Comorbidity of binge eating disorder and other psychiatric disorders: a systematic review.

OBJECTIVE: Binge eating disorder (BED), although relatively recently recognized as a distinct clinical syndrome, is the most common eating disorder. BED can occur as a separate phenomenon or in combination with other mental disorders, adding to the overall burden of the illness. Due to the relatively short history of recognizing BED as a distinct disorder, this review aimed to summarize the current knowledge on the co-occurrence of BED with other psychiatric disorders. METHOD: This review adhered to the PRISMA guidelines. Multiple databases, such as MEDLINE, MEDLINE Complete, and Academic Search Ultimate, were used to identify relevant studies. Of the 3766 articles initially identified, 63 articles published within the last 13 years were included in this review. This systematic review has been registered through INPLASY (INPLASY202370075). RESULTS: The most frequently observed comorbidities associated with BED were mood disorders, anxiety disorders and substance use disorders. They were also related to more severe BED presentations. Other psychiatric conditions frequently associated with BED include reaction to severe stress and adjustment disorders, impulse control disorder, ADHD, personality disorders, behavioral disorders, disorders of bodily distress or bodily experience, and psychotic disorders. Additionally, BED was linked to suicidality and sleep disorders. DISCUSSION: The findings highlight the interconnected nature of BED with various psychiatric conditions and related factors, shedding light on the complexity and broader impact of BED on mental health and the need for appropriate screening and appropriately targeted clinical interventions.

An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by the depressed mood.

An analysis of placental chorionic villous and decidual basalis tissue immunoreactivity in patients after cesarean section due to a placenta accreta spectrum disorder and elective cesarean section followed by a depressed mood. RESEARCH BACKGROUND: Over the past few years, interest in investigating immune dysfunction in patients with psychiatric disorders has increased. B7-H4 is a molecule with immunosuppressive properties that seems to play a key role in establishing maternal tolerance against fetal antigens. The aim of this study was to compare the B7-H4 immunoreactivity levels in patients after cesarean section. METHODS: Placental and decidual tissue samples were obtained from 49 women who delivered at Bielanski Hospital in Warsaw between 2009 and 2015. Fifteen of the patients developed postpartum depression and 14 had a diagnosis of placenta accreta spectrum. The control group consisted of 20 healthy patients on whom cesarean section was performed due to breech presentation at term. RESULTS: The highest levels of B7-H4 immunoreactivity were found in the placental chorionic villous and decidual basalis tissue samples of the patients who later developed postpartum depression, while the lowest levels were found in the samples of those patients with a placenta accreta spectrum disorder. The difference between the B7-H4 immunoreactivity levels of these two groups was statistically significant. The B7-H4 expression levels were statistically significantly higher in the women in the postpartum depression group than in the control group. CONCLUSION: Postpartum depression follows a disturbance of the suppressive milieu responsible for rebalancing the maternal immune system after the initial cytotoxic activation during labor.

Sexual Inhibition and Sexual Excitation Scales in Men: Psychometric Properties of a Polish Adaptation.

