Patterns and practices of parenting transgender children: A brief Comparative study.

The practices of parents raising children with trans* life experiences influence their subsequent social adjustment. The aim of the study was to identify potential differences in parenting patterns and practices between two groups, one comprising families with transgender children and the other group comprising families with cisgender children. Twenty-eight adults and 15 children and adolescents from Bogotá, Colombia, participated. We performed descriptive, nonparametric comparative, and Bayesian comparative analyses for independent samples. We used a frequentist inferential comparative method with the Mann-Whitney U test with an effect size based on rank-biserial correlation, which revealed no statistically significant difference values. Bayesian comparisons showed minimal evidence in favor of the null hypothesis in all comparisons performed, except for the Behavioral Control or Regulation variable. The main finding of this study suggests that parents of children with trans* life experiences may not be addressing their specific needs, which could lead to a lack of understanding of their situation and support in their transition process.

Progressive arousal: a new concept and definition for premature ejaculation.

Background: Premature ejaculation (PE) is a nosologic entity with issues in its conceptualization and definition. Aim: To understand if the altered sexual response in men with PE is in the orgasm phase, as currently assumed, or the arousal phase with difficulties in modulating, regulating, or decreasing sexual arousal. Methods: Men were recruited who looked for help for PE and met the diagnostic criteria according to clinical standards. The participants completed a sociodemographic survey and the Premature Ejaculation Diagnostic Tool. They also performed a masturbation exercise with a maximum of 5 stops, with the intention of prolonging the arousal phase. The time of the exercise was measured from the beginning of genital masturbation to ejaculation. Outcomes: We calculated the total time of the exercise, the median time at each start, and the number of dropouts. We performed a pairwise comparison analysis between starts and made a survival curve representing the percentage of men who remained in the exercise. Results: A total of 481 men with PE participated (mean ± SD; age, 29.25 ± 8.72 years). We found that the expected median survival time until ejaculation was 317.00 seconds (95% CI, 288.34-345.65). However, the average time during stimulation decreased as the exercise progressed, and statistically significant differences were observed in their pairwise comparison (P < .001). Also, the chances of ejaculation increased as the exercise progressed, with 62.16% of the participants ejaculating before the end of the exercise. The results indicated increasing sexual arousal, where stops in stimulation were progressively less effective at maintaining ejaculation times at starts. Clinical Implications: We showed that the arousal phase is altered in PE, not the orgasm phase, and this could finally have implications in the diagnosis and/or treatment of this condition. Strengths and Limitations: The analysis of the times at starts and stops in a masturbation exercise in men with PE, had been barely addressed before. In the future, it would be important to verify the effect of stops during sexual intercourse and to incorporate a control group of men without PE. Conclusions: We propose a new conceptualization and definition for PE: progressive arousal disorder is the inability to modulate, regulate, or decrease arousal during any sexual activity, even with brief stops during sexual stimulation, causing unwanted ejaculation.

Validation of a Sagittal Section Technique for Measuring Clitoral Blood Flow. Volume Flow: A New Parameter in Clitoral Artery Doppler.

BACKGROUND: Clitoral artery Doppler has been used as an objective technique to measure changes in genital women response. However, the technique has not been fully validated, and arterial volume flow has never been used as an outcome measure. AIMS: To validate the technique clitoral artery Doppler measured in a sagittal section and explore arterial volume flow as a new parameter in clitoral Doppler. METHODS: We examined 90 healthy volunteers by clitoral artery Doppler using the sagittal section approach described by Battaglia et al in 2008. We calculated intraobserver, interobserver, and intraobserver intersession variability and reliability for all Doppler parameters and described and validated arterial volume flow as a new parameter in clitoral artery Doppler. OUTCOMES: We calculated peak systolic velocity (PSV), time-averaged maximum velocity, time-averaged mean velocity, end-diastolic velocity, pulsatility index, resistance index, and volume flow (v-flow) in all groups. We conducted reliability analyses using the intraclass correlation coefficient for agreement. We explored differences between and within observers and calculated agreement limits using the Bland-Altman test. RESULTS: The intraclass correlation coefficient analysis showed correlation values higher than 0.75 (good reliability) for most of the variables and higher than 0.60 (moderate reliability) for the remaining ones. There were statistically significant differences between PSV and time-averaged maximum velocity in the intraobserver intersession measurements. For the remaining groups and variables, no statistically significant differences were observed. Bland-Altman analyses showed that the limits of agreement were acceptable and the regressions were not significant. The v-flow parameter also showed good reliability and low variability between groups. CLINICAL IMPLICATIONS: We found that PSV was not a good outcome measure because of its high intraobserver and intersession variability. Moreover, it is possible to measure v-flow in the clitoral artery using the sagittal technique described by Battaglia et al, and it seems that this measure is reliable and reproducible. This could be the best parameter to assess clinical changes. STRENGTHS & LIMITATIONS: This study provided full validation of the sagittal section approach and of a new parameter, v-flow, which could beuseful for assessing clitoral blood flow. The main limitation of the study is its retrospective nature for validating v-flow. CONCLUSION: We found that clitoral artery Doppler measured using a sagittal approach is a valid and reliable technique for studying clitoral blood flow in women. The v-flow variable is a promising and reliable parameter for measuring changes in clitoral blood flow. Pérez MF, Agís IF, La Calle Marcos P, et al. Validation of a Sagittal Section Technique for Measuring Clitoral Blood Flow: Volume Flow - A New Parameter in Clitoral Artery Doppler. J Sex Med 2020;17:1109-1117.

