Lifestyles and sexuality in men and women: the gender perspective in sexual medicine.

Sexual health is strictly related with general health in both genders. In presence of a sexual dysfunction, the expert in sexual medicine aims to discover the specific weight of the physical and psychological factors can cause or con-cause the sexual problem. At the same time, a sexual dysfunction can represent a marker of the future development of a Non-communicable diseases (NCDss) as cardiovascular or metabolic diseases.In the evaluation phase, the sexual health specialist must focus on these aspects, focusing especially on the risk and protective factors that could impact on both male and female sexuality.This article presents a review of researches concerning healthy and unhealthy lifestyles and their contribute in the development of sexual quality of life in a gender-dependent manner.Among the unhealthy lifestyle, obesity contributes mostly to the development of sexual dysfunctions, due to its negative impact on cardiovascular and metabolic function. Tobacco smoking, alcohol - substance abuse and chronic stress lead to the development of sexual dysfunction in a med-long term.In order to guarantee a satisfying sexual quality of life, sexual health specialists have the responsibility to guide the patient through the adoption of healthy lifestyles, such as avoiding drugs, smoke and excessive alcohol, practicing a regular physical activity, following a balanced diet and use stress-management strategies, even before proposing both pharmaco- and/or psychotherapies.

Attachment Style, Sexual Orientation, and Biological Sex in their Relationships With Gender Role.

INTRODUCTION: Masculinity and femininity constitute the gender role construct into the general concept of sexual identity. AIM: To investigate the relationships of attachment style, sexual orientation and biological sex with the gender role. METHODS: A convenience sample of 344 subjects (females = 207; males = 137) was recruited. MAIN OUTCOME MEASURES: The Attachment Style Questionnaire (ASQ), the Kinsey Scale, and the Bem Sex Role Inventory assessed, respectively, attachment styles, sexual orientation, and masculinity/femininity was administered. RESULTS: Regression analysis revealed that the confidence scale of the ASQ (secure attachment) and relationship as secondary scale of ASQ (insecure/dismissing attachment) have a predictive role toward a higher score of masculinity (ß = 0.201; P = .000 and ß = 0.208; P = .000, respectively), whereas the need of approval scale of the ASQ (insecure/fearful-preoccupied attachment) shows a reverse association on it (ß = -0.228; P = .001). Moreover, to be a male is predictive for masculinity (ß = 0.196; P = .000). Also, femininity is predicted by the confidence (ß = 0.173; P = .002) and the need of approval (ß = 0.151; P = .03) scales of ASQ. Instead, the relationship as secondary scale of ASQ is negatively related to femininity (ß = -0.198; P = .0001). No association between non-heterosexual orientation and gender role was found. CLINICAL IMPLICATIONS: A better knowledge of links between relational patterns and gender roles for assessment and anamnesis phases in sexual medicine. STRENGTHS & LIMITATIONS: This is the first study considering sexual orientation and biological sex in the relationship between attachment styles and gender role. The main limitation is the use of self-reported psychometric tests. CONCLUSION: Our data indicate that a secure attachment is related to both masculinity and femininity. On the contrary, different and reverse aspects of insecure attachment style characterize masculinity and femininity. Masculinity is mostly linked to insecure/dismissing attachment, whereas femininity is linked to insecure/fearful-preoccupied attachment. Moreover, although being male is a further element in support of masculinity, sexual orientation is not associated with gender role. Ciocca G, Zauri S, Limoncin E, et al. Attachment Style, Sexual Orientation, and Biological Sex in their Relationships with Gender Role. Sex Med. 2019;8:76-83.

Bisexuality among a cohort of university students: prevalence and psychological distress.

Sociocultural prejudices and pressures may impair the mental health of bisexual people. We aim to evaluate psychological status according to sexual orientation in a sample of Italian university students, with specific attention to bisexuality and its frequency. Among a recruited sample of 551 university students, we found the following percentages for sexual orientation: heterosexuals 96.9% (n = 534), homosexuals 1.1% (n = 6), bisexuals 2% (n = 11). The cross-sectional analysis for psychological symptoms, with the Symptoms Check List-90 Revised (SCL-90-R), revealed that bisexual subjects have statistically significant higher scores on some symptomatic scales compared to heterosexuals. In particular, obsession-compulsion, paranoid ideation, hostility were significantly higher in bisexuals. Therefore, if heterosexual or homosexual orientation are not specified by particular psychological symptoms, bisexuality is characterized by a strong link with some facets of psychological distress, which are likely caused by a peculiar double stigma. In conclusion, through a specific psychometric tool, we found an association between bisexuality and various forms of psychological suffering. This evidence should further encourage clinicians to accurately assess the psychological health in young bisexual people.

