Assessment of an onco-sexology support and follow-up program in cervical or vaginal cancer patients undergoing brachytherapy.

PURPOSE: Women's sexual health and wellbeing with cervical or vaginal cancer may be largely affected by complications from external beam radiotherapy (EBRT) and utero-vaginal brachytherapy (BT), of which vaginal stenosis is the main complication. The objective of this study was to assess the impact of support by a nurse sexologist on sexuality, vaginal side-effects, and the quality of clinical follow-up in patients treated with brachytherapy for cervical or vaginal cancer. METHODS: We performed a retrospective study of the sexuality of women treated for cervical or vaginal cancer. Data from patients with cervical or vaginal cancer who underwent brachytherapy between 2013 and 2017 were collected at Institut Universitaire de Cancer de Toulouse-Oncopôle (IUCT-Oncopôle). Patients were divided into two groups: group A (intervention group) received support from a nurse sexologist and group B (control group) did not. The chi-square test and a logistic multivariate model were used for data analysis. RESULTS: A total of 156 patients were included in this study, including 57.7% who were followed by a nurse sexologist. We observed low compliance in using vaginal dilators after brachytherapy and/or radiotherapy over time regardless of the group, and patients' sexual activity was inadequately addressed. Information regarding the resumption of sexuality 2 months after treatment was missing in 1.1% of patients in group A and in 36.4% of patients in group B. Multivariate analysis showed that patients in group A had a lower risk of developing vaginal stenosis with OR crude = 0.5 (95% CI = 0.25-0.92) and OR adj. = 0.5 (95% CI = 0.26-1.09) compared with those in group B. CONCLUSION: This retrospective study highlights the lack of information collected by physicians during follow-up concerning the sexuality of patients with cervical or vaginal cancer treated by EBRT and BT. The support offered by nurse sexologists in improving patients' sexual activity and reducing their physical side-effects such as vaginal stenosis is likely to be beneficial. A prospective study is currently being conducted to validate the present findings.

Expanding Statistical Frontiers in Sexual Science: Taxometric, Invariance, and Equivalence Testing.

Sexual scientists must choose from among myriad methodological and analytical approaches when investigating their research questions. How can scholars learn whether sexualities are discrete or continuous? How is sexuality constructed? And to what extent are sexuality-related groups similar to or different from one another? Though commonplace, quantitative attempts at addressing these research questions require users to possess an increasingly deep repertoire of statistical knowledge and programming skills. Recently developed open-source software offers powerful yet accessible capacity to researchers wishing to perform strong quantitative tests. Taking advantage of these new statistical opportunities will require sexual scientists to become familiar with new analyses, including taxometric analysis, tests of measurement variability and differential item functioning, and equivalence testing. In the current article, I discuss each of these analyses, providing conceptual and historical overviews. I also address common misunderstandings for each analysis that may discourage researchers from implementing them. Finally, I describe current best practices when using each analysis, providing reproducible coding examples and interpretations along the way, in an attempt to reduce barriers to the uptake of these analyses. By aspiring to explore these new statistical frontiers in sexual science, sexuality researchers will be better positioned to test their substantive theories of interest.

Sexual health and needs for sexology care in digestive cancer patients undergoing chemotherapy: a 4-month cross-sectional study in a French University Hospital.

PURPOSE: To assess sexual health and needs for sexology care of cancer patients during chemotherapy. METHODS: We performed a 4-month cross-sectional study in cancer patients treated by chemotherapy in the digestive cancer department of a regional university hospital. Patients were asked to fill out a self-administered questionnaire about their sexual health, Sexual Quality of Life Questionnaire for Male (SQoL-M) or Female (SQoL-F), and their needs for sexology care. RESULTS: The study sample was composed of 47 men and 31 women. Tumor locations were 36 colorectal (46%), 23 pancreatic (30%), and 19 other digestive cancers (24%). SQoL scores were lower in women (p < .001), in pancreatic and colorectal tumors (p = .041 and p = .033, respectively) compared to other digestive cancers, and in less-educated patients (p = .023). During chemotherapy, 40% of sexually active patients had less frequent sexual intercourse than before diagnosis, and 33% had completely stopped sexual activity. Sexuality care was desired by 44% of respondents. Among them, 83% favored a consultation with a medical sexologist and 63% with a psycho-sexologist, 54% wanted couple therapy, and 31% considered support groups. Patients with colorectal cancer had more frequent sexual intercourse without penetration at the time of survey (p = .036) and more often wanted couple therapy than patients with pancreatic cancer (p = .048). CONCLUSIONS: This study is the first determination of sexual health and sexual quality of life in digestive cancers. Targets for interventions during chemotherapy for digestive cancers include populations with lower sexual quality of life: women, pancreatic sites, patients with sexual troubles during chemotherapy, and less-educated patients.

