Decreased Immunoglobulin G Core Fucosylation, A Player in Antibody-dependent Cell-mediated Cytotoxicity, is Associated with Autoimmune Thyroid Diseases.

Autoimmune thyroid diseases (AITD) are the most common group of autoimmune diseases, associated with lymphocyte infiltration and the production of thyroid autoantibodies, like thyroid peroxidase antibodies (TPOAb), in the thyroid gland. Immunoglobulins and cell-surface receptors are glycoproteins with distinctive glycosylation patterns that play a structural role in maintaining and modulating their functions. We investigated associations of total circulating IgG and peripheral blood mononuclear cells glycosylation with AITD and the influence of genetic background in a case-control study with several independent cohorts and over 3,000 individuals in total. The study revealed an inverse association of IgG core fucosylation with TPOAb and AITD, as well as decreased peripheral blood mononuclear cells antennary α1,2 fucosylation in AITD, but no shared genetic variance between AITD and glycosylation. These data suggest that the decreased level of IgG core fucosylation is a risk factor for AITD that promotes antibody-dependent cell-mediated cytotoxicity previously associated with TPOAb levels.

Postcoital Symptoms in a Convenience Sample of Men and Women.

INTRODUCTION: Postcoital dysphoria (PCD) is a condition characterized by inexplicable feelings of tearfulness, sadness, and/or irritability. Previous research has mostly focused on these 3 symptoms, failing to explore other symptoms that can occur after sexual activity. AIM: The aim of the present study was to get a more in-depth understanding of postcoital symptom variety, to compare the type and frequency of these symptoms in men and women, and to explore the context in which they manifest. METHODS: A convenience sample of 223 women and 76 men filled in an online survey consisting of a list of 21 symptoms and a set of additional questions. MAIN OUTCOME MEASURE: The study outcomes were obtained using a study-specific questionnaire to assess postcoital symptoms, consisting of a list of 21 symptoms that form 4 domains and 2 additional questions that assess personal and interpersonal distress. RESULTS: Of all participants, 91.9% reported any postcoital symptom over the past 4 weeks and 94.3% ever since they had been sexually active. The most common symptoms in women were mood swings and sadness, whereas in men, it was unhappiness and low energy. Men and women differed in the frequency of postcoital symptoms experienced ever since being sexually active, with women reporting more sadness, mood swings, frustration, and worthlessness. For 73.5% of individuals, the postcoital symptoms were present after consensual sexual intercourse, for 41.9%, after general sexual activity, and for 46.6% also, after masturbation. Of all participants, 33.9% said that they only experienced the symptoms after orgasm. CLINICAL IMPLICATIONS: Postcoital symptoms are clearly more varied than previously suggested and are not related to classic "dysphoria" only. Hence, we propose to cease calling the phenomenon "postcoital dysphoria" and suggest to simply use the term "postcoital symptoms." STRENGTH & LIMITATIONS: This is the first study ever to provide a more in-depth exploration of postcoital symptom variety. The sample was relatively small, and the representativeness and, therefore, generalizability of the results was limited, given that a convenience sample was used. CONCLUSION: Our results indicate that postcoital symptoms are a multifaceted phenomenon which shows similar expression in men and women. The symptoms are clearly more varied not related to classic "dysphoria" only. Burri A, Hilpert P. Postcoital Symptoms in a Convenience Sample of Men and Women. J Sex Med 2020;17:556-559.

Pain Catastrophizing, Fear of Pain, and Depression and Their Association with Female Sexual Pain.

