[When the Brain Dictates the Rhythm].

INTRODUCTION: In rare cases, an HSV-Encephalitis can lead to sinus node dysfunction, as was the case in this 70-year old woman who suffered from recurrent syncopes. Diagnostic work-up showed sinus bradycardias and short-lasting sinus arrests, primarily consider-ed to be of cardiac etiology. After development of fever and neurological alteration, an HSV1 encephalitis was diagnosed. As our research of the current literature showed, the connection between the two is not completely clear. The HSVtypical infestation of the insular cortex, which influences the autonomic nervous system, should be discussed by all means. However, due to cessation of arrhythmia after seizure-suppressing therapy, we suspected an epileptic cause in this case. This shows the importance of a thorough differential diagnostic evaluation.

Development of a Communication Instrument to Address Sexuality in COPD: COSY.

Introduction: Sexuality, an important aspect of quality of life, is often overlooked in COPD. Our aim was to develop an instrument that facilitates communication and counseling on sexuality in persons living with chronic obstructive pulmonary disease (COPD). Methods: We searched for publications on sexuality in COPD focusing on communication about sexuality and tools to support such communication. We also performed a survey asking 25 patients and 36 health care professionals (HCPs) about their attitudes, experiences, barriers, and facilitators when talking about sexuality. We set up a project expert team of HCPs and 3 persons with COPD. In a half-day workshop, the team discussed the results of the literature review and the survey as a basis for the contents, the "when and how" to address communication about sexuality, and the design of the communication instrument. Results: The survey showed that although patients and HCPs wanted to talk about sexuality, it rarely happened due to communication barriers, lack of self-confidence, and misconceptions on both sides. In review rounds of the expert team, feedback on the drafts was collected and integrated into the final version of the communication instrument: COmmunication about SexualitY in COPD (COSY). The COSY instrument resulted in 4 tools: a communication leaflet, an application guide, a pictorial representation of the spectrum of intimacy for HCPs, and a comprehensible, picturized information booklet for patients. Conclusions: Addressing sexuality in persons living with COPD should not be neglected. The COSY instrument could help to start and shape communication and consultations about sexuality and a more holistic consideration of quality of life.

The Persian Version of Menopause Rating Scale (MRS): A Psychometric Study.

OBJECTIVE: Menopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS). STUDY DESIGN: The study was conducted on a random sample of 270 middle-aged women (age range 40-60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects. RESULTS: Content validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach's alpha coefficient (0.85) and the test-retest reliability score (0.91) indicated good internal consistency. CONCLUSION: The Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.

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.

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.

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.

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.

Body Movement Is Associated With Orgasm During Vaginal Intercourse in Women.

Very few studies have investigated the relationship between women's ability to experience an orgasm during vaginal intercourse and specific stimulation techniques. We examined two common techniques during vaginal intercourse both with and without simultaneous external clitoral stimulation: (1) body movement, in particular back-and-forth swinging movements of the pelvis and trunk; and (2) precise rubbing of the clitoris with an immobilized body. Structural equation modeling was used to compare the effects of the two stimulation techniques on women's orgasm frequency (N = 1,239). As hypothesized, the frequency of orgasm during vaginal intercourse with simultaneous clitoral stimulation was positively associated with a preference for body movement during arousal. Body movement, as opposed to body immobilization, was also associated with a higher frequency of orgasm during vaginal intercourse without simultaneous clitoral stimulation. We conclude that body movement is associated with more orgasms during vaginal intercourse, whereas precise rubbing of the clitoris with an immobilized body is not associated with more orgasms. Teaching women to move their pelvis and trunk in a swinging back-and-forth movement during vaginal intercourse might therefore facilitate reaching an orgasm, whereas encouraging them to self-stimulate the clitoris might be less helpful if done with an immobilized body.

Novel Treatment for Premature Ejaculation in the Light of Currently Used Therapies: A Review.