Clinical Practice in Portuguese Sexology.

Few studies explore the clinicians' knowledge, attitudes, and practices regarding sexuality, despite their role in the sexual-health socialization process. This study focuses on Portuguese sexologists engaged in clinical practice. It aims to characterize sexologists' sex education and training and their clinical practices, including diagnostic and therapeutic approaches. This research followed the methodology of an European survey on sexology as a profession (Euro-Sexo). From the 91 respondents who completed questionnaires, 51 (56%) were active in clinical practice. Results indicate that the Portuguese clinical sexologist is significantly older, predominantly male, has had training in sexology, performs more scientific research, and is more engaged in teaching activities when compared to nonclinical working sexologists. This article describes the main sexual problems presented by patients to Portuguese clinical sexologists and highlights differences in the professional groups and approaches toward treating these problems by medical doctors and nonmedical professionals. Results reinforce the idea that there are intra-European differences in the educational background of sexologists and reveal important variations in Portuguese sexologists' education, training, and clinical practice. The representations and practices of the sexologists in Portugal, as in other European countries, are embedded in cultural scenarios and sexual cultures, with implications for the clinical practice.

Nonprobability and probability-based sampling strategies in sexual science.

With few exceptions, much of sexual science builds upon data from opportunistic nonprobability samples of limited generalizability. Although probability-based studies are considered the gold standard in terms of generalizability, they are costly to apply to many of the hard-to-reach populations of interest to sexologists. The present article discusses recent conclusions by sampling experts that have relevance to sexual science that advocates for nonprobability methods. In this regard, we provide an overview of Internet sampling as a useful, cost-efficient, nonprobability sampling method of value to sex researchers conducting modeling work or clinical trials. We also argue that probability-based sampling methods may be more readily applied in sex research with hard-to-reach populations than is typically thought. In this context, we provide three case studies that utilize qualitative and quantitative techniques directed at reducing limitations in applying probability-based sampling to hard-to-reach populations: indigenous Peruvians, African American youth, and urban men who have sex with men (MSM). Recommendations are made with regard to presampling studies, adaptive and disproportionate sampling methods, and strategies that may be utilized in evaluating nonprobability and probability-based sampling methods.

[Sexological intervention on premature ejaculation]. / Intervención sexológica en eyaculación precoz.

Strategies, recommendations and techniques proposed by sex therapy for intervention on premature ejaculation, have represented for nearly four decades the most effective model of intervention in this sexual dysfunction, which currently is complemented by the efficacy of dapoxetine drug treatment. Clinical experience and recent studies support that combined intervention offers the best therapeutic results. In addition in sex therapy, etiologic diagnosis is obtained from the analysis of the interrelationship of the couple. Diagnostic and therapeutic intervention has to be always centered in the relationship, so the techniques and resources must be applied with the expectation of being implemented in the sexual interaction. It will therefore be the relationship that receive treatment, even if medication is used for one of the members of the couple. On the other hand, this model of intervention can be implemented by a professional with training, although not necessarily a specialist.

Efficacy of sexological healthcare for people with chronic diseases and physical disabilities.

The purpose of this study was to determine whether participation in a short and well-structured psychosexual therapy was effective for people with a broad range of physical impairments and chronic diseases. Data were collected from 37 men and 10 women (between 30 and 70 years of age). The results demonstrated that psychosexual therapy has a positive effect on several areas of sexual well-being: less relational stress and sexual stress and an increase in sexual satisfaction, sexual esteem, sexual interaction competence, and a higher frequency in sexual contact. Although based on a relatively small sample, these findings clearly indicate that people with physical impairments can benefit from psychosexual therapy.

