of women in other physiological conditions concerning the sexual hormonal status during the reproductive age. However, other psychosocial variables may explain this interesting finding.
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Comportamento de Escolha , Face , Masculinidade , Estimulação Luminosa , Terceiro Trimestre da Gravidez , Comportamento Sexual/psicologia , Percepção Social , Adulto , Comportamento de Escolha/fisiologia , Sinais (Psicologia) , Expressão Facial , Feminino , Feminilidade , Humanos , Masculino , Gravidez , Percepção Visual , Adulto JovemRESUMO
INTRODUCTION: Homophobic behavior and a negative attitude toward homosexuals are prevalent among the population. Despite this, few researches have investigated the psychologic aspects associated with homophobia, as psychopathologic symptoms, the defensive system, and attachment styles. AIM: The aim of this study was to investigate the psychologic factors mentioned earlier and their correlation with homophobia. METHODS: Five hundred fifty-one university students recruited, aged 18-30, were asked to complete several psychometric evaluation. MAIN OUTCOME MEASURES: In particular, Homophobia Scale (HS) was used to assess homophobia levels, the Symptoms Check List Revised (SCL-90-R) for the identification of psychopathologic symptoms, the Defence Style Questionnaire (DSQ-40) for the evaluation of defense mechanisms and the Relationship Questionnaire (RQ) for attachment styles. RESULTS: After a regression analysis, we found a significant predictive value of psychoticism (ß = 0.142; P = 0.04) and of immature defense mechanisms (ß = 0.257; P < 0.0001) for homophobia, while neurotic defense mechanisms (ß = -0.123; P = 0.02) and depressive symptoms (ß = -0.152; P = 0.04) have an opposite role. Moreover, categorical constructs of the RQ revealed a significant difference between secure and fearful attachments styles in levels of homophobia (secure = 22.09 ± 17.22 vs. fearful = 31.07 ± 25.09; P < 0.05). Finally, a gender difference to HS scores and a significant influence of male sex was found (ß = 0.213; P < 0.0001). CONCLUSIONS: We demonstrated the involvement of psychoticism and immature defense mechanisms in homophobic attitudes, while a contrasting role is played by neurotic defense mechanisms and depressive symptoms. Moreover, secure attachment is an indicator of low levels of homophobia compared with the subjects demonstrating a fearful style of attachment. Hence, in the assessment of homophobia and in the relevant programs of prevention, it is necessary to consider the psychologic aspects described earlier.
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Sintomas Afetivos/psicologia , Mecanismos de Defesa , Homofobia/psicologia , Homossexualidade , Apego ao Objeto , Atitude , Análise Discriminante , Medo , Feminino , Homofobia/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Psicometria , Percepção Social , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Differences in facial preferences between heterosexual men and women are well documented. It is still a matter of debate, however, how variations in sexual identity/sexual orientation may modify the facial preferences. AIM: This study aims to investigate the facial preferences of male-to-female (MtF) individuals with gender dysphoria (GD) and the influence of short-term/long-term relationships on facial preference, in comparison with healthy subjects. METHODS: Eighteen untreated MtF subjects, 30 heterosexual males, 64 heterosexual females, and 42 homosexual males from university students/staff, at gay events, and in Gender Clinics were shown a composite male or female face. The sexual dimorphism of these pictures was stressed or reduced in a continuous fashion through an open-source morphing program with a sequence of 21 pictures of the same face warped from a feminized to a masculinized shape. MAIN OUTCOME MEASURES: An open-source morphing program (gtkmorph) based on the X-Morph algorithm. RESULTS: MtF GD subjects and heterosexual females showed the same pattern of preferences: a clear preference for less dimorphic (more feminized) faces for both short- and long-term relationships. Conversely, both heterosexual and homosexual men selected significantly much more dimorphic faces, showing a preference for hyperfeminized and hypermasculinized faces, respectively. CONCLUSIONS: These data show that the facial preferences of MtF GD individuals mirror those of the sex congruent with their gender identity. Conversely, heterosexual males trace the facial preferences of homosexual men, indicating that changes in sexual orientation do not substantially affect preference for the most attractive faces.