The present study aimed to develop a Polish version of the Sexual Inhibition/Sexual Excitation Scale (SIS/SES-PL) and explore its psychometric validity in a sample of 498 men aged between 18 and 55 years. We used exploratory and confirmatory factor analyses to obtain the best model fit. Out of the 45 items in the original scale, 32 items with eight subscales and three higher-order factors: (sexual excitation [SES], sexual inhibition due to performance failure [SIS1], and sexual inhibition due to performance consequences [SIS2]) were included in the SIS/SES-PL. The SIS/SES-PL was found to have a good and satisfactory fit (comparative fit index = .87; Tucker-Lewis Index = .85; root mean square error of approximation = .054; χ2 = 1108.7; p < .001; test-retest reliability Cronbach's alpha = .93). A small correlation between age and the SIS1 and SIS2 scores was detected. However, forward multiple regression analysis revealed a significant correlation only between age and SIS1 [ß = .23, p < .001, R2 for model = .05; F(1, 494) = 27.52, p < .001]. Furthermore, a moderate correlation between SIS1 and SES2, as well as SIS1 and general inhibition properties (measured using the Behavioral Inhibition Scale), was noted. In the case of SIS2, only small effects were observed, with the highest values for engaging in risky sexual behavior. Out of the total number of 42 variables, a moderate correlation between SES and the following was described: importance of sex, hypersexual behaviors, frequency of masturbation, frequency of sexual activities per month, sexual risk-taking, high promiscuity (measured using the Sociosexual Orientation Inventory Revised-Drive), general activation properties (measured using the Behavioral Activation Scale), neuroticism, and erotophilic tendencies (measured using the Sexual Opinion Survey-Short Form). The results of the study allowed us to conclude that the SIS/SES-PL might be a useful tool for tailoring therapy for men with sexual problems, as well as in the field of clinical research on sexual inhibition and excitation. Furthermore, it is a reliable and useful tool for measuring propensities for sexual excitement and inhibition.

Gray Matter Volume Differences in Impulse Control and Addictive Disorders-An Evidence From a Sample of Heterosexual Males.

BACKGROUNDS: The classification of addictions and impulse control disorders is changing as reflected in the 11th version of International Classification of Disorders (WHO, 2018). However, studies focusing on direct comparison of structural brain differences in behavioral and substance addictions are limited. AIM: Here, we contrast gray matter volumes (GMVs) across groups of individuals with compulsive sexual behavior disorder (CSBD), gambling disorder (GD), and alcohol use disorder (AUD) with those with none of these disorders (healthy controls participants; HCs). METHODS: Voxel-based morphometry was used to study brain structure, and severities of addiction symptoms were assessed with questionnaires. To identify brain regions related to severities of addictions, correlations between questionnaire scores and GMVs were computed. MAIN OUTCOME: We collected magnetic resonance imaging (GMVs) data from 26 patients with CSBD, 26 patients with GD, 21 patients with AUD, and 25 HC participants (all heterosexual males; age: 24-60; mean = 34.5, standard deviation = 6.48). RESULTS: Affected individuals (CSBD, GD, AUD) compared with HC participants showed smaller GMVs in the left frontal pole, specifically in the orbitofrontal cortex. The most pronounced differences were observed in the GD and AUD groups, and the least in the CSBD group. In addition, a negative correlation was found between GMVs and disorder severity in the CSBD group. Higher severity of CSBD symptoms was correlated with decreased GMVs in the right anterior cingulate gyrus. CLINICAL IMPLICATIONS: Our findings suggest similarities between CSBD and addictions. STRENGHS AND LIMITIATIONS: This study is the first showing smaller GMVs in 3 clinical groups of CSBD, GD, and AUD. But the study was limited only to heterosexual men. Longitudinal studies should examine the extent to which ventral prefrontal decrements in volume may represent preexisting vulnerability factors or whether they may develop with disorder progression. CONCLUSIONS: Our research extends prior findings in substance use disorders of lower GMVs in prefrontal cortical volumes among 3 clinical groups of patients with specific impulse control (CSBD) and behavioral (GD) and substance (AUD) addictive disorders. The negative correlation between CSBD symptoms and GMV of right anterior cingulate gyrus suggests a link with clinical symptomatology. Draps M, Sescousse G, Potenza MN, et al. Gray Matter Volume Differences in Impulse Control and Addictive Disorders-An Evidence From a Sample of Heterosexual Males. J Sex Med 2020;17:1761-1769.

A Systematic Review on Mindfulness Meditation-Based Interventions for Sexual Dysfunctions.