INTRODUCTION: Painful sexual intercourse or dyspareunia is a common complaint among women, affecting 12-21% of premenopausal women. Recent studies have begun to focus on the role of fear avoidance and pain catastrophizing (PC) in genital pain and have consistently highlighted the importance of psych-affective factors in sexual pain. AIM: To establish the importance of PC, fear of pain, and depression for the development and maintenance of female sexual pain. METHODS: This longitudinal study was conducted in the United Kingdom to assess sexual pain at 2 different time points, in 2009 and 2013, in a convenience sample of N = 979 British women. MAIN OUTCOME MEASURE: Well-validated questionnaires including the Pain Catastrophizing Scale, the Pain Anxiety Symptom Scale, and the Female Sexual Function Index (recent and lifelong version) were applied. RESULTS: Multilevel modeling showed a strong increase of short-lived sexual pain over the 4 years (π01 = -0.33; P < .001). According to the moderation analyses, only depression influenced the change in short-lived pain over the 4 years (π11 = 0.46; P = .016). Similarly, only depression turned out to be independently associated with sexual pain when entered into the multiple regression model, as women reporting higher depression levels also reported more sexual pain (P < 0.05). CLINICAL IMPLICATIONS: Clinicians should be aware that the mechanisms influencing short-lived sexual pain and changes in sexual pain seem to be different from the more enduring psychological factors that lead to the development and maintenance of "chronic" sexual pain. STRENGTHS & LIMITATIONS: A very generic and unidimensional definition of sexual pain was used without information on pain frequency or intensity, and no information on the possible underlying (medical or psychological or both) causes was available. However, as far as we know this represents the first study to use repeated measures to assess how pain changes over a 4-year period and to explore the role of potential psychoaffective risk factors. CONCLUSION: Among the variables studied, symptoms of depression seemed to be the only independent predictor of lifelong sexual pain, overriding potential influences of pain catastrophizing or fear of pain. Burri A, Hilpert P, Williams F. Pain Catastrophizing, Fear of Pain, and Depression and Their Association with Female Sexual Pain. J Sex Med 2020;17:279-288.

E-Sexual Health: A Position Statement of the European Society for Sexual Medicine.

BACKGROUND: Opportunities and pitfalls of e-health have been described and assessed in various health domains, but in the field of sexual health, the respective literature is limited. AIM: The aim of this document is to present the European Society of Sexual Medicine's (ESSM) current position statement on e-sexual health. METHODS: This statement article is an expert opinion-based proposal that was developed under the auspices of the ESSM with input from the e-sexual health subcommittee of the ESSM Scientific Committee. OUTCOMES: ESSM statements were provided on four domains: health information for patients, e-learning for professionals, health interventions, and health research. RESULTS: e-Sexual health is the use of information and communication technologies for sexual health including sexual health care, surveillance, education, knowledge, and research. Quality indicators have to be applied on Web pages that provide sexual health information, e-learning can increase educational opportunities for professionals, online treatment interventions can be effective but needs to be available to the public, and online health research can provide access to difficult to reach populations. CLINICAL IMPLICATIONS: The ESSM acknowledges the necessity for the use of information and communication technologies to meet the sexual health needs of citizens and patients and also the professional needs of sexual healthcare providers, in an evidence-based manner. STRENGTHS & LIMITATIONS: ESSM statements on this topic were provided based on expert opinion and summarize the ESSM position in this field. CONCLUSION: The ESSM believes that e-sexual health can provide opportunities for the improvement of the sexual health of the population. Kirana PS, Gudeloglu A, Sansone A, et al. E-Sexual Health: A Position Statement of the European Society for Sexual Medicine. J Sex Med 2020;17;1246-1253.

Current Strategies in the Management of Peyronie's Disease (PD)-Results of a Survey of 401 Sexual Medicine Experts Across Europe.

INTRODUCTION: Peyronie's disease (PD) is a progressive and devastating penile disorder that often results in severe penile curvature with penile shrinking, making vaginal insertion difficult or even impossible. Until now, in contrast to other penile disorders such as erectile dysfunction, PD is characterized by a paucity of conservative treatment options. AIM: To investigate the current status quo in the management of PD across European experts in sexual medicine. METHODS: Members of the European Society of Sexual Medicine and of various andrology and urology societies across Europe, with the majority (78%) being urologists, were contacted via e-mail and newsletters and asked to fill in an online questionnaire. The survey comprised 56 items developed by an expert consensus of the educational committee of the European Society of Sexual Medicine. In the end, 401 participants responded to the entire survey, with 277 reporting treating PD patients themselves and knowing this penile entity very well. MAIN OUTCOME MEASURES: Main outcome measures include description of current strategies regarding diagnosis and treatment of PD as reported by specialists in this field. RESULTS: Of the physicians treating PD patients, 94% performed penile palpation, and 74% perform ultrasonography. 45% assessed the degree of penile curvature by means of intravenous drug testing, but only 17% measured it accurately with a goniometer. Penile length, flaccid or in erect state, was measured by only 39% or 25%, respectively. Only 45% assessed testosterone. Primary treatment options were oral (65%), counseling (57%), and topical/local therapy (30%). Among oral drug users, tadalafil 5 mg was the most commonly used (57%), followed by vitamin E (40%). Regarding intralesional therapy, collagenase clostridium histolyticum was the leading drug (34%), followed by calcium channel blockers (17%). Considering surgical procedures, the original Nesbit technique was the preferred procedure (33%). 36% of the specialists expressed their dissatisfaction with the currently available treatment options, and 64% reported the impression that their patients were mostly dissatisfied with the treatment outcomes. CLINICAL IMPLICATIONS: Innovative and presumably multi-modal treatment protocols for PD are urgently needed. STRENGTHS & LIMITATIONS: The survey represents 1 of the largest studies on the management of PD. The results are representative for the standard management of PD mostly among European Urologists with specialization in sexual medicine and may therefore not be generalizable to regions outside Europe or to other physicians treating PD. CONCLUSION: Around one-third of experts and, from their perspective, around two-thirds of patients are dissatisfied with the currently available PD treatment options. Porst H, Burri A, the European Society for Sexual Medicine (ESSM) Educational Committee. Current Strategies in the Management of Peyronie's Disease (PD)-Results of a Survey of 401 Sexual Medicine Experts Across Europe. J Sex Med 2019;16:901-908.