Episode-like pulse testosterone supplementation induces tumor senescence and growth arrest down-modulating androgen receptor through modulation of p-ERK1/2, pARser81 and CDK1 signaling: biological implications for men treated with testosterone replacement therapy.

Despite the growing body of knowledge showing that testosterone (T) may not significantly affect tumor progression in hypogonadal patients treated for prostate cancer (Pca), the use of this hormone in this population still remains controversial. The effects of continuous or pulsed T stimulation were tested in vitro and in vivo on androgen-sensitive Pca cell lines in order to assess the differential biological properties of these two treatment modalities. Pulsed T treatment resulted in a greater inhibition than continuous T supplementation of tumor growth in vitro and in vivo. The effects of pulsed T treatment on tumor growth inhibition, G0/G1 cell cycle arrest, and tumor senescence was more pronounced than those obtained upon continuous T treatments. Mechanistic studies revealed that G0/G1 arrest and tumor senescence upon pulsed T treatment were associated with a marked decrease in cyclin D1, c-Myc and SKp2, CDK4 and p-Rb levels and upregulation of p27 and p-ERK1/2. Pulsed, but not continuous, T supplementation decreased the expression levels of AR, p-ARser81 and CDK1 in both cellular models. The in vitro results were confirmed in an in vivo xenografts, providing evidence of a greater inhibitory activity of pulsed supraphysiological T supplementation than continuous treatment, both in terms of tumor volume and decreased AR, p-ARser81, PSA and CDK1 staining. The rapid cycling from hypogonadal to physiological or supra-physiological T intraprostatic concentrations results in cytostatic and senescence effects in preclinical models of androgen-sensitive Pca. Our preclinical evidence provides relevant new insights in the biology of Pca response to pulsed T supplementation.

Is Testosterone a Food for the Brain?

INTRODUCTION: Testosterone is fundamental for psychological, sexological, cognitive, and reproductive aspects, and its lack or reduction largely impacts the quality of life in males and females. AIM: Therefore, the aim of this review is to describe the role of testosterone in the neurophysiology of the brain and related aspects regarding the quality of general and sexual life. METHODS: We listed and discussed the principal studies on the role of testosterone in the brain regarding sexual health, psychopathological conditions, and the elderly. The search strategies were composed by the insertion of specific terms in PubMed regarding the main studies from January 2000 to June 2015. MAIN OUTCOME MEASURES: Using a psychoneuroendocrinologic perspective, we considered 4 main sections: brain and testosterone, sexuality and testosterone, psychopathology and testosterone, and cognitive impairment and testosterone. RESULTS: Much evidence on the neuroendocrinology of testosterone regarding brain activity, sexual function, psychological health, and senescence was found. In any case, it is known that testosterone deficiency negatively impacts quality of life, first, but not exclusively, through a central effect. Moreover, testosterone and androgen receptors are differently expressed according to age and gender. This aspect contributes to gender differences and to the dimorphic physiological role of this hormone. CONCLUSION: A universal role for testosterone can be recognized: low levels of testosterone are associated with mental disorders, sexual dysfunction, and cognitive impairment in both sexes. Hence, physicians should carefully assess testosterone levels, not only in the management of sexual dysfunctions but also when seeking to help patients with severe mental or organic diseases.

Epidemiology of delayed ejaculation.

A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished between the orgasm and ejaculation disorders leading to doubtful results. Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. The present review is aimed at providing a comprehensive overview of the current knowledge on the definition and epidemiology of diminished ejaculatory disorders. We focus on the acquired diseases, such as benign prostatic hyperplasia (BPH) and specific drug regimens that may cause an iatrogenic form of ejaculatory disorder. In addition, the impact of aging is discussed since the prevalence of DE appears to be moderately but positively related to age. Finally, we also focus on the importance of the hormonal milieu on male ejaculation. To date, evidence on the endocrine control of ejaculation is derived from small clinical trials, but the evidence suggests that hormones modulate the ejaculatory process by altering its overall latency.