INTRODUCTION: Mindfulness-based therapies (MBT) are more and more frequently used in the treatment of sexual dysfunctions; therefore, it seems very important to assess evidence-based data on the clinical efficacy of these interventions. AIM: To provide a systematic review of published studies into the efficacy of MBT in the treatment of sexual dysfunctions. METHODS: The material for the analysis was obtained by searching 3 internet databases: EBSCO, PubMed, and ResearchGate. Articles describing therapeutic interventions on the basis of mindfulness and their efficiency in reducing sexual dysfunction symptoms in men and women were sought. MAIN OUTCOME MEASURES: 15 original research articles were included to the review: 4 articles were devoted to the analysis of the efficiency of the mindfulness-based therapy in the reduction of sexual dysfunction related to pain in the genital-pelvic area, 10 to desire or sexual arousal disorders or both in women, and 1 to erectile dysfunction in men. RESULTS: Studies indicate that MBT led to improvement in subjectively evaluated arousal and desire, sexual satisfaction, and a reduction of fear linked with sexual activity, as well as improving the consistency between the subjectively perceived arousal and genital response in women. The research indicated that MBT did not make a significant change in a reduction of pain during sexual activities. Evidence-based data were found on the efficacy of MBT in the treatment of male erectile dysfunction in 1 study. CLINICAL IMPLICATIONS: MBT could be effectively used in the treatment of female sexual dysfunction, specifically to improve sexual arousal/desire and satisfaction and to reduce sexual dysfunction associated with anxiety and negative cognitive schemas. STRENGTHS & LIMITATIONS: The few studies available are affected by several methodologic limitations, including small numbers of participants, patient selection, application of complex therapeutic interventions, and a lack of homework assessment, which makes definite conclusions difficult to draw. CONCLUSION: The effects of MBT in female sexual dysfunctions are promising. In future studies, the mindfulness-based monotherapies should be implemented to verify their potential in reducing symptoms of sexual dysfunction. More research is needed to explore the potential of MBT in the treatment of male sexual dysfunction. Jaderek I, Lew-Starowicz M. A Systematic Review on Mindfulness Meditation-Based Interventions for Sexual Dysfunctions. J Sex Med 2019;16:1581-1596.

Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)? Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males.

INTRODUCTION: Human sexuality is a multidimensional phenomenon related to several factors, such as self-esteem, awareness of sexual needs, and ability to communicate them to others. AIM: To examine the sexual characteristics of patients seeking treatment for compulsive sexual behavior disorder (CSBD)-a clinical diagnosis recently included in the 11th edition of the International Classification of Diseases classification. METHODS: We have investigated the sexual characteristics of 72 Polish men seeking treatment for CSBD compared with 208 men from the Polish general population. MAIN OUTCOME MEASURES: The Multidimensional Sexual Questionnaire-PL was used to examine 12 sexual aspects of human sexuality. The severity of CSBD symptoms was assessed using Sexual Addiction Screening Test-PL, and the severity of problematic pornography use was measured by Brief Pornography Screener. RESULTS: Results show that CSBD patients (when compared with the general population) exhibit higher sexual anxiety, sexual depression, external sexual control, and fear of sexual relationship. Furthermore, CSBD severity is negatively related to sexual esteem, internal sexual control, sexual consciousness, sexual assertiveness, and sexual satisfaction. CLINICAL IMPLICATIONS: Our findings suggest that the impairment of the abovementioned dimensions warrant attention during clinical work and future studies on CSBD. STRENGTHS & LIMITATIONS: This study was limited to men, most of whom self-identified as heterosexual. Future research should include women and non-heterosexual identified individuals. CONCLUSION: Sexual esteem, consciousness, assertiveness, satisfaction and internal sexual control are commonly affected among CSBD individuals and should be properly addressed during the clinical interview and treatment intervention. Kowalewska E, Kraus SW, Lew-Starowicz M, et al. Which Dimensions of Human Sexuality Are Related to Compulsive Sexual Behavior Disorder (CSBD)? Study Using a Multidimensional Sexuality Questionnaire on a Sample of Polish Males. J Sex Med 2019;16:1264-1273.

Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM).