INTRODUCTION: Besides erectile dysfunction, premature ejaculation (PE) is the most frequent male sexual disorder and shows a high level of bother and distress. The negative consequences of long-term and unsuccessfully treated PE on both patient and partner are well established in the literature and include personal distress, impairment of the partner's sexual function, and interpersonal difficulties. AIM: To outline the consequences of untreated PE and the advantages and disadvantages of currently available treatment options with a special focus on a new topical eutectic lidocaine/prilocaine metered dose spray (Fortacin; Lidocaine/Prilocaine, Recordati, Milan, Italy) which represents the second officially approved drug in this indication. METHODS: Narrative overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases such as Web of Science, Medline, PubMed, and Google Scholar, hand searches, and authoritative texts. Combinations of keywords including premature ejaculation, ejaculatory control, intravaginal ejaculation latency time, IELT, PE, PDE5 inhibitors (PDE5i), SSRIs, topical anesthetics, lidocaine, prilocaine, and treatment were used. In the end, 59 studies published between 2000 and 2018 were considered relevant for this review. MAIN OUTCOME MEASURES: Published studies on PE-related negative psychosocial outcomes, as well as advantages and disadvantages of currently available off-label and officially approved treatment options. RESULTS: Although a variety of treatment options for PE have shown marked improvements in stopwatch-measured intravaginal ejaculation latency time (IELT) and patient-reported outcomes as assessed by the Premature Ejaculation Profile (PEP), none of the investigated drugs has reached market approval. The only so far officially approved medication-dapoxetine-is characterized by high discontinuation rates of up to 90%, mostly because of high side effects, cost issues, efficacy below expectations, and the need for scheduling sexual intercourse. CONCLUSION: With the official approval in Europe the new dose-metered lidocaine-prilocaine spray (Fortacin) may become a real first-line therapy option for PE and may offer a satisfactory and affordable solution, especially because of its unique galenic preparation, making its handling easy and customer friendly. In addition, it has the potential to significantly increase the currently low patients' acceptance of available monotherapies and become an established second-line therapy for the severe PE patients with IELTs <1 to 2 minutes or with ante-portal ejaculation in combination with oral therapy. Porst H, Burri A. Novel treatment for premature ejaculation in the light of currently used therapies: A review. Sex Med Rev 2019; 7:129-140.

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.

The relationship between penile deformity, age, psychological bother, and erectile dysfunction in a sample of men with Peyronie's Disease (PD).

The aim of the present study was to investigate which PD specific factors (e.g., degree of penile curvature, levels of pain) cause most distress and to further explore whether there are specific subgroups of patients that report particularly high levels of psychological distress. Data were available for N = 119 men with a clinical diagnosis of PD presenting at a private Uro-Andrology in Germany. The strongest complaint of men with PD was being bothered by the look of the penis as opposed to being distressed by the pain (3.48 vs. 2.11). 75.4% reported having significantly less intercourse due to PD and for 61.4% this was very bothersome. Plaque size correlated positively with the level of symptom bother (r = 0.73, p < 0.05). Furthermore, men with a stronger curvature reported more concerns regarding size and form of the penis (r = 0.18, p < 0.05), more overall sexual dissatisfaction (r = -0.38, p < 0.001), and more PD related psychological and physiological symptoms (r = 0.58, p < 0.001). 44.4% of patients had a concurrent ED. Highest level of symptom bother was reported by men with a a strong curvature and a comorbid ED. Clinicians should pay special attention to patients presenting with extreme penile deformity and impaired sexual functioning, as they show the highest levels of psychological distress. Here, additional psychosexual support might be necessary.

Pain catastrophizing, neuroticism, fear of pain, and anxiety: Defining the genetic and environmental factors in a sample of female twins.

The objective of the present study was to establish the heritability of pain catastrophizing and its subdomains of helplessness, magnification, and rumination and to further explore the genetic and environmental sources that may contribute to pain catastrophizing as well as to its commonly reported psycho-affective correlates, including neuroticism, anxiety sensitivity, and fear of pain. N = 2,401 female twin individuals from the TwinsUK registry were subject to univariate and multivariate twin analyses. Well validated questionnaires including the Pain Catastrophizing Scale, the Pain Anxiety Symptom Scale, the Ten Item Personality Index, and the Anxiety Sensitivity Index were used to assess the study variables. Moderate estimates of heritability for pain catastrophizing (36%) and the three subdomains of helplessness (35%), rumination (27%), and magnification (36%) were detected. The high correlations observed between the three subdomains were explained mainly by overlapping genetic factors, with a single factor loading on all three phenotypes. High genetic correlations between pain catastrophizing and its psycho-affective correlates of fear of pain and anxiety sensitivity were found, while the genetic overlap between neuroticism and pain catastrophizing was low. Each measure of negative affect demonstrated relatively distinct environmental contributing factors, with very little overlap. This is the first study to show shared genetic factors in the observed association between pain catastrophizing and other measures of negative affect. Our findings provide deeper insight into the aetiology of pain catastrophizing and confirm that it is at least partially distinct from other measures of negative affect and personality that may influence the development and treatment of chronic pain conditions. Further research in males is warranted to check the comparability of the findings.