Sexual dysfunctions in people with first-episode psychosis assessed according to a gender perspective.

AIM: Patients with chronic mental disorders often can suffer from sexual dysfunction. Nevertheless, the sexual functioning of new patients with first-episode psychosis has been little explored. The aim of this study was to investigate gender differences in sexual functioning in people with first-episode psychosis. METHODS: A group of 40 males and 37 females with first-episode psychosis took part in the research. We administered a psychiatric protocol composed of the PANSS, UKU and SCID-DSM-IV diagnosis. RESULTS: We found that the 42.5% of the male group had sexual dysfunctions while the percentage of the female group was 37.8%. The correlation between sexual dysfunctions and psychopathology did not reveal any association in males. However, in females, general psychopathology and positive symptoms are linked to the alteration of vaginal lubrication: (r=0.547; p=0.003) and (r=0.485; p=0.011), although orgasm alteration was also associated with general psychopathology (r=0.500; p=0.013). Moreover, we found a relation between the alteration of vaginal lubrication with depression(r=0.627; p<0.0001) and disorder of volition (r=0.600; p<0.001). DISCUSSION AND CONCLUSIONS: These data suggest that the association between sexual dysfunctions and psychopathology regarded only women. Therefore, during the taking charge of patients it is fundamental to consider the gender-specific relationship between psychopathology and sexual problems.

Italian Validation of Homophobia Scale (HS).

INTRODUCTION: The Homophobia Scale (HS) is a valid tool to assess homophobia. This test is self-reporting, composed of 25 items, which assesses a total score and three factors linked to homophobia: behavior/negative affect, affect/behavioral aggression, and negative cognition. AIM: The aim of this study was to validate the HS in the Italian context. METHODS: An Italian translation of the HS was carried out by two bilingual people, after which an English native translated the test back into the English language. A psychologist and sexologist checked the translated items from a clinical point of view. We recruited 100 subjects aged18-65 for the Italian validation of the HS. The Pearson coefficient and Cronbach's α coefficient were performed to test the test-retest reliability and internal consistency. MAIN OUTCOME MEASURES: A sociodemographic questionnaire including the main information as age, geographic distribution, partnership status, education, religious orientation, and sex orientation was administrated together with the translated version of HS. RESULTS: The analysis of the internal consistency showed an overall Cronbach's α coefficient of 0.92. In the four domains, the Cronbach's α coefficient was 0.90 in behavior/negative affect, 0.94 in affect/behavioral aggression, and 0.92 in negative cognition, whereas in the total score was 0.86. The test-retest reliability showed the following results: the HS total score was r = 0.93 (P < 0.0001), behavior/negative affect was r = 0.79 (P < 0.0001), affect/behavioral aggression was r = 0.81 (P < 0.0001), and negative cognition was r = 0.75 (P < 0.0001). CONCLUSIONS: The Italian validation of the HS revealed the use of this self-report test to have good psychometric properties. This study offers a new tool to assess homophobia. In this regard, the HS can be introduced into the clinical praxis and into programs for the prevention of homophobic behavior.

Psychoticism, Immature Defense Mechanisms and a Fearful Attachment Style are Associated with a Higher Homophobic Attitude.