INTRODUCTION: Hormonal contraception is available worldwide in many different forms. Fear of side effects and health concerns are among the main reasons for not using contraceptives or discontinuing their use. Although the safety and efficacy of contraceptives have been extensively examined, little is known about their impact on female sexual function, and the evidence on the topic is controversial. AIM: To review the available evidence about the effects of hormonal contraceptives on female sexuality in order to provide a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine. METHODS: A comprehensive review of the literature was performed. MAIN OUTCOME MEASURE: Several aspects of female sexuality have been investigated, including desire, orgasmic function, lubrication and vulvovaginal symptoms, pelvic floor and urological symptoms, partner preference, and relationship and sexual satisfaction. For each topic, data were analyzed according to the different types of hormonal contraceptives (combined estrogen-progestin methods, progestin-only methods, and oral or non-oral options). RESULTS: Recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria and specific statements on this topic, summarizing the European Society of Sexual Medicine position, were developed. CLINICAL IMPLICATIONS: There is not enough evidence to draw a clear algorithm for the management of hormonal contraception-induced sexual dysfunction, and further studies are warranted before conclusions can be drawn. A careful baseline psychological, sexual, and relational assessment is necessary for the health care provider to evaluate eventual effects of hormonal contraceptives at follow-up. STRENGTHS & LIMITATIONS: All studies have been evaluated by a panel of experts who have provided recommendations for clinical practice. CONCLUSION: The effects of hormonal contraceptives on sexual function have not been well studied and remain controversial. Available evidence indicates that a minority of women experience a change in sexual functioning with regard to general sexual response, desire, lubrication, orgasm, and relationship satisfaction. The pathophysiological mechanisms leading to reported sexual difficulties such as reduced desire and vulvovaginal atrophy remain unclear. Insufficient evidence is available on the correlation between hormonal contraceptives and pelvic floor function and urological symptoms. Both S, Lew-Starowicz M, Luria M, et al. Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine (ESSM). J Sex Med 2019;16:1681-1695.

Digital Ethnography of Zoophilia - A Multinational Mixed-Methods Study.

This study investigates people who have sex with animals (PSA) by describing their living situation, sexual activity, beliefs, and attitudes toward stigmatization. These data are highly applicable to the work of psychiatric and forensic professionals investigating paraphilias. We apply mixed-methods approach, using qualitative and quantitative analyses. The findings come from anonymous forum postings of 953 participants; of which 345 agreed to complete a survey upon advertising the study. We identify several themes, describing concerns of zoosexuals chatting within online communities: living situation; sex life; social acceptability; getting help. First, we provide data on how PSA justify their relationships with animal sex partners - with particular emphasis on sex practices and physical features most attractive to them. Second, we elaborate on the stigma associated with being a zoosexual, including the coping mechanism for dealing with social ostracism. Third, we elaborate, in detail, on why PSA find animals sexually appealing. Lastly, we present evidence that online discussion spaces serve as the platform for help-seeking behavior for individuals with paraphilias. This study presents the largest analyses of zoophiles in modern history, using mixed-methods approach, uncovering their daily activities, sexual preferences, and help-seeking behavior.

Thrombocytopenia in Patients Hospitalized for Alcohol Withdrawal Syndrome and Its Associations to Clinical Complications.

BACKGROUND: The aim of this study was to assess the predictive value of thrombocytopenia (TP) in alcohol withdrawal syndrome (AWS) as a marker of evolution of non-complicated AWS (nAWS) to severe, complicated AWS (cAWS): delirium tremens (DTs) and withdrawal seizures (wS), and to broaden knowledge about differences between nAWS and cAWS groups in relation to severity of TP. METHODS: This study involved 300 people (236 males and 64 females), aged 19-65 years (M = 44.64, SD = 11.32), hospitalized in the detoxification ward with ICD-10 diagnosis of F10.3 (AWS) or F10.4 (DTs), divided into nAWS and cAWS groups, 150 cases each. AWS severity was measured by CIWA-Ar. Available clinical and laboratory data were analyzed. RESULTS: TP was found in 139 (46%) of all subjects (nAWS = 32, cAWS = 107). nAWS and cAWS did not differ according to age, gender, length and severity of the last binge. A relationship between the occurrence of TP and cAWS was found (P < 0.001). The lower was the number of PLT, the more AWS incidence was observed. In CIWA-Ar, TP subjects had at least moderate AWS (P < 0.001). nAWS had higher PLT values than cAWS cases (Mrang = 195.96 vs. 105.04, P < 0.001). The predictive value of TP in cAWS was confirmed. CONCLUSIONS: The study demonstrates that patients with AWS and TP (in particular <119k/mL) are at higher risk of developing cAWS.

