The effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment: a randomized controlled study.

INTRODUCTION AND HYPOTHESIS: The purpose of this study is to determine the effects of sexual counseling and pelvic floor relaxation on sexual functions in women receiving vaginismus treatment. METHODS: A total of 34 women at the vaginismus treatment stage, including 17 in the experiment group and 17 in the control group, were included in the study with a randomized controlled design. In addition to the routine treatment protocol, women in the experiment group were provided with pelvic relaxation and sexual counseling based on the Information, Motivation, Behavior (IMB) model consisting of four sessions. The control group received the routine treatment protocol. The assessments were made at the 3rd week and 2nd month after coitus. The women filled out an Information Form, the validated Female Sexual Function Index (FSFI), and the Vaginal Penetration Cognition Questionnaire (VPCQ). RESULTS: The mean age of the women was 27.59±5.32, and their mean duration of marriage/relationship was 33.44±12.11 months. After the treatment statistically significant increases were observed in the total FSFI scores and the desire, arousal, and pain dimension scores of the experiment group in comparison with the control group (p<0.05). In the VPCQ total scores, there was a significant reduction in the experiment group in comparison with the control group and after the treatment in comparison with before the treatment (p<0.01). CONCLUSIONS: The sexual counseling based on the IMB model and pelvic relaxation interventions provided to the women who were receiving vaginismus treatment affected their sexual function positively. It may be recommended to conduct comparative studies with a broader sample and different models.

The Influence of Fantasy Proneness, Dissociation, and Vividness of Mental Imagery on Male's Aggressive Sexual Fantasies.

Many researchers have studied the prevalence and content of men's aggressive sexual fantasies, including their link with rape-supportive cognition. However, little to no research has examined the link between imaginal ability and the use of such fantasies. Based on existing research and theory, we propose that men who hold hostile beliefs toward women will use aggressive sexual fantasies more often if they possess a greater ability to engage in a "rich fantasy life." Operationally, we argue this involves (a) a proneness to fantasize in general, (b) an ability to vividly envision mental imagery, and (c) frequent experiences of dissociation. To test this, the present study hypothesized that a latent variable termed "rich fantasy life," via "hostile beliefs about women," influences the use of "aggressive sexual fantasies." A sample of 159 community males was recruited. Each participant completed a measure of fantasy proneness, dissociation, and vividness of mental imagery, along with two measures that assess hostile beliefs about women. Assessing how often the participants fantasized about rape-related and sadistic themes provided a measure of aggressive sexual fantasies. Structural equation modeling (along with bootstrapping procedures) indicated that the data had a very good fit with the hypothesized model. The results offer an important contribution to our understanding of aggressive sexual fantasies, which may have implications for clinical assessment and treatment. The limitations of the study are discussed, along with suggestions for future research.

An Analysis of Popular Online Erectile Dysfunction Supplements.

INTRODUCTION: Erectile dysfunction supplements (ED-Ss) are featured on online marketplaces like Amazon.com, with dedicated pages and claims that they naturally treat ED. However, their efficacy and safety are largely unknown, limiting the ability to counsel patients regarding their use. AIM: To evaluate the highest rated and most frequently reviewed ED-Ss on Amazon.com to facilitate patient counseling regarding marketing myths, ingredient profiles, and evidence for product efficacy and safety. METHODS: The Amazon marketplace was queried using the key term "erectile dysfunction" with default search settings and ranking items based on relevance. The top 6 ED-S products identified on September 29, 2018, were reviewed based on price, ratings, reviews, manufacturer, and ingredients. Consumer reviews were categorized using subtopics within the International Index of Erectile Function (IIEF) questionnaire to better understand ED-S efficacy and then reanalyzed following filtration of untrustworthy comments using ReviewMeta.com, a proprietary Amazon review analysis software. OUTCOMES: Quantitative and qualitative evaluation of ED-S products sold on Amazon.com. RESULTS: The top 6 ED-Ss had an average of 2,121 ± 1,282 reviews and a mean rating of 3.92 ± 0.42 stars. A total of 21 ingredients were identified in these ED-Ss. Ginseng, horny goat weed, L-arginine, and tongkat ali were the most popular ingredients included in the analyzed products. Our literature review identified 413 studies involving the 21 identified ingredients, of which 59 (16%) involved human subjects. Among these 69 human studies, only 12 (17%) investigated supplement ingredients individually and reported improvement in ED. Analysis of top-ranked customer reviews from the first 2 pages of reviews for each supplement revealed differences in IIEF scores before and after ReviewMeta.com filtration. After filtration, we observed a 77% decrease in reviews reporting improved erection strength, an 83% decrease in reviews reporting improved ability to maintain erection, a 90% decrease in reviews reporting increased sexual satisfaction, an 88% decrease in reviews reporting increased enjoyment with intercourse, and an 89% decrease in reviews reporting increased erection confidence. STRENGTHS & LIMITATIONS: Study strengths include a novel approach to ascertaining consumers' perceptions and satisfaction with ED-Ss and practical summary information that clinicians can provide to patients. Limitations include selection bias, the small number of supplements analyzed, and the proprietary nature of the Amazon review analysis software. CONCLUSIONS: Our investigation revealed that human studies evaluating the efficacy of ED-S ingredients are limited and have yielded no definitive findings of the effects on ED. Patients considering ED-S use should receive appropriate counseling, given the prevalence of disingenuous reviews and the ready availability of Food and Drug Administration-approved drug therapies. Balasubramanian A, Thirumavalavan N, Srivatsav A, et al. An Analysis of Popular Online Erectile Dysfunction Supplements. J Sex Med 2019;16:843-852.

