Prevalence of sexual dysfunction in depressive and persistent depressive disorders: a systematic review and meta-analysis.

The aim of this study was to estimate the prevalence of sexual dysfunction in depressive disorders in individuals not in pharmacological treatment. For this purpose, we performed a systematic review and meta-analysis using the PRISMA guidelines, and the review was registered in PROSPERO (registration number CRD42020179709). Studies that evaluated sexual function and dysfunction in major depressive disorder (MDD) and persistent depressive disorder (PDD) were identified through searches in PubMed/Medline, Web of Science, PsychINFO, Scopus, and Scielo. Twelve cross-sectional studies were eligible. In women with MDD, the pooled prevalence rates of sexual impairment were: 47.22% (95% CI: 34.86-59.58) for arousal; 65.30% (95% CI: 45.86-84.73) for desire; 36.98% (95% CI: 28.42-45.54) for lubrication; 34.17% (95% CI: 17.87-50.46) for orgasm; and 33.91% (95% CI: 17.48-50.34) for sexual satisfaction. In men, the sexual impairment prevalence rates were: 26.45% (95% CI: 12.26-40.63) for arousal; 40.32% (95% CI: 22.19-58.46) for desire; 32.07% (95% CI: 26.14-37.99) for erection; 35.27% (95% CI: 5.13-65.41) for orgasm; and 23.05% (95% CI: 13.60-32.51) for sexual satisfaction. Overall sexual dysfunction was found in 82.75% of women (95% CI: 74.71-90.78) and 63.26% of men (95% CI: 52.83-73.69). Our results show that various sexual functions are impaired in MDD, making imperative the systematic evaluation of these alterations by clinicians. Future studies should be conducted, especially in PDD, to elucidate the role of these disorders in sexual function.

Treatment effects and adherence of sexually compulsive men in a randomized controlled trial of psychotherapy and medication.

Background: Little attention has been given to efficacious treatment and adherence to treatment of compulsive sexual behavior (CSB). Aims: Randomized controlled trial investigated short-term psychodynamic group therapy followed by relapse prevention group (STPGP-RPGT) and pharmacological treatment (PT) for CSB men on sexual compulsivity and adherence. Method: 135 men, 38 (SD = 9) years old on average, were randomly assigned to 1) STPGP-RPGT; 2) PT; 3) Both. Participants completed measures at baseline, 25th, and 34th week. 57 (42.2%) participants dropped out between baseline and 25th week, and 68 (50.4%) between baseline and 34th week. 94 (69.6%) did not adhere (80% pills taken or attended 75% therapy sessions). Results: A significant interaction effect was found between time and group (F (4, 128) = 2.62, P = 0.038, ES = 0.08), showing who received PT improved less in sexual compulsivity than those who received STPGP-RPGT (t = 2.41; P = 0.038; ES = 0.60) and PT + STPGP-RPGT (t = 3.15; P = 0.007, ES = 0.74). Adherent participants improved more in sexual compulsivity than non-adherent at the 25th week (t = 2.82; P = 0.006, ES = 0.65) and 34th week (t = 2.26; P = 0.027, ES = 0.55), but there was no interaction effect, F (2, 130) = 2.88; P = 0.06; ES = 0.04). The most reported behavior (masturbation) showed greater risk of non-adherence (72.6%). Discussion and conclusions: Adherent participants improved better than non-adherent. Participants who received psychotherapy improved better than those who received PT. Methodological limitations preclude conclusions on efficacy.

Proportion of ALGBT adult Brazilians, sociodemographic characteristics, and self-reported violence.

Asexual, lesbian, gay, bisexual, and trans (ALGBT) individuals face worse life conditions and violence rates than their heterosexual cisgender counterparts. Brazil is often highlighted for having one of the highest rates of hate-related homicides against ALGBTs in the world. However, to date, Brazil's ALGBT population has not been investigated with a representative sample, and basic information such as population size or sociodemographic characteristics are mostly based in non-systematic data. We aimed to assess the proportion of asexual, lesbian, gay, bisexual, trans and non-binary adults in Brazil, their sociodemographic characteristics, and self-reported violence rates. In 2018, a sample (n = 6000) of the Brazilian adult population answered a face-to-face survey assessing sociodemographic characteristics, gender identity, sexual orientation, and self-reported psychological, physical, verbal, and sexual violence. Among Brazilian adults, 12.04% are ALGBT: 5.76% asexual, 0.93% lesbian, 1.37% gay, 2.12% bisexual, 0.68 trans, and 1.18% non-binary. Compared to heterosexual cisgender men, most ALGBT individuals have worse socioeconomic indicators and higher rates of self-reported psychological and verbal violence. All ALGBT groups and heterosexual cisgender women reported sexual violence more often than heterosexual cisgender men. It was reported between 4 up to 25 times more often by heterosexual cisgender women and trans individuals, respectively. The rates of the other ALGBT groups sit among the two. Our findings provide evidence of the important size of the ALGBT Brazilian population, as well as their socioeconomic vulnerability, and concerning violence levels experienced by the group. Policy makers may refer to the present article in order to mitigate this population's vulnerability and to better understand its sociodemographic characteristics.