Cardiovascular aspects of sexual medicine.

INTRODUCTION: Erectile dysfunction (ED) is common and considered to be predominantly of vascular origin. AIM: To evaluate the link between ED and coronary artery disease (CAD) and provide a consensus report regarding evaluation and management. METHODS: A committee of eight experts from six countries was convened to review the worldwide literature concerning ED and CAD and provide a guideline for management. MAIN OUTCOME MEASURE: Expert opinion was based on grading the evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS: ED and CAD frequently coexist. Between 50-70% of men with CAD have ED. ED can arise before CAD is symptomatic with a time window of 3-5 years. ED and CAD share the same risk factors, and endothelial dysfunction is the common denominator. Treating ED in cardiac patients is safe, provided that their risks are properly evaluated. CONCLUSION: ED is a marker for silent CAD that needs to be excluded. Men with CAD frequently have ED that can be treated safely following guidelines.

Endocrine aspects of male sexual dysfunctions.

INTRODUCTION: Endocrine disorders may adversely affect men's sexual function. AIM: To provide recommendations based on best evidence for diagnosis and treatment of endocrine-related male sexual dysfunctions. METHODS: The Endocrine Aspects of Male Sexual Dysfunctions Committee, including 11 members from eight countries and four continents, collaborated with the Endocrine subcommittee of the Standards Committee of the International Society for Sexual Medicine. Medical literature was reviewed in detail, followed by extensive internal committee discussion over 2 years, then public presentation and discussion with the other experts before finalizing the report. MAIN OUTCOME MEASURE: Recommendations based on grading of evidence-base medical literature and interactive discussion. RESULTS: From animal studies, it is derived that testosterone modulates mechanisms involved in erectile machinery, including expression of enzymes that both initiate and terminate erection. In addition, testosterone is essential for sexual motivation. Whether these findings could be extrapolated to human erections is unclear. Testosterone plays a broad role in men's overall health. Recent studies have established strong associations between low testosterone and metabolic and cardiovascular imbalances. In some studies, low testosterone decreased longevity; however, longitudinal studies do not support the predictive value of low testosterone for further cardiovascular events. The article proposes a standardized process for diagnosis and treatment of endocrine-related male sexual dysfunctions, updating the knowledge on testosterone and prostate safety. There is no compelling evidence that testosterone treatment causes prostate cancer or its progression in men without severe testosterone deficiency (TD). The possible roles of prolactin and thyroid hormones are also examined. CONCLUSIONS: Men with erectile dysfunction, hypoactive sexual desire and retarded ejaculation, as well as those with visceral obesity and metabolic diseases, should be screened for TD and treated. Prospective interventional studies are required before screening for TD in more conditions, including cardiovascular diseases, and considering correction as preventive medicine as much data suggests.

Trauma, gender reassignment, and penile augmentation.

INTRODUCTION: Penile trauma is common with standard management options. Gender reassignment techniques are rapidly changing and penile augmentation remains a controversial topic. Consequently, there is need for a state-of-the-art information in this area. AIM: This study aims to develop an evidence-based state-of-the-art consensus report on the management of penile trauma, gender, reassignment and penile augmentation. METHODS: The study provides state-of-the-art knowledge regarding the prevalence, etiology, medical and surgical management of penile trauma, gender reassignment and penile augmentation, representing the opinion of leading experts developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURES: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. CONCLUSIONS: Penile fracture should be managed surgically. Information should be readily available to patients to help them decide the surgical technique desired for gender reassignment and to justify any form of penile augmentation.

Disorders of orgasm and ejaculation in men.