Socio-Demographic, Health and Lifestyle Factors Influencing Age of Sexual Initiation among Adolescents.

Behavioural and developmental factors mean that adolescents who initiate sexual intercourse early may be at an increased risk of adverse sexual health outcomes at the time of first sex and later in life. In an Irish context, there is insufficient knowledge about the specific correlates of early sexual initiation. This research explores relationships between contextual socio-demographic, health and lifestyle factors and the timing of first sexual intercourse among 15⁻17-year-olds in Ireland. Multiple regression analysis was carried out in conjunction with Multiple Imputation using data collected through the 2014 Health Behaviour in School-Aged Children Ireland study on a sample of 879 sexually active adolescents. The socio-demographic and lifestyle factors measured were a stronger predictor of age of sexual initiation among girls than boys. Risk behaviour initiation was significantly related to age of sexual initiation for adolescents, while alcohol use/drunkenness and unhealthy food consumption was significant among girls only. Family support and number of male friends were significant predictors for boys only. The study highlights the need for holistic approaches to sexual health promotion and provides a foundation for the development of alternative strategies and policies aimed at reducing negative health, well-being, educational and economic outcomes.

Diagnosis and treatment of unconsummated marriage in an Iranian couple.

BACKGROUND: Unconsummated marriage is a problem among couples who would not be able to perform natural sexual intercourse and vaginal penetration. This disorder is more common in developing countries and sometimes couples would come up with non-technical and non-scientific methods to overcome their problem. Multi-dimensional approach and narrative exposure therapy used in this case. METHODS: This study would report a case of unconsummated marriage between a couple after 6 years. The main problem of this couple was vaginismus and post-traumatic stress. RESULTS: Treatment with multi-dimensional approach for this couple included methods like narrative exposure therapy, educating the anatomy of female and male reproductive system, correcting misconceptions, educating foreplay, educating body exploring and non-sexual and sexual massage and penetrating the vagina first by women finger and then men's after relaxation. The entire stages of the treatment lasted for four sessions and at the one-month follow-up couple's satisfaction was desirable. CONCLUSION: Unconsummated marriage is one of the main sexual problems; it is more common in developing countries than developed countries and cultural factors are effective on intensifying this disorder. The use of multi-dimensional approach in this study led to expedite diagnosis and treatment of vaginismus.

Low-Level Laser Therapy for the Treatment of Provoked Vestibulodynia-A Randomized, Placebo-Controlled Pilot Trial.

