Overall and domain-specific life satisfaction when living with familial Alzheimer's disease risk: A quantitative approach.

In this study, we explored life satisfaction and sense of coherence in relation to biopsychosocial variables in individuals at risk for the development of familial Alzheimer's disease. Forty nine individuals (response rate: 96%) were interviewed. Life satisfaction was found to be high for the majority of participants. Those who were older than the expected age of onset of disease, those <6 years' inclusion in the Familial Alzheimer's disease biomarker study, and males tended to experience positive psychological health. Sense of coherence was positively associated with satisfaction with life as a whole, psychological health, vocation, and economy. Women seem to be more vulnerable than men, and attention should be given to those who have not passed the age of expected symptom onset. Early and recurrent counseling and psychosocial support were found to be essential. Issues related to vocation and economy are areas of concern, and are closely associated with sense of coherence, life satisfaction, and psychological health. This study emphasizes the importance of professional teams working together with the patient and their families.

The meaning of living close to a person with Alzheimer disease.

Only a few studies explore the lifeworld of the spouses of persons affected by early-onset Alzheimer disease (AD). The aim of this study is to explore the lifeworld of spouses when their partners are diagnosed with AD, focusing on spouses' lived experience. The study employs an interpretative phenomenological framework. Ten in-depth interviews are performed. The results show that spouses' lifeworld changes with the diagnosis. They experience an imprisoned existence in which added obligations, fear, and worry keep them trapped at home, both physically and mentally. In their longing for freedom, new strategies and attitudes helps the spouses to create an extended "lived space" with their partner. The findings stress the importance of paying attention to the lifeworld of spouses and making clinical recommendations on this basis. Most importantly, the lifeworld perspective has implications for how we understand what care is. We hope to challenge all different healthcare professionals and invite them to discuss the deep meaning of care and the definition of being professional in encounters with vulnerable others from a lifeworld perspective.

Standard operating procedures for female genital sexual pain.

INTRODUCTION: Female genital sexual pain (GSP) is a common, distressing complaint in women of all ages that is underrecognized and undertreated. Definitions and terminology for female GSP are currently being debated. While some authors have suggested that GSP is not per se a sexual dysfunction, but rather a localized genial pain syndrome, others adhere to using clearly sexually related terms such as dyspareunia and vaginismus. AIM: The aims of this brief review are to present definitions of the different types of female GSP. Their etiology, incidence, prevalence, and comorbidity with somatic and psychological disorders are highlighted, and different somatic and psychological assessment and treatment modalities are discussed. METHODS: The Standard Operating Procedures (SOP) committee was composed of a chair and five additional experts. No corporate funding or remuneration was received. The authors agreed to survey relevant databases, journal articles and utilize their own clinical experience. Consensus was guided by systematic discussions by e-mail communications. MAIN OUTCOME/RESULTS: There is a clear lack of epidemiological data defining female GSP disorders and a lack of evidence supporting therapeutic interventions. However, this international expert group will recommend guidelines for management of female GSP. CONCLUSIONS: GSP disorders are complex. It is recommended that their evaluation and treatment are performed through comprehensive somato-psychological multidisciplinary approach.

When Ejaculation Becomes the Goal in Itself: A Psychodynamic Approach to Delayed Ejaculation.

There are a group of men with delayed ejaculation (DE) where the etiology as well as the consequences of the dysfunction are unclear. The aim of the present study was to explore, from a psychodynamic perspective, personality traits among men seeking treatment due to DE. During a 2.5-year period, a consecutive series of 14 men with DE were seeking help at Karolinska University hospital, Sweden. Full medical history and physical examination, sexological case-history and psychological assessments were performed by physicians and a psychotherapist. The results found all patients to be healthy. Mean age was 34 years (range 20-43 years). No other sexual dysfunction occurred. With one exception, they were sexually active. The psychological assessment (The Karolinska Psychodynamic Profile; KAPP) found patients to have difficulties in areas of dependency and separation, control and impulse control, regression in the service of the ego, coping with aggressive affects, alexithymic traits, sexual function, and satisfaction. The results add a deeper understanding of personality traits among healthy patients with DE, which may be a tool for the case history, and offer new treatment strategies. We suggest that DE can be the physical manifestation of some specific personality difficulties, and thus, ejaculation becomes the goal in itself and not the climax of an enjoyable adventure.

Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation.

INTRODUCTION: The consequences of stroke on sexual life in stroke patients in need of specialized cognitive rehabilitation have been limited explored. A biopsychosocial perspective in post-stroke sexuality studies is warranted to capture the complex picture of stroke consequences and sexual life after stroke and sexual satisfaction is an important outcome measure when exploring such multifactorial associations. AIM: To explore sexual satisfaction and associated biopsychosocial factors in stroke patients admitted to specialized cognitive rehabilitation. METHODS: A cross-sectional study was performed including 91 consecutive stroke patients admitted to specialized cognitive rehabilitation. Data were collected from medical records and by face-to-face interviews using a structured interview guide and questionnaires. Descriptive and inferential statistics were applied. MAIN OUTCOME MEASURES: A wide range of biopsychosocial variables including medical and sociodemographic characteristics, social support, sexual complaints, aspects of sexual life, psychological distress and life satisfaction were analyzed in relation to the main outcome "Satisfaction with sexual life." RESULTS: Only 33 % were satisfied with sexual life. Prevalence of sexual complaints was high, more frequent in women (84%) than in men (64%). Three-quarters were less sexually active than before stroke. Multivariable analyses showed that anxiety, sleep problems, manifested sexual complaint, decrease in sexual activity and fear of partner rejection were significantly associated with low odds of sexual satisfaction, while affectionate support and partnership satisfaction were significant for sexual satisfaction. When combined in a biopsychosocial multivariable model only fear of partner rejection (OR 0.07; 95 % CI: 0.01-0.42) and decrease in sexual activity (OR 0.11; 95 % CI: 0.02-0.58) showed significant contribution to sexual satisfaction. CONCLUSION: The variety of predictors for sexual satisfaction indicates that therapeutic actions need to be individualized and points towards a broad assessment and interventional approach to meet the sexual rehabilitation needs of stroke patients with cognitive impairments in need of specialized rehabilitation. Vikan JK, Snekkevik H, Nilsson MI, et al. Sexual Satisfaction and Associated Biopsychosocial Factors in Stroke Patients Admitted to Specialized Cognitive Rehabilitation. Sex Med 2021;9:100424.

Definitions/epidemiology/risk factors for sexual dysfunction.

INTRODUCTION: Accurate estimates of prevalence/incidence are important in understanding the true burden of male and female sexual dysfunction and in identifying risk factors for prevention efforts. This is the summary of the report by the International Consultation Committee for Sexual Medicine on Definitions/Epidemiology/Risk Factors for Sexual Dysfunction. AIM: The main aim of this article is to provide a general overview of the definitions of sexual dysfunction for men and women, the incidence and prevalence rates, and a description of the risk factors identified in large population-based studies. METHODS: Literature regarding definitions, descriptive and analytical epidemiology of sexual dysfunction in men and women were selected using evidence-based criteria. For descriptive epidemiological studies, a Prins score of 10 or higher was utilized to identify population-based studies with adequately stringent criteria. This report represents the opinions of eight experts from five countries developed in a consensus process and encompassing a detailed literature review over a 2-year period. MAIN OUTCOME MEASURES: The study aims to provide state-of-the-art prevalence and incidence rates reported for each dysfunction and stratified by age and gender. Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: A wealth of information is presented on erectile dysfunction, its development through time, and its correlates. The field is still in need of more epidemiological studies on the other men's sexual dysfunction and on all women's sexual dysfunctions. CONCLUSIONS: A review of the currently available evidence from epidemiological studies is provided.