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Identidade de Gênero , Heterossexualidade/psicologia , Homossexualidade Masculina/psicologia , Comportamento Sexual/psicologia , Adulto , Face , Feminino , Feminização , Humanos , Masculino , Adulto JovemRESUMO
Premature ejaculation (PE), despite its wide prevalence, is largely underdiagnosed and undertreated. Being a multifactorial dysfunction with strong cultural characteristics, PE requires skillful attitudes in the psychosexological support, necessary to manage the patient's and the couple's expectations, as well as in the medical treatment. Dapoxetine is a short-acting selective serotonin reuptake inhibitor approved for use in lifelong and acquired PE in a number of countries. Opinions, not always generated by the evidence-based medicine, impacted the attitudes of Western andrologists, as a nocebo effect which produced a drug's Waterloo, characterized by low prescription rates much more built on the patients' and doctors' expectations than on costs, side effects, and efficacy. In the present study, we retrospectively reviewed real-life data from eight Andrology and Sexual Medicine Public Centers in China to assess the prevalence of PE among attending patients, its association with erectile dysfunction, its subtype, and the proposed treatments. In 2019, among 156,486 patients coming to the centers, 32,667 visits having PE as the chief complaint were performed (20.9%). Almost all patients received treatment prescriptions (32,641 patients, 99.92%); 23,273 patients came back for a follow-up visit in the subsequent 12 months (71.2% of those who initially received treatment). Dapoxetine, either alone or in combination with another therapy, was the most prevalent treatment, prescribed to 22,767 patients (69.7% of treated patients), followed by traditional Chinese medicine (TCM) (39.4%). At follow-up, 8174 patients were unsatisfied with treatment, and a new treatment was proposed (35.12%). Dapoxetine was the best treatment, with an overall 27.1% switching rate when used either alone or in combination: Although the switching rate for Dapoxetine alone was 44.2%, the association of the same drug with psychotherapy resulted in much lower rates (19.5%) and reached a minimum of 12% when also combined with TCM demonstrating how cultural aspects and medical attitudes may dramatically impact on the therapy of a multifaceted, complex, and culture-grounded sexual symptom such as PE. In conclusion, taking switching rates as surrogate markers of treatment failure, this real-life study-the largest in the field-shows that in a more patient-oriented (as in Chinese medical culture), and less symptom-oriented (as in Western medical attitudes), Dapoxetine is a successful treatment for PE patients, with higher reliability when used alone or as part of combined and integrated therapies.
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Naftalenos , Ejaculação Precoce , Masculino , Humanos , Ejaculação Precoce/tratamento farmacológico , Ejaculação , Estudos Retrospectivos , Reprodutibilidade dos Testes , Benzilaminas/uso terapêutico , Benzilaminas/farmacologia , China , Resultado do TratamentoRESUMO
Metaverse is the implementation of an Internet-based hypothetical meta-universe, which should facilitate an immersive experience in meeting people, working, shopping and other leisure activities. Immersive reality makes it possible to feel involved in a virtual environment using the mechanism of the "embodied simulations", i.e., the capacity to evoke a sense of presence in a specific reality, whether real or imagined. The growing interest in the metaverse suggests exploring how this new kind of communicative space could be used to provide and guarantee sexual entertainment and/or education for people with disabilities. Through a thematic analysis, we aimed to define the theoretical framework and analyze scientific literature on this subject. Our purpose is to provide a comprehensive picture of the use of metaverse as a tool for sexuality, and of the possible benefits of such technologies for people with disabilities. To this end, we have also discussed a major topic, related to the Sexual Assistants, examining how their possible application can be implemented within the context of augmented reality. Our study further explores the importance of the metaverse in sexual education. Finally, we addressed the issue of cyber security as well as possible threats and negative consequences linked to metaverse misuse.
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INTRODUCTION: Strategies of harm reduction (HR) include policies and community-based measures aimed to reduce the risk of self-harm while continuing potentially hazardous behaviors, such as illegal drug, alcohol, and tobacco use. OBJECTIVES: To assess whether and to which extent strategies of HR could have beneficial, or harmful, effects on sexual and reproductive health, for general and at-risk populations. METHODS: A literature research was performed between July 2020 and January 2021, investigating the association between harm reduction strategies and sexual and reproductive health. RESULTS: HR strategies are mostly aimed at providing support to at-risk population, such as injection drug users or sex workers. Alcohol and drug use, smoking and high-risk sexual behaviors are among the main targets for HR strategies. Barriers to access, such as stigma, marginalization or lacking awareness, are often present as negative risk factors and require attention from professionals. Preventing sexually transmitted infections (STIs), early/unwanted pregnancies and violence are the most important results HR programs could provide for sexual and reproductive health. However, evidence is limited and often qualitative, rather than quantitative. CONCLUSION: HR strategies are important measures to improve sexual and reproductive health in at-risk populations. Increasing personal and social awareness is a key factor for the success of HR programs. A Sansone, E. Limoncin, E Colonnello, et al. Harm Reduction in Sexual Medicine. Sex Med Rev 2022;10:3-22.