Sexual satisfaction following bariatric surgery: A prospective exploratory study. / Satisfacción sexual tras cirugía bariátrica: estudio observacional prospectivo.

INTRODUCTION: Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction. METHODS: We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire. RESULTS: Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD=9.4] years and BMI 46.9 [SD=6.2] kg/m2), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD=20.1) in women and 24.4 (SD=16.0) in men (P>0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P=0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P=0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038). CONCLUSIONS: A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women.

Satisfacción sexual tras cirugía bariátrica: estudio observacional prospectivo / Sexual satisfaction following bariatric surgery: A prospective exploratory study

Introducción: La cirugía bariátrica mejora la función sexual en pacientes obesos, aunque el alcance de mejora de la satisfacción sexual es desconocido. Los objetivos del estudio son 1) describir la satisfacción sexual en hombres y mujeres obesos severos/mórbidos candidatos a cirugía bariátrica; 2) valorar los efectos de la cirugía bariátrica en la satisfacción sexual a los 12 meses de seguimiento y 3) evaluar si los cambios en el peso tras el seguimiento se asocian con cambios en la satisfacción sexual. Métodos: Estudio observacional prospectivo desde febrero de 2011 hasta junio de 2014. Un total de 44 pacientes con obesidad severa/mórbida participaron en el estudio. Se valoró la satisfacción sexual (al inicio del estudio y tras 12 meses de seguimiento) a través del cuestionario del índice de satisfacción sexual (ISS). Resultados: De los 44 pacientes que completaron el cuestionario preoperatoriamente con una edad media de 40,3 años (DE = 9,4) y un IMC de 46,9 kg/m2 (DE = 6,2), 17 se perdieron durante el seguimiento. La puntuación total del ISS preoperatorio fue de 32,0 (DE = 20,1) en mujeres y de 24,4 (DE = 16,0) en hombres (p > 0,05). La proporción de hombres y mujeres con satisfacción sexual preoperatoria fue 62,5 y 46,6%, respectivamente (p = 0,360). Durante el seguimiento, la satisfacción sexual mejoró significativamente en mujeres (diferencia media de 13,7 unidades; p = 0,032), pero no en hombres (diferencia media de 3,6 unidades; p = 0,717). El porcentaje de mujeres con problemas de satisfacción sexual se redujo en un 33% tras el seguimiento (p = 0,038). Conclusiones: Un porcentaje relativamente amplio de mujeres y hombres obesos severos/mórbidos presentan problemas de satisfacción sexual antes de la cirugía bariátrica. La satisfacción sexual mejora significativamente tras 12 meses de seguimiento, sobre todo en mujeres (AU)

Introduction: Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction. Methods: We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire. Results: Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD = 9.4] years and BMI 46.9 [SD = 6.2] kg/m2), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD = 20.1) in women and 24.4 (SD = 16.0) in men (P > 0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P = 0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P = 0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038). Conclusions: A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women (AU)

Adaptation of the New Sexual Satisfaction Scale-Short Form Into Spanish.

Measuring and understanding sexual satisfaction is a key element in the evaluation of sexual health and the human sexual response. This study sought to adapt and validate the New Sexual Satisfaction Scale-Short Form from English into the Spanish language. A four-sample (two community samples, one LGB sample, and one university sample) study of 1,200 participants was completed in Spain between 2012-2014. Exploratory and confirmatory factor analyses demonstrated that the adapted version satisfactorily meets validation requirements. In posterior analyses, relationship stability and sexual orientation were factors that increased sexual satisfaction. Self-identified lesbian participants were more sexually satisfied than their heterosexual counterparts. Stable relationships appeared to be a factor for increased sexual satisfaction while age was not. Age and sexual identity/gender did not influence sexual satisfaction.

Enacted Sexual Stigma, Stigma Consciousness, and Subjective Happiness Scale Adaptation: A Two-Country Study.

Violence against people due to their sexual orientation is a phenomenon that exists within a framework of sexual stigma and sexual prejudice that can result in enacted stigma. The present study primarily aimed to validate the Stigma Consciousness Questionnaire (SCQ) and the Subjective Happiness Scale (SHS; for lesbian, gay, and bisexual [LGB] populations) in the Spanish context by using samples from two countries (Spain [N = 157] and the United States [N = 83]). Also, to examine how the construct of stigma consciousness correlates with anti-LGBQ (anti-lesbian, gay, bisexual, and queer) hate crime victimization and violent incidents, as well as examine whether the former influences subjective happiness. The population from the United States reported higher stigma consciousness and received more anti-LGBQ threats and insults. Hate crime victimization was the same across the two samples and positively correlated with violent incidents in both samples. Subjective happiness was negatively correlated with SCQ, although its subscales it did not correlate with enacted stigma measures.