Summary of the recommendations on sexual dysfunctions in men.

INTRODUCTION: Sexual health is an integral part of overall health. Sexual dysfunction can have a major impact on quality of life and psychosocial and emotional well-being. AIM: To provide evidence-based, expert-opinion consensus guidelines for clinical management of sexual dysfunction in men. METHODS: An international consultation collaborating with major urologic and sexual medicine societies convened in Paris, July 2009. More than 190 multidisciplinary experts from 33 countries were assembled into 25 consultation committees. Committee members established scope and objectives for each chapter. Following an exhaustive review of available data and publications, committees developed evidence-based guidelines in each area. Main Outcome Measures. New algorithms and guidelines for assessment and treatment of sexual dysfunctions were developed based on work of previous consultations and evidence from scientific literature published from 2003 to 2009. The Oxford system of evidence-based review was systematically applied. Expert opinion was based on systematic grading of medical literature, and cultural and ethical considerations. RESULTS: Algorithms, recommendations, and guidelines for sexual dysfunction in men are presented. These guidelines were developed in an evidence-based, patient-centered, multidisciplinary manner. It was felt that all sexual dysfunctions should be evaluated and managed following a uniform strategy, thus the International Consultation of Sexual Medicine (ICSM-5) developed a stepwise diagnostic and treatment algorithm for sexual dysfunction. The main goal of ICSM-5 is to unmask the underlying etiology and/or indicate appropriate treatment options according to men's and women's individual needs (patient-centered medicine) using the best available data from population-based research (evidence-based medicine). Specific evaluation, treatment guidelines, and algorithms were developed for every sexual dysfunction in men, including erectile dysfunction; disorders of libido, orgasm, and ejaculation; Peyronie's disease; and priapism. CONCLUSIONS: Sexual dysfunction in men represents a group of common medical conditions that need to be managed from a multidisciplinary perspective.

Sexual function in men treated for testicular cancer.

INTRODUCTION: Testicular germ cell cancer (TGCC) patients may be at risk of developing sexual dysfunction after treatment. AIM: The aim of this study was to assess the prevalence of sexual dysfunctions in TGCC patients 3 to 5 years after treatment, and relate findings to biochemical hypogonadism, treatment intensity, and the expected prevalence in the Swedish male population. METHODS: A questionnaire study on 129 consecutive TGCC patients 3 to 5 years post-treatment was performed. Comparators were an age-matched nationally representative group of men (N = 916) included in a study on sexual life in Sweden. MAIN OUTCOME MEASURES: Sexual functions (including erectile dysfunctional distress), time since last intercourse, sexual satisfaction, and experience of sexological treatment seeking were assessed using the same questions used in the epidemiological study on sexual life in Sweden. The findings in TGCC patients were correlated to biochemical signs of hypogonadism and type of oncological treatment: Surveillance, adjuvant chemotherapy, adjuvant radiotherapy, or standard doses of chemotherapy. RESULTS: A higher proportion of TGCC patients than comparators were likely to report low sexual desire (odds ratio [OR] 6.7 [95% confidence interval {CI} 2.1-21]) as well as erectile dysfunction (OR 3.8 [95% CI 1.4-10]). No significant differences were observed regarding erectile dysfunctional distress, change of desire over time, interest in sex, premature or delayed ejaculation, time since last intercourse, need for or receiving sexual advice, or sexual satisfaction. Hypogonadism did not predict erectile dysfunction (OR 1.1 [95% CI 0.26-4.5]) or low sexual desire (OR 1.2 [95% CI 0.11-14]). Treatment modality had no obvious impact on sexual function. CONCLUSION: Men treated for testicular cancer had higher risk of having low sexual desire and erectile dysfunction 3 to 5 years after completion of therapy than comparators. These sexual dysfunctions were not significantly associated with treatment intensity or hypogonadism.