Proportion of people identified as transgender and non-binary gender in Brazil.

Studies estimate that gender-diverse persons represent 0.1 to 2% of populations investigated, but no such assessment was performed in Latin America. In a representative sample of Brazil's adult population (n = 6000), we investigated participants' sociodemographic characteristics and possible associations between these and current gender identity, categorized as cisgender, transgender or non-binary gender. We also investigated transgender individuals' distress associated with gender-related body characteristics. As main results, we found that transgender individuals represented 0.69% (CI95% = 0.48-0.90) of the sample, whereas non-binary persons were 1.19% (CI95% = 0.92-1.47). These percentages were not different among Brazil's 5 geographic regions. Preliminary analyses showed that transgender individuals were on average younger (32.8 ± 14.2 years, CI95% = 28.5-37.1), compared to cisgender (42.2 ± 15.9, CI95% = 42.5-42.8) and non-binary (42.1 ± 16.5 years, CI95% = 38.3-46.5) groups. Non-binary persons are less likely to be in a relationship compared to cisgender individuals (OR = 0.57, CI95% = 0.35-0.93). In the transgender group, 85% of transgender men and 50% of transgender women reported distress due to gender-related body characteristics. Our main findings draw attention that gender-diverse Brazilian individuals represent around 2% of the country's adult population (almost 3 million people), and are homogeneously located throughout the country, reiterating the urgency of public health policies for these individuals in the five Brazilian sub-regions.

Erectile dysfunction and correlated factors in Brazilian men aged 18-40 years.

INTRODUCTION: Few population-based studies in erectile dysfunction (ED) included subjects less than 40 years old and analyzed the several factors and consequences potentially associated with this condition. AIM: Evaluation of the prevalence of erectile dysfunction (ED) and associated factors in a sample of Brazilian men aged 18 to 40 years old. METHODS: Cross-sectional study in which subjects were contacted in public places of 18 major Brazilian cities and interviewed using an anonymous questionnaire. Survey data were submitted to chi-squared, student's t-test and logistic regression analyses. MAIN OUTCOME MEASURES: The data were collected by means of a self-administered questionnaire with 87 questions about sociodemographic variables, general health, habits and lifestyle-related factors, sexual behavior and sexual difficulties, including ED which was assessed by a single question. RESULTS: Prevalence of ED in 1,947 men was 35.0% (73.7% mild, 26.3% moderate/complete). Greater frequency of ED was seen in subjects that never had information about sex, experienced difficulties in the beginning of sexual life and have never masturbated. ED was associated to lower level of education, but not to race, sexual orientation, employment or marital status. Also, no association was found between ED and smoking, alcoholism, obesity, sedentary life, diabetes, hypertension, cardiovascular disease, hyperlipidemia, depression or anxiety. ED caused negative impact in men's self-esteem, interpersonal relationships, work and leisure activities, and in sexual life satisfaction. Less than 10% of men with ED had received medical treatment for this problem. CONCLUSIONS: Prevalence of ED in this young population was high, mostly of mild severity. Low education and psychosocial problems were associated to ED and, due probably to the sample subjects' young age, no association was found with organic problems. Measures in the fields of education and psychosocial difficulties prevention would have a positive impact in the control of erectile dysfunction in the young population.

Prevalence of erectile dysfunction as defined by the International Index of Erectile Function (IIEF) and self-reported erectile dysfunction in a sample of Brazilian men who consider themselves healthy.

A cross-sectional study was carried out with 288 male blood donors, aged between 40 and 60 years old, with the aim of comparing the prevalence of erectile dysfunction (ED) as defined by the International Index of Erectile Function (IIEF) and that resulting from the simple questioning of the presence of ED. Socio-demographic, clinical, and behavioral factors that are associated with the presence of ED were considered. Erectile dysfunction prevalence in the IIEF was 31.9%, while self-reported ED prevalence was 3.1%. The factors associated to ED, as reported by the IIEF were: professional inactivity, suspected depression and/or anxiety, reduced sexual desired, and self-reported ED.