INTRODUCTION: Ejaculatory/orgasmic disorders are common male sexual dysfunctions, and include premature ejaculation (PE), inhibited ejaculation, anejaculation, retrograde ejaculation, and anorgasmia. AIM: To provide recommendations and guidelines concerning current state-of-the-art knowledge for management of ejaculation/orgasmic disorders in men. METHODS: An international consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 25 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge of disorders of orgasm and ejaculation represent the opinion of seven experts from seven countries developed in a process over a 2-year period. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Premature ejaculation management is largely dependent upon etiology. Lifelong PE is best managed with PE pharmacotherapy (selective serotonin re-uptake inhibitor [SSRI] and/or topical anesthetics). The management of acquired PE is etiology specific and may include erectile dysfunction (ED) pharmacotherapy in men with comorbid ED. Behavioral therapy is indicated when psychogenic or relationship factors are present and is often best combined with PE pharmacotherapy in an integrated treatment program. Retrograde ejaculation is managed by education, patient reassurance, pharmacotherapy, or bladder neck reconstruction. Delayed ejaculation, anejaculation, and/or anorgasmia may have a biogenic and/or psychogenic atiology. Men with age-related penile hypoanesthesia should be educated, reassured, and instructed in revised sexual techniques which maximize arousal. CONCLUSIONS: Additional research is required to further the understanding of the disorders of ejaculation and orgasm.

[Psychoanalysis and sexology: antagonism or synergy?]. / Psychanalyse et sexologie: antagonisme ou complémentarité?

Psychoanalysis and sexology are both int-rested in human sexuality but they do not share the same approach. Sexual medicine and sexotherapy aim to o-jectify sexuality and to treat sexual disorders whereas psychoanalysis is more interested in the discovery and the understanding of the subjective experienceoof sexuality. In psych-analysis, change arises rather from acceptance than modification. Evidence based medicine shows that the efficacy of sex therapy is limited and recommends the use of integrative approaches. Psychoanalysis is a necessary complement to sexology because of the links it forges between functional sexuality and psychosexuality, a sexuality with a psychological and emotional dimension, related to an individual's personal history and his identity.

Elucidating women's (hetero)sexual desire: definitional challenges and content expansion.

The literature on women's sexual desire is reviewed with an emphasis on definitional challenges, an assessment of the empirical basis for the distinction between spontaneous and responsive desire, a reconsideration of the extent to which women's sexual desire is relational in nature, and an exploration of the incentive value of sex for women as a factor partially independent from the experience of sexual desire. Nine recommendations are made regarding research and diagnostic directions. The article concludes with an appeal for the inclusion of eroticism in research and clinical work on sexual desire.

El sexo y el género: dos dominios científicos diferentes que debieran ser clarificados / Sex and gender: two different scientific domains to be clarified

Donde hasta hace poco se utilizaba el vocablo sexo y sus derivados (diferencias sexuales, roles y estereotipos sexuales), hoy aparece una tendencia generalizada a sustituirlo por género y sus derivados (diferencias de género, roles y estereotipos de género), o bien a que el sexo y el género compartan espacio en los trabajos científicos, haciendo referencia a dos dominios distintos. Aquí se tratará de justificar la necesidad de un modelo capaz de integrar ambas complejas realidades, la del sexo y la del género, dando lugar a dos disciplinas autónomas, aunque complementarias, como son la sexología y la generología. En ambos casos, se parte de un punto de vista funcional, que es el que daría sentido a la especificidad de ambas disciplinas, dado que con él se pretende concatenar las distintas aportaciones provenientes de diferentes campos del saber. Este planteamiento puede tener importantes consecuencias en el terreno de la investigación, en el de la educación, en el de la vivencia de mujeres, varones y personas ambiguas, y en el clínico(AU)

Nowadays, the word sex and its related terms (sexual differences, sexual roles and stereotypes), so common not long ago, seems to have been replaced by gender and its related terms (gender differences, gender roles and stereotypes). We can sometimes find both sex and gender sharing the same space in scientific articles, although referring to different domains. In this paper, I try to explain the need for a model that can integrate both of these complex domains of sex and gender, leading to two independent, although complementary, disciplines: Sexology and Genderology. In both cases, I start from a functional standpoint, which will give meaning to both disciplines’ specificities, as it is meant to link contributions from different fields of knowledge. This approach can have consequences for research, education, the experience of women, men, and ambiguous individuals, and therapy(AU)

Beyond the pleistocene: using phylogeny and constraint to inform the evolutionary psychology of human mating.