Closeness and life satisfaction after six years for persons with stroke and spouses.

OBJECTIVE: To explore long-term experiences of satisfaction with life in persons with stroke and spouses. DESIGN: This prospective cohort-study collected data on life satisfaction 1 and 6 years after stroke using the Life Satisfaction Checklist; focusing on "Life as a whole" and the domain "Closeness" ("Family life", "Partner relationship", "Sexual life"). Open-ended questions were added to illustrate changes in daily life. SUBJECTS: A total of 72 stroke participants (24 singles, 48 married) and 24 spouses. Most of the stroke participants were men with a mild stroke. Median age for persons with stroke and spouses was 65 years. RESULTS: All groups (singles/married stroke participants, spouses) experienced changes in satisfaction regarding "Closeness", and most often these changes were perceived as negative. The item "Sexual life" had the lowest proportion of satisfied participants. After 6 years, 58% of singles and 78% of married stroke participants were satisfied with "Life as a whole". The proportion of satisfied spouses was 41%. CONCLUSION: For the vast majority of people who have had a stroke and their spouses, long-term satisfaction with aspects of "Closeness" decline. The results suggest a need to develop, evaluate and implement programmes that support satisfaction with the different aspects of "Closeness".

Sexual health policies in stroke rehabilitation: A multi national study.

OBJECTIVE: To identify and explore sexual health policies at specialized stroke rehabilitation centres in relation to the perspectives of healthcare personnel concerning sexual health. DESIGN: Cross-sectional study. SUBJECTS: Nine specialized rehabilitation centres representing 7 countries, and healthcare personnel (n = 323) working with stroke rehabilitation at the 9 centres were included in the study. METHODS: Two structured questionnaires were used: (i) an organizational-audit on sexual health policies; (ii) an anonymous web-questionnaire assessing the perspectives of healthcare personnel concerning sexual health. RESULTS: Of the 9 centres, 5 scored high on having sexual health policy in stroke rehabilitation and 4 scored low. Healthcare personnel working at centres with high scores reported higher levels of knowledge and comfort in working with sexual health, and looked more positively on the workplace sexual health policies, than personnel working at centres scoring low on these factors. Most personnel expressed a need for knowledge on the topic. Being comfortable about addressing sexuality was significantly associated with higher levels of knowledge about sexuality and working at centres having sexual health policies. CONCLUSION: A lack of sexual health policy represents a barrier to evidence-based practice in stroke rehabilitation. Such protocols need to be implemented in standard care in order to meet the sexual rehabilitation needs of stroke patients and partners.

Sexual Function and Testosterone Level in Men With Conservatively Treated Chronic Kidney Disease.

Sexual dysfunctions are common, but underrecognized, in patients with chronic kidney disease (CKD) and are inversely associated with the glomerular filtration rate (GFR). Sexual dysfunctions may affect quality of life in males with CKD. The aim of this study was to analyze the relationship among sex hormones, sexual function, and sexual satisfaction in a group of men between 18 and 50 years of age with CKD Stages 1 to 5 not treated with hemodialysis or peritoneal dialysis. Fasting blood samples for hemoglobin, testosterone, prolactin, and luteinizing hormone and questionnaire surveys (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) were evaluated in 100consecutive men. Higher CKD stage (i.e., lower renal function) had a statistically significant ( p < .01) correlation with lower total testosterone, free testosterone, and hemoglobin levels, and higher luteinizing hormone and prolactin levels. Sexual function/dysfunctions were not significantly associated with CKD stage, even after adjustment for age and serum testosterone. The results indicate that CKD stage is a factor affecting testosterone levels in combination with age in men between 18 and 50 years of age at different stages of CKD but not treated with hemodialysis or peritoneal dialysis. Sexual dysfunctions are common but not strongly correlated to testosterone levels, prolactin levels, and survey (Sexual Complaints Screener for Men, International Index of Erectile Function, and Aging Male Symptom scale) responses in patients with CKD.