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.

Preliminary Validation of a German Version of the Sexual Complaints Screener for Women in a Female Population Sample.

BACKGROUND: To date, neither the original English nor any of the translated versions of the Sexual Complaints Screener for Women (SCS-W) have been tested for their psychometric properties. AIM: To evaluate the validity and utility of the German version of the SCS-W by assessing content, convergent, and discriminant validity. METHODS: A population sample of 309 women (mean age = 26.9 years) completed the online survey and had matching data available on the SCS-W and the Female Sexual Function Index (FSFI). Spearman bivariate correlations between the SCS-W and FSFI domain scores and exploratory factor analysis with principal component analysis were conducted. OUTCOMES: Convergent validity was excellent for the domain of orgasm, good for satisfaction, dyspareunia, and the total questionnaire score, and acceptable for desire, lubrication, arousal, and vaginismus. Discriminant validity was present for all domains apart from arousal, lubrication, and vaginismus. Varimax rotation suggested an 8-factor model was the most robust. CLINICAL IMPLICATIONS: This brief screener seems suitable to provide a brief overview of female patients' sexual problems in a clinical setting. STRENGTHS AND LIMITATIONS: This is the 1st study to assess the psychometric properties of the German version of the SCS-W. However, available information on the psychometric properties of the German SCS-W was limited because the validity of the screener could not be counterchecked against a clinical diagnosis of female sexual dysfunction. CONCLUSION: Our results provide preliminary evidence of good validity of the German version of the SCS-W. Overall, the SCS-W can offer support for clinicians who are less familiar with sexual medicine and who might not routinely discuss sexual issues with their patients. Burri A, Porst H. Preliminary Validation of a German Version of the Sexual Complaints Screener for Women in a Female Population Sample. Sex Med 2018;6:123-130.

Ethnic- and sex-related differences in pain characteristics, psychological distress and pain-related disability in patients attending a New Zealand teaching hospital pain service.

AIM: The aim of the present observational study was to provide a description of the demographic, psychological and pain characteristics of patients attending the Waitemata Pain Services (WPS), Auckland, New Zealand. METHOD: Data were collected via a comprehensive paper-pencil questionnaire handed out to 798 consecutive new patients seen at the WPS over a four-year period. RESULTS: 32.3% attending the WPS were men and 67.7% women, with a mean age of 52.1 years. 65.7% of patients were New Zealand Europeans, followed by 19.1% other Europeans, 5.7% Asians, 3.9% Maori, 2.8% Middle Eastern/Latin/Africans and 2.7% Pacific Islanders. Patients reported an average of 2.6 visits to the GP before presenting to the unit. Average pain duration was seven years and seven months. Women reported a significantly higher number of pain sites in the whole body, as well as in the left and right side of the body compared to men (p<0.0001 for all). Highest interference due to pain was found for enjoyment of life. Men and women further differed in a range of psycho-behavioural variables, with women reporting less psychological distress and depression but more stress compared to men (p<0.05 for all). Men showed higher levels of kinesiophobia (p<0.005) and less pain acceptance and pain willingness (p<0.05 for both). Cross-cultural comparison found Maori patients reported highest pain levels, highest number of pain sites, highest pain interference, as well as highest levels of psychological distress, depression, stress and anxiety compared to all other ethnicities. Lowest pain severity was reported for New Zealand European patients and lowest interference due to pain for Pacific Islanders. While Middle Eastern/Latin/African patients showed highest levels of kinesiophobia, Pacific Islanders had the highest tendencies to catastrophise about their pain. CONCLUSION: There are important sex- and ethnicity-related differences in the clinical presentation of chronic pain patients attending a large, hospital-based New Zealand pain service. While service provision can be based on generalised guidelines, specific interventions should be informed by important demographic and cultural variables. Studies are needed to identify strategies to improve service delivery in subgroups of the population who may be undertreated or lack access to appropriate interventions.

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.