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Saúde Sexual , Infecções Sexualmente Transmissíveis , Feminino , Redução do Dano , Humanos , Gravidez , Saúde Reprodutiva , Comportamento SexualRESUMO
BACKGROUND: Diabetes mellitus (DM), one of the worldwide leading causes of death, is associated with a plethora of micro- and macro-vascular complications which should be carefully investigated and, in case, treated in order to improve quality of life and reduce the risk of premature mortality. OBJECTIVE: The study aimed to investigate and report current evidence with regard to the association between sexual dysfunction and diabetes. METHODS: A detailed analysis of current literature has been performed on PubMed and Scholar in order to retrieve the most relevant findings pertaining to the study topic. RESULTS: Female and male sexual dysfunction often occurs in diabetes; while cardiovascular complications are clearly involved, psychosexological factors, endocrine complications, and endothelial dysfunction all contribute to the pathogenesis of sexual dysfunctions. Psychological symptoms are seldom investigated, yet they should not be overlooked by the clinician; in fact, an interplay between sexual dysfunctions and depressive symptoms has been reported, and beneficial effects in both conditions might be obtained by adequate psychological support. Sexual dysfunctions can also act as early biomarkers of cardiovascular disease, a phenomenon frequently reported in men, in which erectile dysfunction predicts the development of coronary artery disease. Additionally, drug therapies can act in both directions, with treatments for diabetes possibly improving male sexual function and exerting beneficial effects for cardiovascular health being reported for pro-erectile drugs. CONCLUSION: Sexual dysfunctions often occur in men and women with diabetes. Investigating micro- and macro-vascular complications might not be enough to prevent the development or worsening of any sexual dysfunction; endocrine and psychological assessments are therefore needed to provide the best chances for adequate treatment.
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Diabetes Mellitus , Disfunção Erétil , Disfunções Sexuais Fisiológicas , Disfunções Sexuais Psicogênicas , Diabetes Mellitus/epidemiologia , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Feminino , Humanos , Masculino , Qualidade de Vida , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologiaRESUMO
INTRODUCTION: The "lost penis syndrome" (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection. OBJECTIVES: To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners. METHODS: Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations. RESULTS: Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity. CONCLUSION: We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2022;10:113-129.
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Pênis , Disfunções Sexuais Fisiológicas , Ejaculação , Feminino , Humanos , Masculino , Ereção Peniana/fisiologia , Comportamento SexualRESUMO
INTRODUCTION: Long term complications of COVID-19, the disease caused by the SARS-CoV-2, involve many organ systems, dramatically worsening the quality of life, and finally contributing to impaired physical functioning. Despite the presence of well-identified pathogenetic mechanisms, the effect of "Long COVID" on sexual health has been only marginally addressed. OBJECTIVES: To provide coverage of the current literature on long COVID, its epidemiology, pathophysiology, and relevance for erectile function. METHODS: Comprehensive review of literature pertaining to the epidemiology and pathophysiology of long COVID, and its relevance for erectile function. RESULTS: Symptoms of long COVID are highly prevalent and involve almost all systems of the human body, with a plethora of clinical manifestations which range from minor nuisances to life-threatening conditions. "Brain fog" and fatigue are the most common complaints, although other neuropsychiatric complications, including sensory dysfunctions, anxiety, depression, and cerebrovascular events have also been reported. The respiratory and cardiovascular systems are also affected, with dyspnea, pulmonary fibrosis, endothelial dysfunction, and myocarditis occurring in some COVID long haulers. A subset of patients might develop endocrine manifestations, including onset of diabetes, thyroid dysfunction, and hypogonadism. Overall, long COVID features many complications which can impair erectile function by multiple pathogenetic mechanisms, and which could require tailored treatment: (i) careful investigation and management from the sexual medicine expert are therefore much needed, (ii) and future research on this topic is warranted. CONCLUSION: in COVID-19 long haulers, several complications can adversely affect erectile function which, upon future tailored studies, could be used as biomarker for the severity of the long COVID disease and for its follow-up. Sansone A, Mollaioli D, Limoncin E et al. The Sexual Long COVID (SLC): Erectile Dysfunction as a Biomarker of Systemic Complications for COVID-19 Long Haulers. Sex Med Rev 2022;10:271-285.