Life satisfaction in 18- to 64-year-old Swedes: in relation to education, employment situation, health and physical activity.

OBJECTIVE: The aim of this study is to relate different sociodemographic, health and physical activity parameters to levels of satisfaction with life as a whole and with 10 specific domains of life. DESIGN: Data on socio-demographic items were sampled, using strictly structured interviews, while a checklist (LiSat-11) was used for self-reported levels of life satisfaction. SUBJECTS: A nationally representative Swedish sample of 1207 women and 1326 men aged 18-64 years. RESULTS: Univariately most of these socio-demographic variables were associated with several of the LiSat-11 items. Using logistic regression, perceived good health and not being a first generation immigrant were the most prominent positive predictors of satisfaction with life as a whole and of most of the domains. Also educational level impacted predictively on satisfaction with many LiSat-11 items. Furthermore, those who were vocationally active, perceived their financial situation as better than or similar to most people's and had a steady partner relationship were particularly likely to be satisfied with life as a whole and with two or more of the domains. CONCLUSION: These results indicate that a multitude of aspects must be taken into account when assessing life satisfaction.

Life satisfaction in 18- to 64-year-old Swedes: in relation to gender, age, partner and immigrant status.

Satisfaction with life as a whole and with 10 domains of life was assessed in a nationally representative Swedish sample of 1207 women and 1326 men aged between 18 and 64 years, using a generic self-report checklist (LiSat-11), with levels of satisfaction ranging along a six-grade ordinal scale from 1 (very dissatisfied) to 6 (very satisfied). The main findings are that, with marginal exceptions, life satisfaction is gender independent, while age is systematically and positively associated with vocational and financial situations. Having no partner and being a first-generation immigrant implies for most LiSat-11 items a relatively low level of satisfaction. Factor analysis of the domain-specific items yields a gender-independent four-factor structure, which is robustly independent of different scaling reductions. Gross levels of satisfaction (dichotomized scales 1-4 vs 5-6) of seven domains were significant classifiers (odds ratio 1.7-3.9) of gross level of satisfaction with life as a whole. This investigation provides reference values for LiSat-11, which, with its ease of administration may be an adequate instrument for analysing, in terms of subjects' cognitive appraisal of emotions, aspirations-achievement gaps.

Treatment-seeking, aspects of sexual activity and life satisfaction in men with laser-treated penile carcinoma.

OBJECTIVES: The aims were to assess the initial symptoms of penile carcinoma and patients' time frame in treatment seeking, and to describe the effect of laser treatment on sexual activity and life satisfaction. PATIENTS AND METHODS: A retrospective face-to-face structured interview study of patients laser treated for localised penile carcinoma at the department of Urology in Orebro, Sweden, during 1986 to 2000. Sixty-seven was treated and 58 of them (mean age, 63 yr; range, 34-90) were alive at the time of this study. Forty-six (79%) agreed to participate. RESULTS: Ninety-six percent of the patients recalled their first symptom of penile carcinoma. Superficial ulceration and fissures were the most common symptoms (39%). Thirty-seven percent delayed seeking treatment for more than 6 mo. The patients had a greater lifetime number of sexual partners and a greater lifetime prevalence of STIs than a Swedish representative comparator population. Some aspects of sexual life, such as manual stimulation/caressing and fellatio, decreased markedly after laser treatment. Patient satisfaction with life as a whole was approximately the same as that of the general population. CONCLUSIONS: Patients delayed seeking treatment for a considerable period, despite awareness of the first local symptoms. Men with laser-treated localised penile carcinoma resume their sexual activities to a large extent after the treatment. Except for satisfaction with somatic health, similar-or even higher-proportions of patients than comparators are satisfied with life as a whole and with other domains of life including satisfaction with sexual life.

On orgasm, sexual techniques, and erotic perceptions in 18- to 74-year-old Swedish women.