Unconventional sexual behaviors and their associations with physical, mental and sexual health parameters: a study in 18 large Brazilian cities.

OBJECTIVE: There have been many studies investigating paraphilias and sexual compulsion, but thus far little data about prevalence of unusual sexual practices that are subthreshold for these diagnoses. The associations between unconventional sexual behavior and sociodemographic and health parameters were investigated. METHOD: A cross-sectional study of 7,022 individuals (45.4% of women) was carried out using a self-administered questionnaire that compared individuals carrying at least one reference of unconventional sexual behavior (group 1) with individuals without such reference (group 2). RESULTS: Women's mean age was 35.0 vs. 35.9 years (p < 0.05) and men's mean age was 36.5 vs. 37.8 years (p < 0.05) being lower in group 1 than in group 2, respectively. More men (52.3%) than women (30.4%) (p < 0.001) presented unconventional sexual behavior. Fetishism (13.4%) and voyeuristic behavior (13.0%) were more frequent. Unconventional sexual behavior was associated with male gender, single or separated marital status, black or mulatto race, elementary and high school educational level, history of posttraumatic stress disorder treatment, alcohol dependence, emergency contraception, difficulty at the beginning of sexual life, sexual violence, bisexuality, and performance of anal or oral intercourse. CONCLUSION: Unconventional sexual behaviors are important because they are associated with poorer health status and lower educational levels.

A influência das mídias sociais nos relacionamentos sexuais dos jovens / The influence of social media on young people's sexual relationships

As redes sociais revolucionaram a maneira como os indivíduos de todas as faixas etárias se comunicam e interagem, tendo um impacto significativo nos relacionamentos sexuais. Essas plataformas oferecem acesso a informações sobre saúde sexual e facilitam a formação de vínculos amorosos e sexuais. Para os jovens que não se identificam como heterossexuais, as redes sociais desempenham um papel crucial no desenvolvimento da orientação sexual e na busca por aceitação. Embora as mídias sociais possam promover uma melhor compreensão da sexualidade e do sexo seguro, estão associadas a comportamentos de risco, como o sexting, e podem levar a consequências negativas, como abuso e insatisfação sexual. A agência sexual (habilidade para sentir prazer sexual, assertividade, comunicação, percepção de limites e empatia) é fundamental para navegar nas complexidades dos relacionamentos sexuais online. A privacidade é um desafio nesse contexto, com a vida pública e privada muitas vezes sendo confundida. Estabelecer limites claros com os parceiros sobre o que pode ser compartilhado online é essencial para evitar mal-entendidos e conflitos. Por outro lado, as redes sociais também podem ser uma ferramenta valiosa para educação em saúde sexual, capacitando os indivíduos a tomarem decisões informadas sobre seus relacionamentos e bem-estar sexuais. Profissionais de saúde e pesquisadores precisam estar cientes dessas influências para informar jovens, pais e educadores sobre o uso seguro e saudável dessa ferramenta para a sexualidade.

Sexual function in female juvenile idiopathic arthritis patients.

OBJECTIVE: To evaluate sexual function female adolescents and young adults with juvenile idiopathic arthritis (JIA) and healthy controls. METHODS: After exclusion, 21 female adolescent and young JIA patients and 25 healthy controls were selected for this study. Sexual function was assessed by the Sexual Quotient Questionnaire for Females (SQQ-F) score, which is a validated tool and adapted for Brazilian Portuguese language. Demographic data, JIA clinical/laboratory parameters and treatment were also assessed. RESULTS: The median current age [26.5 (17-38.1) vs. 29.3 (19.7-35.8) years, p = 0.700)] as well as age at the first sexual activity [18 (14-30) vs. 17 (10-24) years, p = 0.158] were similar in JIA patients and healthy controls. The median of SQQ-F score was alike in both groups [75.9 (50-92) vs. 78.2 (58-94), p = 0.529], as well as frequencies of sexual dysfunction (14% vs. 12%, p = 1.000). The frequencies of all sexual domains (desire/sexual fantasies, desire/interest, arousal/foreplay, arousal/lubrication, arousal/in tune with partner, penetration/relaxation, pain/penetration, desire/involvement, orgasm and general satisfaction scores) were similar in JIA patients and healthy controls (p > 0.05). CONCLUSIONS: To our knowledge, this was the first study using a validated sexual score in a chronic arthritis population suggesting a low frequency of overall sexual dysfunction in young JIA patients. Future multicenter studies with a large sample will be necessary to confirm this finding.