Masturbatory Behavior in a Population Sample of German Women.

BACKGROUND: Human masturbation is and has been a very heatedly and controversially discussed topic in human sexuality. Studies investigating aspects of human masturbatory behavior and female sexual pleasure remain scarce. This lack of knowledge opens the door to further controversies and misconceptions. AIM: To conduct an explorative study on female masturbatory behavior to gain more insight into this nonreproductive sexual behavior and provide an empiric basis for future research. METHODS: A total of 425 German women (mean age 26.6 years), 61.4% of whom were in a committed relationship, completed a comprehensive 76-item online survey consisting of study-specific, self-constructed questions and validated and standardized questionnaires. MAIN OUTCOME MEASURE: Correlation and comparative analyses were performed. Results are presented numerically as means and percentages. RESULTS: The majority (94.5%) of women indicated having masturbated at least once in their life, with a mean age at first masturbation of 14 years. 85.9% of women described masturbation as "genital self-stimulation until reaching orgasm." The majority of women reported masturbating 2 or 3 times a week (26.8%) or once a week (26.3%). Factors independently associated with masturbation frequency were relationship status, orgasm frequency, openness to new experience, and body acceptance. Almost all women (91.5%) reported masturbating also when in a relationship. For the 5.5% of women who had never engaged in autoerotic stimulation, the 2 main reasons were "I hardly every feel sexual desire" and "sex is a partner-only thing." 7.6% reported never experiencing an orgasm during masturbation, whereas 50.3% indicated that they always reached orgasm during autostimulation. The reasons cited for engaging in masturbation were manifold, ranging from sexual desire to relaxation and stress reduction. The most common fantasy included the partner; however, 20.7% fantasized about being "defenseless," and 8.7% thought about a "disturbing" scenario that they chose not to elaborate further. CLINICAL IMPLICATIONS: For many women, masturbation does not represent "a partner substitute" to seek sexual pleasure, but rather is a stress coping and relaxation strategy. STRENGTHS & LIMITATIONS: This is one of the very first studies to provide more in-depth insight into a variety of aspects related to female masturbation. The representativeness of the data is limited to this particular sample of German women. CONCLUSION: Our findings highlight the huge diversity in terms of masturbation frequency, motivations, styles, and preferences that can be observed in this particular population sample of German women. Burri A, Carvalheira A. Masturbatory Behavior in a Population Sample of German Women. J Sex Med 2019;16:963-974.

Stability of Genetic and Environmental Influences on Female Sexual Functioning.

BACKGROUND: Genetic factors have been implicated in the etiology of female sexual dysfunction. Yet, how much the dynamic nature of sexual functioning is influenced by changes in genetic and/or environmental factors remains unknown. AIM: To explore temporal stability of genetic and environmental influences on female sexual functioning over a 4-year period. METHODS: Data on desire, arousal, lubrication, orgasm, satisfaction, and pain were collected in 2009 and 2013 using the Female Sexual Function Index and were available for 1,209 British twin women. OUTCOMES: To track the stability of genetic influences the Female Sexual Function Index sub-domain and total scores were subject to multivariate twin analyses for repeated measures. RESULTS: Desire showed a lower heritability at follow-up (37% vs 14%) whereas for arousal and sexual pain the heritability at follow-up was higher compared to baseline (28% vs 34% and 30% vs 45%, respectively). The heritability of lubrication remained stable at 27%. According to the best-fitting additive environmental (AE) Cholesky model for all domains except for sexual pain there were no new genetic factors expressing themselves over the 4-year period, but an addition of new, unique environmental determinants could be observed. For sexual pain an additional genetic factor could be observed at follow-up, explaining 39% of the phenotypic variance. CLINICAL TRANSLATION: The biological pre-disposition to sexual problems seems to remain relatively stable over time. CONCLUSIONS: This is the first study to investigate the genetic stability of female sexual functioning in a large population sample of women. White ethnicity and the relatively high mean age of women asks for caution in extrapolating the findings to other ethnic and age groups. The findings highlight the value of more in-depth exploration of the non-shared environmental influences that could provide clues to the mechanisms behind remittance and/or persistence of sexual problems. Integration of these findings may provide a useful conceptual framework for the treatment and prevention of certain types of sexual problems. Burri A, Ogata S. Stability of Genetic and Environmental Influences on Female Sexual Functioning. J Sex Med 2018;15:550-557.