Sexual Functioning, Desire, and Satisfaction in Women with TBI and Healthy Controls.

Traumatic brain injury (TBI) can substantially alter many areas of a person's life and there has been little research published regarding sexual functioning in women with TBI. Methods. A total of 58 women (29 with TBI and 29 healthy controls) from Neiva, Colombia, participated. There were no statistically significant differences between groups in sociodemographic characteristics. All 58 women completed the Sexual Quality of Life Questionnaire (SQoL), Female Sexual Functioning Index (FSFI), Sexual Desire Inventory (SDI), and the Sexual Satisfaction Index (ISS). Results. Women with TBI scored statistically significantly lower on the SQoL (p < 0.001), FSFI subscales of desire (p < 0.05), arousal (p < 0.05), lubrication (p < 0.05), orgasm (p < 0.05), and satisfaction (p < 0.05), and the ISS (p < 0.001) than healthy controls. Multiple linear regressions revealed that age was negatively associated with some sexuality measures, while months since the TBI incident were positively associated with these variables. Conclusion. These results disclose that women with TBI do not fare as well as controls in these measures of sexual functioning and were less sexually satisfied. Future research is required to further understand the impact of TBI on sexual function and satisfaction to inform for rehabilitation programs.

Cambios ecográficos en el bulbo uretral durante la respuesta sexual femenina: un estudio piloto / Ultrasound changes in the urethral bulb during female sexual response: a pilot study

Objetivo: La submucosa del esfínter uretral interviene en el mecanismo de continencia urinaria y es rica en tejido esponjoso. La hipótesis de este estudio es que esta submucosa tiene carácter eréctil y, por tanto, debe sufrir cambios ecográficos durante la respuesta sexual en la mujer. Material y métodos: Se realiza un estudio piloto en una serie de 9 casos, mujeres sanas, con una edad media de 30,1 años y previo consentimiento informado por escrito. Para la exploración ecográfica se usa un General Electric Voluson® E8 HD. Se realiza, en primer lugar, una ecografía en estado basal, y en un segundo tiempo, en excitación sexual obtenida mediante autoestimulación. En los 4 primeros casos se realizan medidas del esfínter uretral, y en los 5 casos siguientes, además, se registra la vascularización y ecogenicidad intrauretral. Las imágenes son registradas y los datos analizados con el paquete estadístico SPSS® v. 22. Resultados: Se comprueba en la serie el aumento discreto, aunque significativo, del volumen del esfínter uretral durante la excitación sexual (p = 0,016). Además, se advirtieron importantes cambios vasculares y un cambio muy apreciable de la ecorrefringencia de la submucosa uretral, la cual pasaba de ser marcadamente hipoecogénica a ser isoecogénica. Se encontraron vasos longitudinales a lo largo de toda la submucosa en número de 3, con aferencias transversales desde el plexo de Santorini y de la pared uretrovaginal. Discusión: Con la cautela propia de un estudio piloto, se informa de cambios discretos en el volumen uretral, y cambios importantes en ecogenicidad y vascularización de la submucosa uretral durante la excitación sexual en la mujer. Estos hallazgos apoyan la hipótesis de que la submucosa uretral forma parte del sistema eréctil femenino. Se abre una nueva vía de investigación en torno a la ecografía introital como herramienta para la valoración tanto anatómica como funcional de la respuesta sexual genital femenina (AU)

Objective: The urethral sphincter submucosa is part of the urinary continence mechanism and it is rich in spongy tissue. The study hypothesis was that this submucosa has erectile properties and therefore must undergo echographic changes during the sexual response in women. Material and method: A pilot study was done in 9 healthy women with an average age of 30.1 years, after receiving prior written informed consent. For the ultrasound examination we used a General Electric Voluson® E8 HD. At the beginning we made an ultrasound in basal state and a second time during sexual arousal by self-stimulation. In the 4 former cases we measured the urethral sphincter and in the following 5 participants we also registered the vascularization and intraurethral echogenicity. Images were registered and the data were analyzed with statistical package SPSS® v. 22. Results: Discrete but significant increase in the volume of the urethral sphincter during sexual arousal (P = .016) is found in the series. In the last 5 cases of the study in addition we found important vascular changes and a significant change in echographic reference values of the urethral submucosa: it changed from markedly hypoechogenic to be isoechogenic. We found 3 longitudinal vessels along submucosa with transversal afferents from Santorini plexus and from urethrovaginal wall. Discussion: With the caution typical of a pilot study, a discrete increase of urethral volume and important changes in the urethral submucosa of echogenicity and vascularization were noticed during female sexual arousal. These results support the hypothesis that the urethral submucosa is part of the erectile female system. We offer a new way of research utilizing introital echography as a tool to evaluate anatomical and functional female genital sexual response (AU)