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COVID-19 , Disfunção Erétil , Biomarcadores , COVID-19/complicações , Disfunção Erétil/epidemiologia , Humanos , Masculino , Qualidade de Vida/psicologia , SARS-CoV-2 , Síndrome de COVID-19 Pós-AgudaRESUMO
BACKGROUND: Erectile dysfunction (ED), as the hallmark of endothelial dysfunction, could be a short- or long-term complication of COVID-19. Additionally, being ED a clinical marker and predictor of non-communicable chronic diseases, particularly cardiovascular, subjects with ED could potentially have a higher risk of contracting COVID-19. OBJECTIVES: To investigate the prevalence of ED among subjects with a reported diagnosis of COVID-19 and to measure the association of COVID-19 and ED. MATERIALS AND METHODS: We reviewed data from the Sex@COVID online survey (performed between April 7 and May 4, 2020, in Italy) to retrieve a sample of Italian male sexually active subjects with reported SARS-CoV-2 infection. A matching sample of COVID-19-negative male sexually active subjects was also retrieved using propensity score matching in a 3:1 ratio. The survey used different standardized psychometric tools to measure effects of lockdown and social distancing on the intrapsychic, relational, and sexual health of Italian subjects. RESULTS: One hundred subjects were included in the analysis (25 COVID-positive; 75 COVID-negative). The prevalence of ED, measured with the Sexual Health Inventory for Men, was significantly higher in the COVID+ group (28% vs. 9.33%; p = 0.027). Logistic regression models confirmed a significant effect of COVID-19 on the development of ED, independently of other variables affecting erectile function, such as psychological status, age, and BMI [OR 5.66, 95% CI: 1.50-24.01]. Likewise, subjects with ED were more likely to have COVID-19, once corrected for age and BMI [OR 5.27, 95% CI: 1.49-20.09]. DISCUSSION AND CONCLUSION: On top of well-described pathophysiological mechanisms, there is preliminary evidence in a real-life population of ED as a risk factor of developing COVID-19 and possibly occurring as a consequence of COVID-19. Universal vaccination against the COVID-19 and the personal protective equipment could possibly have the added benefit of preventing sexual dysfunctions.
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COVID-19/complicações , Disfunção Erétil/etiologia , Adulto , Estudos de Coortes , Estudos Transversais , Disfunção Erétil/epidemiologia , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
INTRODUCTION: Hypersexuality is a complex behavioral dysfunction concerning the excess of sexual activities. In this study, we aim to investigate the role of attachment styles, post-traumatic and depression symptoms in hypersexual behavior. METHODS: We recruited through an online platform a snowball convenience sample of 1025 subjects (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90) and we administered them a sociodemographic questionnaire, with a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the Relationship Questionnaire (RQ) for the attachment styles, the International Trauma Questionnaire (ITQ) to evaluate the trauma and Patient Health Questionnaire (PHQ) for depression. RESULTS: We found a significant and predictive impact of preoccupied and fearful attachment styles on hypersexual behavior (ß=.116; p<.0001 and ß=.121p<.0001, respectively). The categorical analysis of RQ confirmed also statistically significant differences between secure attachment style with fearful and preoccupied ones in terms of HBI levels (secure=30.01±10.79; preoccupied=35.50±14.46; fearful=36.57±13.50). Moreover, we found that depression symptoms and the total score of ITQ also resulted predictive for hypersexuality (ß=.323; p<.0001 and ß=.063; p<.04). However, in our model, depression and post-traumatic symptoms played a mediation role between insecure attachment and hypersexual behavior. CONCLUSION: This study found a fundamental role of insecure attachment styles, post-traumatic and depression symptoms in the development of problematic sexuality. Hypersexual behavior is related in a causal manner with an insecure attachment style, fearful and preoccupied attachment, particularly. Nevertheless, the traumatic core of personality together with depression symptoms could play a mediation role towards the hypersexual behavior.