BACKGROUND: Low-level laser therapy (LLLT) is an emerging medical technology in which non-thermal laser irradiation is applied to treat pain. Because LLLT has been found effective in treating various pain syndromes without known side effects, we conducted a study evaluating the effect of LLLT on provoked vestibulodynia (PVD), a complex sexual pain disorder characterized by pain confined to the vulvar vestibule in response to contact or pressure. AIM: To investigate the effectiveness of LLLT for PVD in a randomized, placebo-controlled, double-blinded trial. METHODS: Patients with PVD were randomly assigned to receive treatment with LLLT or sham treatment. Patients were treated twice weekly for 6 weeks, for a total of 12 LLLT or placebo sessions. Patients who showed improvement after LLLT were followed for 1 year by clinical pain report and Q-tip examination. OUTCOMES: Change in pain scores obtained in response to the Q-tip test, clinical pain report, visual analog scale score, pain with tampon insertion, daily pain intensity, intercourse pain intensity, frequency of intercourse, and a battery of quality-of-life measures. RESULTS: Thirty-four patients with PVD participated, 18 received LLLT and 16 received placebo. In the clinical pain report at study completion, 14 of 18 patients (78%) receiving LLLT reported improvement compared with 7 of 16 (44%) in the placebo group (P = .042). This effect was not apparent in other outcome measurements. None of the patients reported side effects during the study. At 1-year follow-up, eight patients (57%) reported lasting improvement. CLINICAL IMPLICATIONS: Larger studies with various treatment protocols are needed to define which patients can benefit from LLLT therapy. STRENGTHS AND LIMITATIONS: Strengths include a placebo-controlled, double-blinded design, measurement of a large number of multidimensional end points, and a follow-up period of 1 year. Limitations include the small number of patients recruited, no improvement in measurable parameters, a high improvement rate in the placebo group, the absence of use of validated questionnaires, and the lack of evaluation of psychological and interpersonal factors that might have influenced the results. CONCLUSIONS: Given the results of this pilot study, LLLT cannot currently be recommended as a treatment for PVD. Further studies with a larger population, various treatment protocols, and evaluation of LLLT in different subgroups of PVD are needed to define which patients can benefit from this therapy. Lev-Sagie A, Kopitman A, Brzezinski A. Low-Level Laser Therapy for the Treatment of Provoked Vestibulodynia-A Randomized, Placebo-Controlled Pilot Trial. J Sex Med 2017;14:1403-1411.

[Efficacy and safety of Yimusake Tablets plus dapoxetine hydrochloride in the treatment of premature ejaculation].

OBJECTIVE: To evaluate the effect and safety of Yimusake Tablets combined with dapoxetine hydrochloride and either of them used alone in the treatment of premature ejaculation (PE). METHODS: We randomly assigned 180 PE patients to oral medication of Yimusake Tablets at 1.5 g per night (group A), dapoxetine hydrochloride at 30 mg at 1－3 hours before anticipated sexual activity (group B), the Yimusake Tablets plus dapoxetine hydrochloride simultaneously (group C), all for 8 weeks. After 4 and 8 weeks of medication, we recorded and compared the changes in the intravaginal ejaculation latency time (IELT), measures of the PE profile (PEP), and adverse events among the three groups of patients. RESULTS: The treatment was accomplished and complete data obtained from 154 of the patients, 56 in group A, 52 in group B, and 46 in group C. After 4 and 8 weeks of medication, the mean IELT was dramatically prolonged in all the three groups as compared with the baseline (P<0.01), most significantly at 8 weeks in group C (ï¼»2.08±0.68ï¼½ min), followed by B (ï¼»1.76±0.52ï¼½ min) and A (ï¼»1.47±0.44ï¼½ min), with statistically significant differences among the three groups (P<0.01). The PEP measures were remarkably improved in group A at 8 weeks (P<0.05), and both in B and C at 4 and 8 weeks (P<0.05), most significantly at 8 weeks in group C (P<0.05), in which the patients scored 1.96±0.77 in perception of control over ejaculation, 2.62±0.98 in satisfaction with sexual intercourse, 3.04±0.62 in PE-related distress, and 3.57±0.80 in PE-induced difficult relationship with their partners, all markedly improved as compared with groups A and B (P<0.05). Adverse reactions were observed in 2 cases (3.6%) in group A, 6 cases (9.6%) in B, and 5 cases (10.9%) in C. No severe adverse events occurred in any of the patients during the study. CONCLUSIONS: Combined medication of Yimusake Tablets and dapoxetine hydrochloride, with its advantages of effectiveness and safety, deserves to be recommended for the treatment of PE.

Testosterone and weight loss: the evidence.

PURPOSE OF REVIEW: The purpose of this article is to examine the contemporary data linking testosterone therapy in overweight and obese men with testosterone deficiency to increased lean body mass, decreased fat mass, improvement in overall body composition and sustained weight loss. This is of paramount importance because testosterone therapy in obese men with testosterone deficiency represents a novel and a timely therapeutic strategy for managing obesity in men with testosterone deficiency. RECENT FINDINGS: Long-term testosterone therapy in men with testosterone deficiency produces significant and sustained weight loss, marked reduction in waist circumference and BMI and improvement in body composition. Further, testosterone therapy ameliorates components of the metabolic syndrome. The aforementioned improvements are attributed to improved mitochondrial function, increased energy utilization, increased motivation and vigor resulting in improved cardio-metabolic function and enhanced physical activity. SUMMARY: The implication of testosterone therapy in management of obesity in men with testosterone deficiency is of paramount clinical significance, as it produces sustained weight loss without recidivism. On the contrary, alternative therapeutic approaches other than bariatric surgery failed to produce significant and sustained outcome and exhibit a high rate of recidivism. These findings represent strong foundations for testosterone therapy in obese men with testosterone deficiency and should spur clinical research for better understanding of usefulness of testosterone therapy in treatment of underlying pathophysiological conditions of obesity.