INTRODUCTION: Homophobic behavior and a negative attitude toward homosexuals are prevalent among the population. Despite this, few researches have investigated the psychologic aspects associated with homophobia, as psychopathologic symptoms, the defensive system, and attachment styles. AIM: The aim of this study was to investigate the psychologic factors mentioned earlier and their correlation with homophobia. METHODS: Five hundred fifty-one university students recruited, aged 18-30, were asked to complete several psychometric evaluation. MAIN OUTCOME MEASURES: In particular, Homophobia Scale (HS) was used to assess homophobia levels, the Symptoms Check List Revised (SCL-90-R) for the identification of psychopathologic symptoms, the Defence Style Questionnaire (DSQ-40) for the evaluation of defense mechanisms and the Relationship Questionnaire (RQ) for attachment styles. RESULTS: After a regression analysis, we found a significant predictive value of psychoticism (ß = 0.142; P = 0.04) and of immature defense mechanisms (ß = 0.257; P < 0.0001) for homophobia, while neurotic defense mechanisms (ß = -0.123; P = 0.02) and depressive symptoms (ß = -0.152; P = 0.04) have an opposite role. Moreover, categorical constructs of the RQ revealed a significant difference between secure and fearful attachments styles in levels of homophobia (secure = 22.09 ± 17.22 vs. fearful = 31.07 ± 25.09; P < 0.05). Finally, a gender difference to HS scores and a significant influence of male sex was found (ß = 0.213; P < 0.0001). CONCLUSIONS: We demonstrated the involvement of psychoticism and immature defense mechanisms in homophobic attitudes, while a contrasting role is played by neurotic defense mechanisms and depressive symptoms. Moreover, secure attachment is an indicator of low levels of homophobia compared with the subjects demonstrating a fearful style of attachment. Hence, in the assessment of homophobia and in the relevant programs of prevention, it is necessary to consider the psychologic aspects described earlier.

Pregnant Women's Preferences for Men's Faces Differ Significantly from Nonpregnant Women.

INTRODUCTION: There is evidence that women's preferences for facial characteristics in men's faces change according to menstrual phase and sexual hormones. Literature indicates that the pregnancy is characterized by a specific sexual hormonal pattern with respect to all other physiological conditions concerning the sexual hormone status during the reproductive age, configuring this physiological condition as an excellent surrogate to study how the sexual hormones may affect many of the aspects concerning the sexual behavior. AIM: The aim of this study was to investigate pregnancy as a model of hormonal influence on women's facial preferences in short-term and long-term relationships and compare the choices of pregnant women with those of nonpregnant women. MAIN OUTCOME MEASURES: Measurement of women's preferences for synthetic men's faces, morphed from hyper-masculine to hypomasculine shape. MATERIALS AND METHODS: Forty-six women in the third trimester of pregnancy, and 70 nonpregnant women took part in the study. All women were shown a composite male face. The sexual dimorphism of the images was enhanced or reduced in a continuous fashion using an open-source morphing program that produced a sequence of 21 pictures of the same face warped from a feminized to a masculinized shape. RESULTS: Pregnant women's choices differed significantly from those of nonpregnant women. In fact, in the context of both a hypothetical short- (M = -0.4 ± 0.11) and long-term relationship (M = -0.4 ± 0.07) pregnant women showed a clear preference for a less masculine man's face than the other group (short-term: M = 0.15 ± 0.13; long-term: M = -0.06 ± 0.15; P < 0.0001). CONCLUSIONS: Women in the third trimester of pregnancy clearly prefer more feminine men's faces, distancing themselves from the choices of women in other physiological conditions concerning the sexual hormonal status during the reproductive age. However, other psychosocial variables may explain this interesting finding.

Post-traumatic stress disorder, coping strategies and type 2 diabetes: psychometric assessment after L'Aquila earthquake.

AIM: After natural and collective catastrophes, many behavioral phenomena can occur through psychobiological responses that involve also the diabetic condition.The aim of this study was to investigate post-traumatic stress disorder (PTSD) and coping strategies in type 2 diabetic patients after L'Aquila earthquake, with a particular attention to the newly diagnosed patients and to the gender differences. METHODS: Among the local diabetic population, we recruited 100 diabetic patients (46 women and 54 men). Sixty of these had diabetes before the earthquake (pre-quake patients), and other 40 received diabetes diagnosis after the earthquake (post-quake patients). A psychometric protocol composed by Davidson Trauma Scale for PTSD and Brief-COPE for coping strategies was administered. RESULTS: We found significant differences in the levels of PTSD when comparing both post-quake with pre-quake patients (post-quake = 51.72 ± 26.05 vs. pre-quake = 31.65 ± 22.59; p < 0.05) and the female patients with males (women = 53.50 ± 27.01 vs. men = 31.65 ± 23.06; p < 0.05) and also in the prevalence [post-quake = 27/40 (67.5 %) vs. pre-quake = 20/60 (33.3 %); p < 0.05], [women = 27/46 (58.69 %) vs. men = 16/54 (29.62 %); p < 0.05]. Moreover, maladaptive coping was a predictive factor for PTSD in the post-quake group only (OR 1.682; 95 % CI 1.155-2.450; p = 0.006). CONCLUSIONS: Our results revealed that PTSD may be considered an important comorbidity factor in newly diagnosed patients and in diabetic women. Hence, a psychological support seems particularly important in these patients after a collective traumatic event to help them react to both PTSD and diabetes and to help them improve their coping skills.