Personality traits, gender roles and sexual behaviours of young adult males.

BACKGROUND: Previous studies have shown that personality characteristics affect sexual functioning. The aim of this exploratory study was to assess and describe the relationship between global personality traits and the stereotypical femininity and masculinity levels with the broad aspects of sexual behaviours and attitudes in the group of 97 heterosexual young adult men aged 19-39 and living in Poland. METHODS: The 'Big Five' personality traits were measured with the NEO-FFI questionnaire; stereotypical femininity and masculinity with the Bem sex role inventory (BSRI); sexual disorders with the International index of erectile function (IIEF); socio-epidemiological data, sexual behaviours and attitudes towards sexuality with a self-constructed questionnaire. RESULTS: We identified weak to moderate associations with particular sexual behaviours and attitudes. Neuroticism correlated positively with lower sexual satisfaction, self-acceptance and more negative attitudes towards sexuality; extraversion with higher desire, frequency of sexual intercourses, their diversity, sexual satisfaction, masculinity level and lower report of erectile problems; openness to experience with better quality of partnership, more positive attitudes towards sexual activity and masculinity level; conscientiousness with later sexual initiation age, more frequent and diverse sexual behaviours (but lower interest in masturbation and coitus interruptus), overall sexual satisfaction, satisfaction with one's body and femininity level; agreeableness with a better quality of relationship with a partner, satisfaction from body, lower number of previous partners and more frequent sexual encounters (but less masturbation). Stereotypical masculinity, more so than femininity, was related to a wide range of positive aspects of sexuality. CONCLUSIONS: The Big Five personality traits and stereotypical femininity/masculinity dimensions were found to have a noticeable, but weak to moderate influence on sexual behaviour in young adult males.

Sexual dysfunctions and sexual quality of life in men with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is one of the most frequent diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. Clinicians working in this field commonly concentrate on the classical neurological deficits and often overlook symptoms that seriously affect the quality of life, such as sexual dysfunction (SD). Sexual functioning of MS patients remains poorly understood. AIM: The aim of this study was to assess the prevalence of SDs, their relationship with demographic factors, and sexual quality of life in men with multiple sclerosis (MS). METHODS: Sixty-seven patients from the National Multiple Sclerosis Center were interviewed, completed the questionnaires, and underwent neurological assessment. MAIN OUTCOME MEASURES: Primary outcome measures included the International Index of Erectile Function (IIEF), the Sexual Quality of Life Questionnaire (SQoL), and the Expanded Disability Status Scale (EDSS). RESULTS: The most common complaints were erectile dysfunction (52.9%), decreased sexual desire (26.8%), and difficulties in reaching orgasm (23.1%) or ejaculation (17.9%). The severity of SD had a clear impact on sexual quality of life, especially in the domains of erectile function and intercourse satisfaction. However, neither IIEF nor SQoL scores were correlated with age, time since onset of MS symptoms, or EDSS scores. Only 6% of the patients had ever discussed their concerns with a medical professional or undergone sexual therapy. CONCLUSIONS: SD is highly prevalent but commonly overlooked in MS patients and has a significant impact on their sexual quality of life. The data support a multifactorial etiology of SD in MS. More focus on SD and use of appropriate screening tools in clinical practice with MS patients are recommended.

Correlates of sexual function in male and female patients with multiple sclerosis.