The Importance of Male Ejaculation for Female Sexual Satisfaction and Function.

INTRODUCTION: Although links between ejaculatory control or intravaginal ejaculatory latency time and female sexual functioning have frequently been reported in the past, no study has investigated the importance of other male ejaculatory characteristics, such as ejaculation volume and intensity, for women's sexuality. AIM: To assess the importance of subjectively perceived ejaculation intensity and ejaculation volume for female sexual function and satisfaction. METHODS: This was a cross-sectional online survey including 240 sexually active, heterosexual women (median age 27.4 years), using study-specific questions and validated questionnaires. MAIN OUTCOME MEASURE: Results are presented as means, percentages, and age-controlled partial correlation coefficients of the main study variables. RESULTS: 50.43% of women considered it very important that the partner ejaculates during intercourse. 18.3% of women preferred that the partner ejaculates before they reach orgasm, whereas for 53.5% this did not matter. 22.6% of women stated that they experienced a more intense orgasm when their partner ejaculated during vaginal intercourse. 17.4% reported that they definitely experienced a more intensive orgasm depending on the intensity of their partner's ejaculation, whereas for 17.8% this did not matter at all. 20.9% of women did not feel that their orgasm was more intense depending on the subjectively felt ejaculate quantity, whereas the majority (37.9%) stated that it did not matter. 13.1% of women regarded the quantity of expelled ejaculate as an expression of their own sexual attractiveness. Women stating that they experienced more intense orgasms when the partner ejaculated, when the partner experienced a more intense ejaculation, and when he expelled a greater ejaculate quantity also reported better lifelong orgasmic function (r = 0.24, r = 0.15, r = .26, respectively) and more lifelong sexual satisfaction (r = .29, r = .15, r = 26, respectively). CLINICAL IMPLICATIONS: The perception of ejaculatory characteristics can be related to the female partner's sexual satisfaction and overall sexual functioning. STRENGTH & LIMITATIONS: This is the very first study to explore the importance of male ejaculation volume and intensity for women's sexual functioning. Data are of self-report nature and ejaculation characteristics were not objectively measured but by women's self-report. CONCLUSION: Although male ejaculation and its different aspects seem to play an important role for women, the study demonstrates a considerable variability of women's attitudes toward ejaculatory characteristics. Further research is required to examine the sources of this variability. Burri A, Buchmeier J, Porst H. The importance of male ejaculation for female sexual satisfaction and function. J Sex Med 2018;15:1600-1608.

Interpersonal Sensitivity as a Mediator Between Cumulative Childhood Traumatic Events and Adult Sexual Disturbance.

Previous research has shown that cumulative childhood traumatic events are stronger predictors of sexual disturbances than childhood sexual abuse. Additional factors are likely to influence this relationship. Whereas socio-interpersonal factors such as interpersonal sensitivity have repeatedly been shown to be salutogenic in the aftermath of traumatic events, the specific underlying mechanisms are little understood. The aim of the present study was to examine the relationship between cumulative childhood traumatic events and adult sexual disturbances (i.e., the avoidance of sexual contacts, disruptive sexual behavior, poor sexual boundaries, decreased regulation of sexual impulses) and to investigate the role of interpersonal sensitivity as a potential mediator. The sample comprised 100 adult psychiatric in-patients. As expected, cumulative childhood traumatic events were found to be strong predictors of sexual disturbances, with interpersonal sensitivity partially mediating this relationship.

DNA methylation profiles of elderly individuals subjected to indentured childhood labor and trauma.