Challenges to treat hypogonadism in prostate cancer patients: implications for endocrinologists, urologists and radiotherapists.

The literature suggests that the serum testosterone level required for maximum androgen receptor (AR) binding may be in the range of nanomolar and above this range of concentrations; this sexual hormone may not significantly affect tumour biology. This assumption is supported by clinical studies showing that cell proliferation markers did not change when serum T levels increased after exogenous T treatment in comparison to subjects treated with placebo. However, a considerable part of the global scientific community remains sceptical regarding the use of testosterone replacement therapy (TRT) in men suffering from hypogonadism and prostate cancer (Pca). The negative attitudes with respect to testosterone supplementation in men with hypogonadism and Pca may be justified by the relatively low number of clinical and preclinical studies that specifically dealt with how androgens affect Pca biology. More controversial still is the use of TRT in men in active surveillance or at intermediate or high risk of recurrence and treated by curative radiotherapy. In these clinical scenarios, clinicians should be aware that safety data regarding TRT are scanty limiting our ability to draw definitive conclusions on this important topic. In this review we critically discuss the newest scientific evidence concerning the new challenges in the treatment of men with hypogonadal condition and Pca providing new insights in the pharmacological and psychological approaches.

Gender identity rather than sexual orientation impacts on facial preferences.

INTRODUCTION: Differences in facial preferences between heterosexual men and women are well documented. It is still a matter of debate, however, how variations in sexual identity/sexual orientation may modify the facial preferences. AIM: This study aims to investigate the facial preferences of male-to-female (MtF) individuals with gender dysphoria (GD) and the influence of short-term/long-term relationships on facial preference, in comparison with healthy subjects. METHODS: Eighteen untreated MtF subjects, 30 heterosexual males, 64 heterosexual females, and 42 homosexual males from university students/staff, at gay events, and in Gender Clinics were shown a composite male or female face. The sexual dimorphism of these pictures was stressed or reduced in a continuous fashion through an open-source morphing program with a sequence of 21 pictures of the same face warped from a feminized to a masculinized shape. MAIN OUTCOME MEASURES: An open-source morphing program (gtkmorph) based on the X-Morph algorithm. RESULTS: MtF GD subjects and heterosexual females showed the same pattern of preferences: a clear preference for less dimorphic (more feminized) faces for both short- and long-term relationships. Conversely, both heterosexual and homosexual men selected significantly much more dimorphic faces, showing a preference for hyperfeminized and hypermasculinized faces, respectively. CONCLUSIONS: These data show that the facial preferences of MtF GD individuals mirror those of the sex congruent with their gender identity. Conversely, heterosexual males trace the facial preferences of homosexual men, indicating that changes in sexual orientation do not substantially affect preference for the most attractive faces.

The psychosexual profile of sexual assistants: an internet-based explorative study.

INTRODUCTION: Sexual assistance may have some aspects that resemble prostitution and others that might lead one to think of sexual assistants as similar to a group of subjects whose sexual object is disability (devotees). In this study, we investigate whether a rigorous selection and training process on the part of specialised organisations may reduce the risk of training subjects with an atypical sexual interest and behaviours resembling prostitution. MATERIALS AND METHODS: The study population consisted of 152 subjects defining themselves as sexual assistants. Subjects were initially contacted on websites specifically dedicated to sexual assistants and prostitutes. One hundred and twenty subjects were selected, by propensity score analysis, and studied by means of a modified version of a semi-structured questionnaire previously developed to investigate a population of subjects attracted by disability. RESULTS: The study group was composed of 80 trained and 40 untrained sexual assistants, with mean ages of 41.5 (SD +/-12.58) and 44.5 (SD +/-11.62), respectively. A significant number of untrained subjects affirmed that their motivation in carrying out sexual assistance was of a remunerative nature, while this number was lower among the trained assistants (p = 0.001). Nearly all untrained subjects claimed to do one or more of the following activities during sexual assistance: sexual intercourse, oral sex, and masturbation. Among the trained subjects, however, only 47.5% claimed to do one or more of these activities, which means that there is a significant gap between trained and untrained assistants (p<0.0001). The existence of an atypical sexual interest was more evident between untrained rather than between trained subjects (p<0.0001). CONCLUSIONS: Sexual assistance represents a way through which people affected by disabilities may attain the right to explore their sexuality in a safe setting. This can be guaranteed only if sexual assistants are trained and carefully selected by specialised organisations.