INTRODUCTION: Many factors have been suggested to contribute to sexual dysfunction (SD) in multiple sclerosis (MS) patients, but the research on their impact on sexual functioning (SF) and sexual quality of life (SQoL) remains scant. AIM: The aim of this study was to investigate correlates of SF and SQoL in MS patients, as well as possible gender differences. METHODS: 204 MS patients were interviewed, completed the questionnaires, and underwent neurological assessment. MAIN OUTCOME MEASURE: Primary outcome measures included the International Index of Erectile Function, the Female Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire, the Beck Depression Inventory, and the Expanded Disability Status Scale. RESULTS: The course and duration of the disease did not predict patients' SF. Negative correlations were found for brainstem symptoms with orgasmic function and overall satisfaction in men and between cognitive functioning and the partner domain in women. Interestingly, brainstem symptoms correlated positively with the arousal domain in women. More than half (52.1%) of patients fulfilled Beck Depression Inventory criteria for depression, and these patients showed more SD than nondepressive individuals. The strongest negative correlations with depressive symptoms were found for desire, erectile function, and overall satisfaction with sexual life in men and for orgasm and sexual enjoyment in women. Deterioration in particular domains of SF was clearly related with diminished SQoL. The main gender difference was a strong influence of decreased desire on SQoL in women and no such correlation in men. Negative assessment of the relationship with partner significantly affected all domains of SF and SQoL in MS women and the desire domain in MS men. CONCLUSIONS: Several correlates of SF in MS patients were found. The role of brainstem symptoms needs further investigation. Clinicians should pay close attention to depressive symptoms and relationship factors in MS patients who suffer from SD.

[Children sexual abuse in Poland--study of 257 sexual offenders against minors]. / Wykorzystywanie seksualne dzieci w Polsce--analiza badan 257 sprawców, którzy popelnili przestepstwa seksualne wobec maloletnich.

INTRODUCTION: Obtaining objective data on sexual offenders against minors is difficult. In order to enhance the possibilities to prevent such crimes it is essential to determine factors that condition this kind of sexual behavior. AIM: The aim of the study was to prepare a multidimensional analysis of a profile of sexual offenders against minors. MATERIAL AND METHOD: A detailed analysis of documentation from forensic sexological, psychiatric and psychological examinations and information from the records of the proceedings concerning 257 perpetrators was performed by the authors. Information analyzed included demographic data, psychosocial background, psychosexual development, recent sexual activity, physical and mental health issues and information concerning accused sexual crime. RESULTS: The majority of the offenders had undisturbed family relations. However, subjects with sexual preference disorders perceived their parents' relationship as worse, reported more difficulties in educational process and in relation to teachers and peers. 5.4% of subjects experienced sexual abuse and 23.3% physical violence in their childhood. The majority reported no sexual dysfunction and had regular but rare sexual activity. 20.6% were diagnosed as having mental disorder and 36.8% were alcohol abusers. Almost 30% were under influence of alcohol or another substance during the crime. The majority had no sexual preference disorder. Definite pedophilia was found in 27% and traits of psychosexual immaturity in 23.1% of cases. There was no relationship between sexual preference disorders and psychiatric comorbidity, alcohol or substance abuse. The acts of sexual abuse comprised genital touching, vaginal or oral intercourse as well as exposing offender's or victim's body. These acts were typically against one child, planned, being aware of victim's age and using physical violence. CONCLUSIONS: The data from our research should be taken into account when planning therapeutic and preventive interventions.

Comparison of risk of recidivism among sexual offenders with and without sexual preference disorders using the STATIC-99R instrument.