BACKGROUND: Childhood trauma is associated with increased vulnerability to mental and somatic disorders later in life. Epigenetic modifications such as DNA methylation are one potential mechanism through which such long-lasting impairments/consequences can be explained. The aim of the present study was to investigate whether childhood trauma is associated with long-term DNA methylation alterations in old age. METHODS: We assessed genome-wide DNA methylation profiles in a cohort of former indentured child laborers ("Verdingkinder") who suffered severe childhood adversities (N = 30; M age = 75.9 years), and compared them to control group with similar demographic characteristics (N = 15, M age = 72.8 years). DNA was isolated from epithelial buccal cells and hybridized to the Illumina Infinium 450 k DNA methylation array, which provides coverage of 485,000 methylation sites. RESULTS: After accounting for batch effects, age, gender and multiple testing, 71 differentially methylated CpG positions were identified between the two groups. They were annotated among others to genes involved in neuronal projections and neuronal development. Some of the identified genes with differential methylation (DLG associated protein 2, mechanistic target of rapamycin) have previously been associated with traumatic stress. CONCLUSIONS: The results indicate specific epigenetic alterations in elderly individuals who were subjected to childhood adversities. Psychiatric and somatic comorbidities as well as differences in buccal epithelial cells proportion may contribute to the observed epigenetic differences.

Sexual Sensation Seeking, Sexual Compulsivity, and Gender Identity and Its Relationship With Sexual Functioning in a Population Sample of Men and Women.

INTRODUCTION: Despite awareness of the importance of psycho-affective factors in the development of sexual problems, there is a lack of studies exploring the relation of sexual sensation seeking (SSS) and sexual compulsivity (SC) to sexual functioning. Because sex differences in SSS and SC have been reported, gender identity (GI; an individual's own experience of his or her gender that is unrelated to the actual biological sex) might act as a moderator in this relation. AIM: To understand the role of SSS and SC for men and women's sexual functioning and to explore whether these potential associations are moderated by GI. METHODS: A population-based cross-sectional online survey targeted 279 individuals (69.2% women, 30.8% men; mean age = 32 years). Validated questionnaires, including the Sexual Sensation Seeking Scale, the Sexual Compulsivity Scale, the Female Sexual Function Index, the Premature Ejaculation Diagnostic Tool, and the International Index of Erectile Function, were applied. MAIN OUTCOME MEASURES: Variations in SSS and SC and their association with sexual functioning were investigated using Spearman rank correlation. Moderation analyses were conducted using regression models in which the interaction terms between SSS and GI and between SCS and GI as predictors of sexual functioning were included. RESULTS: A statistically significant correlation between SSS and SC could be detected in men and women (r = 0.41 and 0.33, respectively; P < .001 for the two comparisons). In women, higher levels of SSS were associated with higher levels of desire, arousal, lubrication, and orgasm and less sexual pain (P < .05 for all comparisons). No moderating effect of GI could be detected. In men, GI was a significant moderator in the relation between SC and erectile function (ß = 0.47; P < .001) and between SSS and erectile and ejaculatory function (ß = -0.41 and 0.30; P < .001 for the two comparisons). CONCLUSION: The present study is the first to show a link between SSS and SC and sexual functioning. The results might have important clinical implications and can provide useful information for programs aimed at sexual health enhancement.

What Women Want-An Explorative Study on Women's Attitudes Toward Sexuality Boosting Medication in a Sample of Swiss Women.

INTRODUCTION: The recent approval of flibanserin to treat hypoactive sexual desire disorder in premenopausal women has once again fueled the ongoing debate about medicalization of female sexual problems and the necessity of such a drug. AIM: To investigate women's attitudes toward sexuality-boosting medication (SBM) and the role of factors potentially associated with these attitudes, including sexual functioning, sexual quality of life, relationship satisfaction, and personality, in an exploratory survey. METHODS: A population sample of 159 women 18 to 73 years old (mean = 31.8) participated in this cross-sectional online survey. Study variables were assessed using a combination of validated questionnaires and self-constructed questions. MAIN OUTCOME MEASURES: Descriptive statistics in the form of proportions and percentages and correlation and moderation analyses. RESULTS: Sixty-one percent of women were willing to take SBM, mostly to increase orgasm frequency and intensity and sexual desire. Likeliness to take SBM correlated negatively with age (r = -0.24; P < .005) and with levels of arousal, lubrication, orgasm, and sexual satisfaction (P < .05 for all comparisons). Higher relationship satisfaction and conscientiousness moderated the association between willingness to take SBM and desire levels (P < .05 for the two comparisons). For desired properties of SBM, 48.2% of women considered an onset of action of "up to 1 hour" ideal, 41% preferred "less than 15 minutes," and 66.9% considered a window of action of "an hour" to be ideal. CONCLUSION: The demand for a drug to enhance sexual performance in women exists and ideally should target desire and orgasm intensity and frequency. By taking such as drug, women hope to benefit in increased sexual satisfaction and fun with sex. Furthermore, the willingness to take SBM seems to greatly depend on the woman's relationship satisfaction and some personality characteristics. Gutsche M, Burri A. What Women Want-An Explorative Study on Women's Attitudes Toward Sexuality Boosting Medication in a Sample of Swiss Women. J Sex Med 2017;14:404-412.