Platelet-derived growth factor regulation of type-5 phosphodiesterase in human and rat penile smooth muscle cells.

INTRODUCTION: Relaxation of cavernous smooth muscle cells (SMCs) is a key component in the control of the erectile mechanism. SMCs can switch their phenotype from a contractile differentiated state to a proliferative and dedifferentiated state in response to a change of local environmental stimuli. Proliferation and contraction are both regulated by the intracellular second messengers cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP), which are degraded by phosphodiesterases (PDEs). The most abundant PDE present in corpora cavernosa is the electrolytic cGMP-specific phosphodiesterase type 5 (PDE5). AIM: We investigated the cellular localization of PDE5 in in vitro cultured corpora cavernosa cells and the effect of mitogenic stimulation on PDE5 expression. METHODS: Biochemical ad molecular techniques on cultured SMCs from human and rat penis. MAIN OUTCOME MEASURES: We studied the ability of the quiescent SMC phenotype vs. the proliferating phenotype in modulation of PDE5 expression. RESULTS: We demonstrated that PDE5 is localized in the cytoplasm, in the perinuclear area, and in discrete cytoplasmic foci. As previously demonstrated in human myometrial cells, the cytoplasmic foci may correspond to centrosomes. In corpora cavernosa, PDE5 protein levels are strongly regulated by the mitotic activity of the SMCs, as they were increased in quiescent cultures. In contrast, treatment with platelet-derived grow factor (PDGF), one of the most powerful mitogenic factors for SMCs, reduces the expression of PDE5 after 24 hours of treatment. CONCLUSION: We found that PDGF treatment downregulates PDE5 expression in proliferating SMCs, suggesting that PDE5 may represent one of the markers of the contractile phenotype of the SMCs of corpora cavernosa.

Strategies for imaging androgen receptor signaling pathway in prostate cancer: implications for hormonal manipulation and radiation treatment.

Prostate cancer (Pca) is a heterogeneous disease; its etiology appears to be related to genetic and epigenetic factors. Radiotherapy and hormone manipulation are effective treatments, but many tumors will progress despite these treatments. Molecular imaging provides novel opportunities for image-guided optimization and management of these treatment modalities. Here we reviewed the advances in targeted imaging of key biomarkers of androgen receptor signaling pathways. A computerized search was performed to identify all relevant studies in Medline up to 2013. There are well-known limitations and inaccuracies of current imaging approaches for monitoring biological changes governing tumor progression. The close integration of molecular biology and clinical imaging could ease the development of new molecular imaging agents providing novel tools to monitor a number of biological events that, until a few years ago, were studied by conventional molecular assays. Advances in translational research may represent the next step in improving the oncological outcome of men with Pca who remain at high risk for systemic failure. This aim may be obtained by combining the anatomical properties of conventional imaging modalities with biological information to better predict tumor response to conventional treatments.

Integrating psychotherapy and pharmacotherapy in the treatment of premature ejaculation.

OBJECTIVES: To describe the different approaches to the treatment of premature ejaculation (PE), with a final focus on integrated treatment, as conventional theories and therapies for PE are based on an organic or psychogenic dichotomy. METHODS: We list the principal hypotheses of the causes and therapy of PE on the basis of psychological and medical perspectives, after identifying all relevant studies available on Medline up to 2012. RESULTS: The cognitive feedback from PE can lead to a 'performance anxiety', which can combine with other conditions to further impair ejaculatory control. For these reasons, a psychological approach is always useful in treating PE, the most useful of which are sex therapy and behavioural therapy. For pharmacological treatment, reports suggest that dapoxetine (60 mg) significantly improves the control of the ejaculatory reflex, and it thus represents the first-line officially approved pharmacotherapy for PE. CONCLUSIONS: A holistic approach which considers the biological, psychological and relational aspects is the advised treatment for PE. Integrated medical and psycho-sexological therapy requires a mutual understanding of and respect for the different disciplines involved in sexology. In this aspect two very important roles are those of the physician and the psychologist.