Purpose: The STATIC-99 instrument is one of the tools used for the assessment of the risk of recidivism, in line with the actuarial approach. One of the risk factors indicated by the scientific literature as having the greatest significance is sexual preference disorder. The aim of the study was to verify whether sexual offenders diagnosed with sexual preference disorders have a higher risk of recidivism. The study also aimed to present, for the first time in Poland, a quantitative scoring of individual risk factors in STATIC-99R and their prevalence, allowing for the verification of the theoretical validity of the STATIC-99R instrument in the analysis of the population of sexual offenders in Poland. Methods: The study material consisted of 100 court and penitentiary files of perpetrators of crimes against sexual freedom from 11 Polish penal institutions and remand centers. We used the STATIC-99R to evaluate each case. Results: The distribution of the individual STATIC-99R risk factors in the population of the Polish sexual offenders is presented. The diagnosis of sexual preference disorders had no influence on the total STATIC-99R score but was associated with its individual factors. Conclusions: It can be concluded that the theoretical validity of the STATIC-99R tool is also relevant to the Polish study population and may be used in clinical practice.

Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective.

INTRODUCTION: The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed "hypersexual disorder," "sexual addiction," "porn addiction," "sexual compulsivity," and "out-of-control sexual behavior." OBJECTIVES: To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. METHODS: A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. RESULTS: CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent "unhealthy" sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. CONCLUSIONS: Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related "out-of-control sexual behaviors" on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine-informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

Assessment of the effect of mindfulness monotherapy on sexual dysfunction symptoms and sex-related quality of life in women.

Background: Mindfulness-based therapies (MBTs) are frequently used in the treatment of sexual dysfunctions. So far, there has not been sufficient evidence for the effectiveness of interventions based on mindfulness monotherapy. Aim: The aim of the study was to assess the effect of mindfulness monotherapy on the reduction of sexual dysfunction symptoms and sex-related quality of life. Methods: We conducted 4 weeks of MBT for 2 groups of heterosexual females: 1 with psychogenic sexual dysfunction (WSD) and 1 with no sexual dysfunction (NSD). Overall 93 women were recruited for the study. We collected data via an online survey regarding sexual satisfaction, sexual dysfunctions, and mindfulness-related features at baseline, 1 week after MBT, and follow-up 12 weeks after MBT. Research tools included the Female Sexual Function Index, Five Facet Mindfulness Questionnaire, and Sexual Satisfaction Questionnaire. Outcomes: Participating in the mindfulness program had a positive effect on women with and without sexual dysfunction. Results: The overall risk for sexual dysfunction decreased from 90.6% at baseline to 46.7% at follow-up in the WSD group and from 32.5% at baseline to 6.9% at follow-up in the NSD group. Participants in the WSD group reported a significant increase in levels of sexual desire, arousal, lubrication, and orgasm between measurements, although not in the pain domain. Participants in the NSD group reported a significant increase in the level of sexual desire between measurements but not in levels of arousal, lubrication, orgasm, and pain. A significant increase in sex-related quality of life was observed in both groups. Clinical Implications: The results of the study have a chance to translate into an introduction of a new therapeutic program for specialists and more effective help offered to women experiencing sexual dysfunctions. Strengths and Limitations: This mindfulness monotherapy research project, which included assessment of meditation "homework," is the first to verify the potential of MBT in reducing symptoms of psychogenic sexual dysfunctions among heterosexual females. Major limitations include the lack of randomization, an adequate control group, and a validated measure of sexual distress. Conclusion: The applied training was beneficial in the treatment of sexual dysfunctions in terms of increasing desire and arousal as well as the ability to reach orgasm. However, this approach needs more investigation before it can be recommended in the treatment of sexual dysfunction. The study should be replicated under a more rigorous research design, including adequate control groups and random allocation of participants to study conditions.

FOXP3-positive cell infiltration in the chorionic villi is increased in the placenta accreta and decreased in the placental abruption.