Differential DNA Methylation in Monozygotic Twins Discordant for Female Sexual Functioning.

BACKGROUND: Research has repeatedly suggested genetic and environmental factors in the etiology underlying female sexual dysfunction (FSD). Because sexual functioning is a highly variable trait, epigenetics could provide a promising approach to tackle the origins of FSD and consequently offer a step-change in our understanding of these problems. AIM: To identify differentially methylated CpG positions for sexual functioning in a sample of monozygotic twin pairs discordant for sexual functioning. METHODS: The sample consisted of 33 trait-discordant monozygotic twin pairs (mean age = 54.1 years, SD = 9.05) from the Twins UK Registry. Phenotypic data on sexual desire, arousal, lubrication, orgasm, satisfaction, and pain were collected using the Female Sexual Function Index-Lifelong (FSFI-LL). The Illumina Infinium HumanMethylation 450 DNA BeadChip was used for epigenome-wide analyses of DNA methylation in whole-blood samples. OUTCOMES: Comparison of DNA methylation patterns associated with the FSFI-LL total score and its six subdomains. RESULTS: Two differentially methylated CpG positions (cg09580409 and cg14734994) reaching experiment-wide statistical significance were found for overall sexual functioning, mapping to MGC45800 and the threonine synthase-like 2 gene (THNSL2), respectively. Furthermore, potential biologically relevant candidates for sexual desire (CUB and zona pellucida-like domains 1, CUZD1) and satisfaction (solute carrier family 6 member 19, SLC6A19) were identified. CLINICAL TRANSLATION: THNSL2 and SLC6A19, which have been linked to weight and adiposity, might represent novel candidates for sexual problems in women. STRENGTHS AND LIMITATIONS: This is the first study to investigate epigenetic mechanisms underlying FSD. The study used a relative small sample of monozygotic female twins. The cutoff to determine discordance in sexual problems was chosen based on a 10% FSFI score difference. Therefore, the results have to be interpreted with caution and need replication in larger clinical samples. CONCLUSION: Understanding how genes and environment interact to influence our sexuality might inform clinical practice and lead to new treatments for women experiencing FSD. Burri A, Leupin M, Spector T, Marinova Z. Differential DNA Methylation in Monozygotic Twins Discordant for Female Sexual Functioning. J Sex Med 2017;14:1357-1364.

Theory of Planned Behavior including self-stigma and perceived barriers explain help-seeking behavior for sexual problems in Iranian women suffering from epilepsy.

PURPOSE: To apply the Theory of Planned Behavior (TPB) and the two additional concepts self-stigma and perceived barriers to the help-seeking behavior for sexual problems in women with epilepsy. METHODS: In this 18-month follow-up study, TPB elements, including attitude, subjective norm, perceived behavioral control, and behavioral intention along with self-stigma and perceived barriers in seeking help for sexual problems were assessed in n=818 women with epilepsy (94.0% aged ≤40years). The basic TPB model (model 1) and the TPB model additionally including self-stigma and perceived barriers (Model 2) were analyzed using structural equation modeling (SEM). RESULTS: Both SEM models showed satisfactory model fits. According to model, attitude, subjective norms, perceived behavioral control, and intention explained 63.1% of the variance in help-seeking behavior. Variance was slightly higher (64.5%) when including self-stigma and perceived barriers (model 2). In addition, the fit indices of the models were better highlighting the importance of self-stigma and perceived barriers in help-seeking behavior for sexual problems. CONCLUSION: Theory of Planned Behavior is useful in explaining help-seeking behavior for sexual problems in women with epilepsy. Self-stigma and perceived barriers are additional factors that should be considered in future interventions aiming to adopt TPB to improve help-seeking behavior for sexual problems.