Premature ejaculation results in female sexual distress: standardization and validation of a new diagnostic tool for sexual distress.

PURPOSE: We measured premature ejaculation related female sexual distress using a new diagnostic tool, the Female Sexual Distress Scale-Revised-Premature Ejaculation questionnaire. MATERIALS AND METHODS: In this large-scale, Internet based population study we evaluated 2,109 women in a stable relationship during the last 6 months. The 1,361 women in the premature ejaculation group had no female sexual disorder but the partner had premature ejaculation alone. The 748 controls had no female sexual disorder and a partner without premature ejaculation. We determined questionnaire content and discriminant validity, internal consistency and test-retest reliability. Multivariate logistic regression with propensity score reweighting was done to determine the clinical impact of demographics on the perception of sexual distress. RESULTS: The questionnaire was well understood. Internal consistency was greater than 0.90 and 0.84 in the premature ejaculation and control groups, respectively. Test-retest reliability was 0.82 (95% CI 0.72-0.87) and 0.85 (95% CI 0.79-0.92) in the premature ejaculation and control groups, respectively. The questionnaire had a high AUC of 0.90 (95% CI 0.89-0.91). The new cutoff score of 12 or greater had 79.1% sensitivity (95% CI 73.8-82.5), 99.5% specificity (95% CI 98.0-100.0), 99.3% positive predictive value (95% CI 98.7-100.0) and 67.9% negative predictive value (95% CI 64.2-73.2). Median questionnaire scores were significantly higher in the premature ejaculation group than in controls (20, 95% CI 19-21 vs 6, 95% CI 6-7, p <0.0001). Logistic regression adjusted and unadjusted by propensity score indicated that women in the premature ejaculation group had a 7.12 (95% CI 5.98-10.14, p <0.0001) to 9.83 (95% CI 7.94-12.15) greater probability of sexual distress than controls. CONCLUSIONS: The Female Sexual Distress Scale-Revised-Premature Ejaculation questionnaire fulfills psychometric requirements for measuring sexual distress related to partner sexual dysfunction.

Differential effects of PXD101 (belinostat) on androgen-dependent and androgen-independent prostate cancer models.

Histone deacetylase inhibitors (HDACi) are promising epigenetic cancer chemotherapeutics rapidly approaching clinical use. In this study, we tested using in vitro and in vivo models the differential biological effects of a novel HDAC inhibitor [belinostat (PXD101)], in a wide panel of androgen-sensitive and androgen-independent tumor cells. Belinostat significantly increased acetylation of histones H3 and H4. Belinostat potently inhibited the growth of prostate cancer cell lines (IC50 range from 0.5 to 2.5 µM) with cytotoxic activity preferentially against tumor cells. This agent induced G2/M arrest and increased significantly the percentage of apoptosis mainly in androgen-sensitive tumor cells confirming its growth-inhibitory effects. The cell death mechanisms were studied in three different prostate cancer cell lines with different androgen dependence and expression of androgen receptor; LAPC-4 and 22rv1 (androgen-dependent and expressing androgen receptor) and PC3 (androgen-independent not expressing androgen receptor). Belinostat induced the expression of p21 and p27, acetylation of p53 and G2/M arrest associated with Bcl2 and Bcl-Xl downmodulation and significant reduction of survivin, IAPs and Akt/pAkt and increased caspase-8 and -9 expression/activity. Belinostat effectiveness was dependent on the androgen receptor (AR), since the stable transfection of AR greatly increased the efficacy of this HDAC inhibitor. These observations were correlated using in vivo models. We demonstrated that belinostat preferentially resulted in antitumor effect in androgen-dependent tumor cells expressing AR. Our findings provide evidence that belinostat may be a promising anticancer drug for prostate cancer expressing AR, supporting its clinical role in prostate cancer.