OBJECTIVES: Growing data suggest a role of Treg cells in placentation. The aim of the study was to evaluate Treg cells (FOXP3-positive cells) placental bed infiltration in patients with placenta accrete syndrome (PAS) and patients who experienced placental abruption. MATERIAL AND METHODS: The study group included 13 patients with PAS and the control group consisted of 66 women who had caesarean (CD) delivery of whom, 44 patients with elective caesarean (EC) delivery, and 22 patients with urgent caesarean (UC) delivery due to placental abruption. FOXP3 cell infiltration was assessed by means of immunohistochemistry in placental chorionic villous (CV) and in the decidua (D) and cumulatively in the placental bed (PB). RESULTS: We observed significant difference in the degree of FOXP3-positive cell CV infiltration between studied groups (p = 0.04). FOXP3-positive cells were the most commonly observed in PAS patients, while, they were the least frequently presented in patients after UC. The immunoreactivity for FOXP3-positive cells in CV were as follows: PAS 5 (38%), urgent CS 1 (5%) and elective CS 8 (18%) subjects. We found no difference in the presence of FOXP3-positive cells in the D (p = 0.35) and in the PB (p = 0.23) of analyzed groups. FOXP3-cell infiltration was not related with patient age, BMI, gestational age and neonatal birth weight. CONCLUSIONS: Our study provides further evidence that abnormal invasive placentation is an associated disturbance of the maternal immune response. Accordingly, we have theorized that alteration of the FOXP3-positive Treg cell infiltration into the placental bed allows trophoblast cell invasion.

News and future perspectives of non-surgical treatments for erectile dysfunction.

The significant discontinuation rate of available therapies and the paucity of curative options promoted the research on potential novel treatments suitable for erectile dysfunction patients. The aim of this study was to provide a summary of available evidence regarding the news and future perspectives related to the non-surgical treatment of erectile dysfunction. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase, and Scopus databases was done. Papers in English-language, published until April 2022, were included. No chronological restriction was applied. Retrospective and prospective clinical studies, as well as meta-analyses, were considered. Oro-dispersible formulations of phosphodiesterase type 5 inhibitors are particularly indicated in patients who have difficulty in swallowing solid dosage form; in addition, they constitute a discrete route of administration not requiring water. Low-intensity extracorporeal shock wave therapy is indicated in mild vasculogenic erectile dysfunction and in patients with vasculogenic erectile dysfunction poorly responsive to phosphodiesterase type 5 inhibitors. Stem cell therapy, platelet-rich plasma injections, and gene therapy seem promising regenerative treatments for selected patients with erectile dysfunction. Novel oral formulations of drugs commonly used in erectile dysfunction patients have recently become part of standard clinical practice. Regenerative treatments have been emerging in recent years and could become routine curative options in the near future. Further well-designed randomized controlled trials are needed to provide conclusive evidence on this topic and guide appropriate recommendations.

Assessing compulsive sexual behavior disorder: The development and international validation of the compulsive sexual behavior disorder-diagnostic inventory (CSBD-DI).

Background and aims: The World Health Organization's International Classification of Diseases (ICD-11) includes Compulsive Sexual Behavior Disorder (CSBD), a new diagnosis that is both controversial and groundbreaking, as it is the first diagnosis to codify a disorder related to excessive, compulsive, and out-of-control sexual behavior. The inclusion of this novel diagnosis demonstrates a clear need for valid assessments of this disorder that may be quickly administered in both clinical and research settings. Design: The present work details the development of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) across seven samples, four languages, and five countries. Setting: In the first study, data were collected in community samples drawn from Malaysia (N = 375), the U.S. (N = 877), Hungary (N = 7,279), and Germany (N = 449). In the second study, data were collected from nationally representative samples in the U.S. (N = 1,601), Poland (N = 1,036), and Hungary (N = 473). Findings: Across both studies and all samples, results revealed strong psychometric qualities for the 7-item CSBD-DI, demonstrating evidence of validity via correlations with key behavioral indicators and longer measures of compulsive sexual behavior. Analyses from nationally representative samples revealed residual metric invariance across languages, scalar invariance across gender, strong evidence of validity, and utility in classifying individuals who self-identified as having problematic and excessive sexual behavior, as evidenced by ROC analyses revealing suitable cutoffs for a screening instrument. Conclusion: Collectively, these findings demonstrate the cross-cultural utility of the CSBD-DI as a novel measure for CSBD and provide a brief, easily administrable instrument for screening for this novel disorder.