Female sexual function mediates the effects of medication adherence on quality of life in people with epilepsy.

PURPOSE: The purpose of this study was to understand the mediating effects of female sexual functioning in the association between medication adherence and quality of life (QoL) in Iranian women with epilepsy (WWE). METHODS: Women's sexual functioning was measured using Female Sexual Function Index; QoL using Quality of Life in Epilepsy; epilepsy severity using Liverpool Seizure Severity Scale; subjective medication adherence using Medication Adherence Report Scale; and objective medication adherence using serum level for antiepileptic drugs in 567 WWE. Medication adherence was measured at baseline, while women's sexual functioning, QoL, and epilepsy severity were measured at the 6-month follow-up. Structural equation modeling and regression models were conducted to examine the mediating role of women's sexual functioning. RESULTS: The mediating effects of sexual functioning in the relationship between medication adherence (including subjective and objective measures) and QoL were supported in the total score of Female Sexual Function Index (coefficient=0.415, SE=0.117, p<0.001 for subjective medication adherence; coefficient=1.980, SE=0.446, p<0.001 for objective medication adherence). Seizure severity was significantly associated with QoL but only when objective medication adherence was measured (coefficient=-0.094, SE=0.036, p=0.009). CONCLUSION: Our results extended the importance of medication adherence from symptom reduction to the beneficial effects of women's sexual functioning and QoL. Health care providers should be aware of these additional benefits of medication adherence and use these arguments to encourage female patients to take their medication, which can eventually increase their sexual satisfaction and overall QoL.

Using the Theory of Planned Behavior incorporated with perceived barriers to explore sexual counseling services delivered by healthcare professionals in individuals suffering from epilepsy.

People with epilepsy (PWE) are highly likely to suffer from sexual dysfunction, and dealing with this issue is a challenge for healthcare providers. Unfortunately, there is no theory-driven study that has investigated the counseling practice of healthcare providers for sexual problems in PWE. Therefore, we decided to apply the well-established Theory of Planned Behavior (TPB) to examine factors associated with healthcare providers' sexual counseling in PWE. Apart from TPB, perceived barriers toward providing counseling could be a possible factor that needs to be investigated as well. Therefore, two models explaining sexual counseling practice were proposed. Model 1 included only TPB and Model 2 included TPB incorporated with perceived barriers. Five hundred fifty-nine Iranian healthcare professionals responsible for PWE were recruited across several neurology clinics and asked to complete TPB-specific questionnaires. The same healthcare professionals were asked to complete an additional questionnaire on their attitudes toward sexual counseling 18months later. Structural equation modeling suggested Model 2 to be more useful in explaining sexual counseling practice compared with Model 1. Moreover, attitude and perceived behavioral control showed stronger associations with behavioral intention, whereas subjective norm showed weaker associations. The associations were similar across different healthcare professionals (i.e., medical doctors vs. nurses). In conclusion, TPB incorporated with perceived barriers might be a useful theory for different types of healthcare providers to improve and enhance sexual counseling practice.

A behavioral strategy to minimize air pollution exposure in pregnant women: a randomized controlled trial.

BACKGROUND: Pregnant women and their fetus belong to a sensitive group in response to air pollution hazards. The aim of this study was to evaluate the effectiveness of a theory-based educational program to change pollution exposure behavior in pregnant women. METHODS: In this randomized controlled trial, pregnant women attending a prenatal clinic in Tehran, Iran were selected and randomized into the experimental and control groups. The inclusion criteria were age between 18 and 35 years, having a history of pregnancies without adverse outcomes and not suffering from chronic diseases. Data collected at baseline and 2-month follow-up. At baseline face-to-face interviews were conducted using a valid and reliable questionnaire including items on demographic characteristics, stages of change, self-efficacy, decisional balance and practice regarding air pollution preventive behaviors. The intervention composed of three parts: motivational interviewing, a booklet and daily small message service (SMS). The control group received no intervention except receiving usual care. Follow-up data were collected after the intervention. Data were analyzed performing t-test, Mann-Whitney U test, and chi-squared. RESULTS: In all the data for 104 pregnant women (53 in the intervention and 51 in the control group) were analyzed. The mean age of participants was 27.2 (SD = 4.11) years and it was 22.89 (SD = 8.75) weeks for gestational age. At baseline there were no significant statistical differences between intervention and control groups on the study measures while we found significant group differences in terms of stages of change, self-efficacy, perceived benefits and practice regarding air pollution preventive behaviors at follow-up assessment (P < 0.05). CONCLUSION: The findings indicated that the TTM-based intervention was effective in increasing air pollution preventive behaviors among pregnant women. This study provided a framework to modify some psychosocial determinants of air pollution preventive behavior other than knowledge using constructs of Transtheoretical model of behavior change, additionally results suggests the importance of education and makes enlightenment of the air pollution risk knowledge accelerate. TRIAL REGISTRATION: IRCT2012091010804N1.