Evolutionary psychologists explore the adaptive function of traits and behaviors that characterize modern Homo sapiens. However, evolutionary psychologists have yet to incorporate the phylogenetic relationship between modern Homo sapiens and humans' hominid and pongid relatives (both living and extinct) into their theorizing. By considering the specific timing of evolutionary events and the role of evolutionary constraint, researchers using the phylogenetic approach can generate new predictions regarding mating phenomena and derive new explanations for existing evolutionary psychological findings. Especially useful is the concept of the adaptive workaround-an adaptation that manages the maladaptive elements of a pre-existing evolutionary constraint. The current review organizes 7 features of human mating into their phylogenetic context and presents evidence that 2 adaptive workarounds played a critical role as Homo sapiens's mating psychology evolved. These adaptive workarounds function in part to mute or refocus the effects of older, previously evolved adaptations and highlight the layered nature of humans' mating psychology.

Male sexual dysfunction: diagnosis and treatment from a sexological and interdisciplinary perspective.

BACKGROUND: Among all types of sexual disturbance in men, disturbances of sexual function are the most important in clinical practice. These are classified by the segment of the sexual reaction cycle in which they arise (appetence, arousal, orgasm, and resolution). Partial functional impairment must be distinguished from dysfunction causing significant suffering and requiring treatment. METHODS: The authors' clinical experience is supplemented with a selective review of the literature on sexual dysfunction, its association with underlying diseases, and its impact on sexual and relational satisfaction. RESULTS: The sexual history (including the partner's sexual history, as far as this can be obtained) is of prime importance in the diagnostic evaluation of sexual disturbances. This evaluation must take the multidimensionality and multiple functions of human sexuality into account. Chronic frustration of the fundamental psychosocial needs for acceptance, closeness, and security is a very important factor that has been neglected until now by the prevailing conceptions of the etiology and pathogenesis of sexual disturbances. Their treatment involves a combination of elements from sexual medicine and psychotherapy, along with somatic medical and pharmacotherapeutic intervention, if needed. The goal of syndyastic sex therapy, a further development of the previous therapies, is to fulfill these fundamental needs and thereby to improve the patient's sexual function and deepen his satisfaction with the relationship in its entirety. CONCLUSIONS: It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for the couple, with respect to reproduction, sexual pleasure, and bonding. Sexual disturbances are common, and patients therefore expect their physicians to be proficient in sexual medicine. The coverage of this subject in both undergraduate and postgraduate medical education in Germany needs to be improved.

Clinical holistic medicine: teaching orgasm for females with chronic anorgasmia using the Betty Dodson method.

The objective of this study was to test the Betty Dodson method of breaking the female orgasm barrier in chronic anorgasmic women. The aim was sexual and existential healing (salutogenesis) through direct confrontation and integration of both the repressed shame, guilt, and other negative feelings associated with body, genitals, and sexuality, and the repressed sexual pleasure and desire. We conducted a retrospective analysis of clinic data from holistic sexological manual therapeutic intervention, an intensive subtype of clinical holistic medicine (CHM). The patients received 3 "e 5 h of group therapy, integrating short-term psychodynamic psychotherapy (STPP) and complementary medicine (CAM bodywork, manual sexology similar to the inverted exclamation mark section signsexological examination inverted exclamation mark ). The therapy used the advanced tools of reparenting, genital acceptance, acceptance through touch, and direct sexual clitoral stimulation. A clitoral vibrator was used. Participants were 500 female patients between 18 and 88 years of age (mean of 35 years) with chronic anorgasmia (for 12 years on average) who were participating in the inverted exclamation mark section signorgasm course for anorgasmic women inverted exclamation mark ; 25% of the patients had never experienced an orgasm. Our results show that 465 patients (93%) had an orgasm during therapy, witnessed by the therapist, and 35 patients (7%) did not. Postmenopausal women were as able to achieve orgasm as fertile women, as were women who never had an orgasm. No patients had detectable negative side effects or adverse effects. NNT: 1.04 < NNT < 1.12, NNH > 500. Therapeutic value: TV = NNH/NNT > 446. Our conclusions are that holistic sexological manual therapy may be rational, safe, ethical, and efficient.