Determinants of sexual activity in four birth cohorts of Swedish 70-year-olds examined 1971-2001.

INTRODUCTION: Knowledge about determinants of sexual activity in older adults in the general population is limited. Human senescence has been delayed by a decade, and people are reaching old age in better health. AIM: The aim of this study was to investigate determinants of sexual activity in four birth cohorts of non-demented 70-year-olds examined in 1971-1977 and 1992-2001. MAIN OUTCOME MEASURE: The main outcome measure was sexual activity (defined as intercourse) during the past year. METHODS: The study is based on cross-sectional data from four population samples of 70-year-olds from Gothenburg, Sweden (N = 1,407) systematically sampled from the Swedish population register. RESULTS: In the time periods 1971-1972 and 2000-2001, sexual activity among men increased from 47% to 66%, and in women from 12% to 34%. Sexual activity was related to positive attitude toward sexuality, sexual debut before age 20, having a very happy relationship, having a physically and mentally healthy partner, self-reported good global health, interviewer-rated good mental health, being married/cohabiting, satisfaction with sleep, and drinking alcohol more than three times a week. Having an older partner, diabetes mellitus, coronary heart disease, higher physical health-sum score, and depression were related to less sexual activity. Interaction effects for birth cohort, with stronger positive associations in 1971-1972, were found for positive attitude toward sexuality, strong desire at age 20-30, premarital sexuality, having a younger partner, self-reported good global health, interviewer-rated good global mental health, overweight, and satisfaction with sleep. Having an older partner and depression showed stronger negative associations in the 1970s. Physical health-sum score showed a stronger negative association in 1992-2001. CONCLUSIONS: We found that determinants of sexual activity in older people are numerous and varied, and change over time. It is thus important that health professionals and others take a holistic approach when dealing with sexual problems in older adults. Sexual aging should be part of health care and medical education. Clinicians should be trained to ask older patients about sexual concerns.

Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting.

BACKGROUND: The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women's ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting. METHODS: A mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants. RESULTS: A total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual 'steaming' practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in 'high-risk' situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly. CONCLUSIONS: Notional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting.

'As prostitutes, we control our bodies': perceptions of health and body in the lives of establishment-based female sex workers in Tijuana, Mexico.

Many studies of female sex work focus on HIV and other sexually transmitted infections because sex workers are considered bridges between high-risk and low-risk populations. The voices of female sex workers as they pertain to health issues are often lacking in the literature. This paper offers a feminist constructivist grounded theory study with establishment-based female sex workers in Tijuana, Mexico. Analyses of interviews with 20 women reveal that they are aware of the impact of their work on their bodies, but conceptualise their health holistically and not just in terms of HIV. They emphasise that working in the sex industry has implications for sexual health, non-sexual physical health and mental health. The paper concludes that in order for public health interventions to have more sustainable impact on the lives of female sex workers, they should take into account the voices of the women, including how they define their health. The findings suggest that public health professionals need to be more aware that female sex workers have agency and a desire to control their health and their bodies.

The effect of adolescent virginity status on psychological well-being.

Although previous research has found that sexually active teens are more likely to suffer from depression, it is not clear whether this association is causal or spurious in nature. This study uses data from the National Longitudinal Study of Adolescent Health to examine whether virginity status affects self-esteem and depression. For males, fixed effects and instrumental variables (IV) estimates provide little evidence that sex is causally related to psychological well-being. In contrast, IV estimates indicate that sexually active female adolescents are at increased risk of exhibiting the symptoms of depression relative to their counterparts who are not sexually active. Comparing the psychological well-being of females who used contraception at last intercourse with that of virgins suggests that these effects may be ameliorated, but not eliminated, by contraceptive use.

Religiosity, spirituality, and adolescent sexuality.