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Depressão , Transtornos de Estresse Pós-Traumáticos , Adolescente , Adulto , Comportamento Compulsivo , Feminino , Humanos , Masculino , Apego ao Objeto , Inventário de Personalidade , Psicometria , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: . Hypersexuality is a clinical condition regarding the psychopathology of sexual behavior. In this study, we aimed to investigate the role of trauma, through the post-traumatic stress-disorder (PTSD), depression, shame and guilt on the hypersexual behavior. METHODS: . Through an online platform, a convenience sample of 1025 subjects was recruited (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90). Recruited subjects compiled a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the International Trauma Questionnaire (ITQ) for PTSD, the Patient Health Questionnaire (PHQ-9) to evaluate depression and the State Shame and Guilt Scale (SSGS) for shame and guilt. Then a mediation/moderation model was performed for the data analysis. RESULTS: . There was a statistically significant direct effect of post-traumatic symptoms (ITQTotal) on hypersexual behavior (HBTotal). Furthermore, indirect effects were also statistically significant, providing support to the hypothesis that depression and guilt would be serial mediators of trauma-hypersexual behavior relations. The paths through depression and guilt have been found to be the most significant with moderate and high indirect effects on hypersexuality. Moreover, male gender, as covariate variable, is a relevant risk factor for hypersexual behavior. CONCLUSION: . We found the relationship between hypersexuality and trauma describing a possible etiological pathway mainly involving depression, shame and guilt. Hypersexuality can be considered as a reactive form of a major affective psychopathology representing a tip of the iceberg hiding the real issues of a suffering personality. Clinicians and researchers should therefore consider hypersexual behavior in the light of a symptomatic manifestation of a major psychopathology involving the affective aspects of personality.
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Comportamento Compulsivo , Transtornos Parafílicos , Adolescente , Adulto , Feminino , Culpa , Humanos , Masculino , Comportamento Sexual , Vergonha , Adulto JovemRESUMO
INTRODUCTION: Masculinity and femininity constitute the gender role construct into the general concept of sexual identity. AIM: To investigate the relationships of attachment style, sexual orientation and biological sex with the gender role. METHODS: A convenience sample of 344 subjects (females = 207; males = 137) was recruited. MAIN OUTCOME MEASURES: The Attachment Style Questionnaire (ASQ), the Kinsey Scale, and the Bem Sex Role Inventory assessed, respectively, attachment styles, sexual orientation, and masculinity/femininity was administered. RESULTS: Regression analysis revealed that the confidence scale of the ASQ (secure attachment) and relationship as secondary scale of ASQ (insecure/dismissing attachment) have a predictive role toward a higher score of masculinity (ß = 0.201; P = .000 and ß = 0.208; P = .000, respectively), whereas the need of approval scale of the ASQ (insecure/fearful-preoccupied attachment) shows a reverse association on it (ß = -0.228; P = .001). Moreover, to be a male is predictive for masculinity (ß = 0.196; P = .000). Also, femininity is predicted by the confidence (ß = 0.173; P = .002) and the need of approval (ß = 0.151; P = .03) scales of ASQ. Instead, the relationship as secondary scale of ASQ is negatively related to femininity (ß = -0.198; P = .0001). No association between non-heterosexual orientation and gender role was found. CLINICAL IMPLICATIONS: A better knowledge of links between relational patterns and gender roles for assessment and anamnesis phases in sexual medicine. STRENGTHS & LIMITATIONS: This is the first study considering sexual orientation and biological sex in the relationship between attachment styles and gender role. The main limitation is the use of self-reported psychometric tests. CONCLUSION: Our data indicate that a secure attachment is related to both masculinity and femininity. On the contrary, different and reverse aspects of insecure attachment style characterize masculinity and femininity. Masculinity is mostly linked to insecure/dismissing attachment, whereas femininity is linked to insecure/fearful-preoccupied attachment. Moreover, although being male is a further element in support of masculinity, sexual orientation is not associated with gender role. Ciocca G, Zauri S, Limoncin E, et al. Attachment Style, Sexual Orientation, and Biological Sex in their Relationships with Gender Role. Sex Med. 2019;8:76-83.
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The present study aims to evaluate the relationship in women between a history of physical/sexual abuse and the preferences regarding the choice of a partner for a short/long-term relationship in terms of male facial dimorphism, and to assess their sexual functioning. We enrolled 48 abused women and 60 non-abused women. Facial preferences were evaluated with the Morphing test. Sexual functioning was measured with the Female Sexual Function Index (FSFI). Regarding the choice for a short-term partner, abused and non-abused women did not show any differences, and both groups chose a less masculine male face. On the other hand, regarding the choice for a long-term partner, abused women showed a preference for an average male face, whilst non-abused women preferred a less masculine face. The sexual functioning of abused women was found significantly dysfunctional in all domains of the FSFI. These data, generated from a small but highly selected cohort, demonstrated that physical/sexual abuse may be associated with a more rational and conscious choice of a male partner for a long-term relationship, but not with an instinctive one, as the choice of an occasional partner. In addition, the sexual functioning of abused women appears to be compromised by the traumatic experience.