Childhood trauma and resilience in old age: applying a context model of resilience to a sample of former indentured child laborers.

OBJECTIVES: Psychological resilience has been rarely investigated in elderly populations. We applied a more comprehensive model of trauma-specific coping and resilience, which included Ungar's context model and included decentral factors of resilience (i.e., environments that provide resources to build resilience). METHOD: We assessed resilience in a cohort of former Swiss indentured child laborers (N = 74; 59% males) at two time points; first at the mean age of 80 years and then again 20 months later. At each time point, the following measures of resilience were assessed: resilience indicators of life satisfaction and lack of depression. In addition, resilience predictors of trauma exposure, perceived social support, dysfunctional disclosure of traumatic experiences, social acknowledgment as a victim, and self-efficacy; and decentral resilience factors of education, income, number of children, and physical health were measured. RESULTS: Using path-analysis, we found that life satisfaction and lack of depression were predicted by dysfunctional disclosure, social support, and self-efficacy at various significance levels. Change scores of resilience were predicted by higher trauma exposure, social acknowledgment as a victim, and an interaction between the two. The model for decentral factors also fitted, with physical health and income predicting the resilience indicators. CONCLUSION: Applying this comprehensive resilience model in a sample of older adults revealed meaningful findings in predicting resilience at a single time point and over time. Atypical coping strategies, such as perceived social acknowledgment as a victim and disclosure, may be particularly important for former victims who have suffered institutional abuse.

A genome-wide association study of early menopause and the combined impact of identified variants.

Early menopause (EM) affects up to 10% of the female population, reducing reproductive lifespan considerably. Currently, it constitutes the leading cause of infertility in the western world, affecting mainly those women who postpone their first pregnancy beyond the age of 30 years. The genetic aetiology of EM is largely unknown in the majority of cases. We have undertaken a meta-analysis of genome-wide association studies (GWASs) in 3493 EM cases and 13 598 controls from 10 independent studies. No novel genetic variants were discovered, but the 17 variants previously associated with normal age at natural menopause as a quantitative trait (QT) were also associated with EM and primary ovarian insufficiency (POI). Thus, EM has a genetic aetiology which overlaps variation in normal age at menopause and is at least partly explained by the additive effects of the same polygenic variants. The combined effect of the common variants captured by the single nucleotide polymorphism arrays was estimated to account for ∼30% of the variance in EM. The association between the combined 17 variants and the risk of EM was greater than the best validated non-genetic risk factor, smoking.

Emotional Intelligence and Sexual Functioning in a Sample of Swiss Men and Women.

INTRODUCTION: Past research has emphasized the importance of psychologic factors in the multifactorial etiology of sexual problems. AIM: The purpose of the study was to examine (i) how emotional intelligence (EI) associates with sexual functioning; and (ii) whether EI moderates the association between sexual functioning and sexual quality of life (SQoL). METHODS: A total of 211 participants completed questionnaires relating to EI, sexual functioning, and SQoL. A set of standardized and validated questionnaires were used, including the International Index of Erectile Function, the Premature Ejaculation Diagnostic Tool, the Female Sexual Function Index, the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and the Sexual Quality of Life Questionnaire (SQoL). MAIN OUTCOME MEASURES: Correlation, partial correlation, and moderation analyses were used to investigate the associations and moderations. RESULTS: When taking into account age and relationship duration, EI was significantly negatively correlated with female sexual desire only (rs = -0.39, P < 0.01). No associations between EI and male sexual functioning on any domain could be detected. A moderation effect of EI in the association between sexual satisfaction and SQoL was observed in women, but not in men. Sexual functioning correlated positively with SQoL in both sexes. CONCLUSIONS: Our findings show for the first time an association between female desire levels and normal variations in EI. Findings also tentatively suggest a relative gender difference in the factors contributing to sexual problems and SQoL, although results need to be confirmed in larger samples.