There are many individual, family, and cultural factors that influence the development of healthy sexuality in adolescents. One factor that is less often described but may play a role is religion/spirituality. Adolescents' religious/spiritual belief system or the cultural religious context within which they are raised may impact their attitudes or beliefs about having sex before marriage, decisions about the timing of coital debut, or contraceptive practices. In this article we will define the terms "religiosity" and "spirituality"; highlight the key scientific literature on the relationships between religiosity, spirituality, and adolescent sexual health outcomes (e.g., coital debut, contraceptive practices), including describing why religiosity/spirituality may be related to these outcomes; and briefly discuss programs/clinical implications for integrating these findings into clinical practice.

Effect of different preparations of hormone therapy on sexual dysfunction in naturally postmenopausal women.

OBJECTIVE: To compare the effect of different formulations of continuous combined hormone therapy on sexual performance in naturally postmenopausal women. MATERIAL AND METHODS: A total of 158 postmenopausal women were enrolled and prospectively randomized to the single-blind study. Fifty-four women received tibolone 2.5 mg, 53 received 2 mg estradiol and 2 mg dienogest (E2/dienogest), and 51 did not receive any menopausal therapy. The patients were monitored after 6 months. Attitudes of sexuality were evaluated by using the Rosen's female sexual function index. RESULTS: Compared with E2/dienogest and the control group, tibolone treatment was associated with more improvement of sexual performance, including sexual desire, sexual arousal and satisfaction. Both of the hormone therapies decreased frequencies of vaginal dryness and painful intercourse. CONCLUSIONS: Tibolone has more positive effects on the sexual dysfunction of postmenopausal women and may be an alternative to the E2/dienogest preparation in postmenopausal women with sexual dysfunction.

Matrimonio no consumado durante diez años y vaginismo crónico / Ten-year unconsummated marriage and chronic vaginismus

Presentamos un caso de matrimonio no consumado durante 10 años y vaginismo crónico en una mujer de 30 años. Se le practica himenectomía y plastia de Pozzi (AU)

We report a case of unconsummated marriage for 10 years and chronic vaginitis in a 30-year-old woman. Hymenectomy and Pozzi's plasty were performed (AU)

Exploring the motivations and fantasies of strip club customers in relation to legal regulations.

Strip clubs are a popular form of adult entertainment in the contemporary United States. Strip clubs are also highly embattled entertainment venues, based on assumptions about their associations with prostitution, drug use, and "negative secondary effects" in surrounding areas, such as increased crime rates and decreased property values. Based on participant observation in five strip clubs in one city and on qualitative interviews with 30 regular male customers of those clubs, this essay seeks to challenge assumptions about the kinds of encounters sought in and purchased in such venues. Instead of visiting strip clubs out of a desire to purchase sexual release with the dancers, I found that the regular male customers were seeking an atmosphere different from both work and home, personal and sexual acceptance from women and the pleasure of a sexualized encounter without the pressures of physical performance, and a form of leisure that offered a relative degree of "safety" as well as "excitement." Further, the men's own fantasies of identity, their understandings of marriage, and their commitment to a particular kind of monogamy influenced their choice of entertainment and the pleasure that they took in their encounters with the dancers. The essay discusses these motivations and their relational aspects and assesses strip club regulation in light of these observations and findings.

Sexual function in menopausal women in Kelantan, Malaysia.

OBJECTIVES: The aim of the study was to document sexual function in Kelantanese postmenopausal women. METHOD: A semi-structured questionnaire in Malay language was administered to 326 women (mean age of 57.1+/-6.58 (S.D.) years) residing in Kelantan. The subjects comprised of naturally menopaused, healthy women. RESULTS: Of the total respondents, 70% (n=227) were with a spouse at the time of the study. Of these, more than two-thirds reported a decrease in sexual activity following menopause. Varying degree of dyspareunia was reported by 44% of the women. A small fraction (8.8%) reported inability of the vagina to stretch sufficiently to enable the complete penetration of an erect penis. Of the total married respondents, vaginal secretion during sexual intercourse was decreased in 52.4%, did not change in 31% but increased in 1.3% of the women following menopause. Sexual desire was reportedly decreased or absent in two-thirds of the total respondents (n=326). CONCLUSION: It appears that sexual function significantly decreases during menopause. This may be due to dyspareunia, poor lubrication, loss of sexual desire, and the spouse's health status and ageing itself. Although declining sexual function was recognised by nearly two-thirds of the women, more than half did not take any action to improve their sexual function. Of those who did, they used hormonal therapy, traditional, alternative medicine or practiced healthy lifestyle or a varied combination of above self-help actions.