OBJECTIVES: To explore, in an age perspective, women's lifetime sexual techniques and the extent to which they had led to orgasm. To relate these techniques and current erotic perceptions to orgasmic function in women sexually active during the last 12 months and to describe the relative impact of orgasmic function/dysfunction on their sexual well-being. METHODS: A nationally representative sample of 18- to 74-year-old women (N = 1,335) participated. Nearly all were heterosexual. Current orgasmic capacity was broadly and subjectively classified into: no, mild, or manifest dysfunction. Sexual techniques and erotic perceptions were recorded together with level of sexual satisfaction. RESULTS: Generational differences characterized age at first orgasm and intercourse, types and width of sexual repertoire, and also current erotic perceptions, while orgasmic dysfunction and distress caused by it were less age dependent. Likely protectors of good orgasmic function, mainly against manifest dysfunction, were: a relatively early age at first orgasm, a relatively greater repertoire of techniques used--in particular having been caressed manually or orally by partner(s), achievement of orgasm by penile intravaginal movements, attaching importance to sexuality and being relatively easily sexually aroused. In turn, among other aspects of female sexual function women who did not have orgasmic dysfunction or distress were particularly likely to be satisfied with their sexual life. CONCLUSION: Besides providing data on matters frequently said to be sensitive this investigation shows that women's generation and with it several long-ranging aspects of women's sexual history and their feelings of being sexual are important indicators of their orgasmic and thereby their overall sexual well-being. When (in clinical practice) establishing treatment strategy for women with orgasmic dysfunction due respect should be given to these factors.

Well-being among children and adolescents with mobility impairment in relation to demographic data and disability characteristics.

AIM: To describe the well-being of children and adolescents with mobility impairment in relation to demographic data and disability characteristics. METHODS: The present study is based on interviews with 141 subjects aged 7 to 18?y with impaired mobility. Perceived overall well-being was measured by a nine-grade visual scale, the Snoopy scale. Independence or dependence was evaluated by the Index of Independence in Activities of Daily Living. Motor capacity was assessed with an instrument including active movements, rapidity, locomotion and balance as well as the presence and localization of pain. RESULTS: Since there were no significant differences in well-being regarding the diagnostic-related group, additional disorder/disability or the degree of disability, the impairment per se did not necessarily influence well-being negatively. Even though the majority of the children and adolescents in the study indicated a high level of well-being, several risk factors for a lower level of well-being were identified: greater age, not living with both parents, being a first-generation immigrant, having an acquired disease/injury and experience of pain. CONCLUSION: These findings increase our limited knowledge of well-being among children/adolescents with mobility impairment and provide a basis for effective care and future research.

A Swedish telephone help-line for sexual problems: a 5-year survey.

INTRODUCTION: Telephone help-lines for people with sexual problems have been established in many European countries during the late decade. They, however, have very different modes of operation, and very few reports focusing on the way they function have been published internationally. AIM: To describe the methods and activities of a Swedish help-line for sexual problems. METHODS: In the 5 years, from 1999 to 2003, 27,387 persons called the Swedish toll-free help-line for "impotence and sexual problems" that operates around the clock. The majority of callers appeared to be looking for information on erectile dysfunction. A counseling option staffed by experts in sexual medicine counseled 2,817 (men 73%, women 27%). A further 478 callers were professionals wanting information or advice. RESULTS: Among a wide spectrum of problems associated with the callers' sexual life, sexual dysfunctions were the most frequent. Calls about sexual abuse, sexual preference, paraphilias, and other subjects were also received. Among those with sexual dysfunction, 33% of men and 41% of women had more than one sexual dysfunction. These were often concomitant with a frequently drug-treated, medical condition. In addition to counseling, the majority of callers were advised to contact physicians or specialists in sexology/sexual medicine for further help. CONCLUSION: Competent person-to-person telephone counseling in the multifaceted bio-psycho-social field of sexual problems requires broad knowledge on sexual medicine.