Atenção plena como opção terapêutica para as disfunções sexuais / Mindfulness as a therapeutic option for sexual dysfunctions

A prevalência das disfunções sexuais é alta na população geral. A capacidade de regular as experiências emocionais facilita o relacionamento mais adaptado aos estados internos e às condições ambientais. A prática da atenção plena promove atenção à experiência do momento presente ­ com curiosidade, abertura, aceitação, não reatividade e não julgamento ­ e tem se mostrado eficaz para melhorar muitas condições biopsicossociais, sendo utilizada em ambientes de saúde, escolas e locais de trabalho. O objetivo é apresentar atualizações na abordagem das dificuldades sexuais por meio do desenvolvimento da atenção plena. Entre outras recomendações, o treinamento para descentralizar a atenção, o desenvolvimento de habilidades para perceber pensamentos e sentimentos como estados mentais, não necessariamente reais, além de promover aceitação, compaixão e melhor gestão de pensamentos intrusivos e ruminativos são alguns pontos positivos da prática da atenção plena como única abordagem ou associada a outras. É apresentado um protocolo com grupo terapêutico para desenvolvimento da atenção plena para casais, em que o parceiro é sobrevivente do câncer de próstata. Segue uma proposta terapêutica com oito módulos desenvolvida em formato presencial e adaptada para a plataforma virtual. Os módulos são: definições e causas da disfunção sexual; conscientização crescente das sensações físicas; exploração do corpo e julgamentos sobre ele; consciência de pensamentos e crenças sexuais; trabalho com aversão e autotoque; consciência das sensações sexuais; foco sensorial com o parceiro; manutenção (e aumento) dos ganhos. Essa prática desenvolvida online abriu um campo importante para beneficiar portadores de disfunção sexual com dificuldade para buscar outras modalidades de intervenção.

A sexualidade de indivíduos transgêneros: recomendações para profissionais de saúde / The sexuality of individuals transgender: recommendations for healthcare professionals

Indivíduos transgêneros (ou trans) apresentam diferença entre a sua identidade de gênero e o sexo que lhe foi atribuído ao nascimento, o que provoca sofrimento grave, nomeado como disforia de gênero, estado que apresenta melhora após a transição para o gênero autor-reconhecido. Pessoas transgêneras apresentam os piores marcadores de saúde mental entre os LGBTQIA+. O objetivo deste texto é levantar aspectos psicossociais e sexuais de indivíduos transgêneros e trazer algumas recomendações para profissionais de saúde. Os tratamentos disponibilizados para essa população são os de afirmação de gênero (supressão da puberdade, tratamento hormonal cruzado, cirurgia reconstrutiva torácica e cirurgias genitais afirmativas de gênero). Muitas vezes, as alterações corporais conseguem diminuir os sintomas de disforia, melhorando a qualidade de vida. Porém, para muitos deles, apenas a mudança do papel social de gênero é suficiente. As disfunções sexuais mais frequentes experimentadas por mulheres e homens trans são dificuldades para iniciar e buscar contato sexual (mulheres, 26%, homens, 32%) e para atingir o orgasmo (29% e 15%). A atenção à saúde transgênera deve conter cuidados inter e multidisciplinares holísticos, envolvendo endocrinologia, cirurgia, voz e comunicação, atenção primária, saúde reprodutiva, saúde sexual e mental para acompanhar intervenções de afirmação de gênero, bem como prevenção, cuidado e gerenciamento de doenças crônicas. Indivíduos transgêneros enfrentam, além de todas as questões que afligem a sociedade contemporânea, a invisibilidade reforçada principalmente pela falta de conhecimento e pelos preconceitos. Faz-se necessário um atendimento que seja acolhedor, educativo, não preconceituoso e que respeite a individualidade daqueles que carregam em suas histórias sofrimento e violência.

Grey and white matter volumes either in treatment-naïve or hormone-treated transgender women: a voxel-based morphometry study.

Many previous magnetic resonance imaging (MRI) studies have documented sex differences in brain morphology, but the patterns of sexual brain differences in transgender women - male sex assigned at birth - with a diagnosis of gender dysphoria (TW) have been rarely investigated to date. We acquired T1-weighted MRI data for the following four (n = 80) groups: treatment-naïve TW (TNTW), TW treated with cross-sex hormones for at least one year (TTW), cisgender men, and cisgender women (cisgender individuals as controls). Differences in whole-brain and regional white matter volume and grey matter volume (GMV) were assessed using voxel-based morphometry. We found lower global brain volumes and regional GMVs in a large portion of the posterior-superior frontal cortex in the cisgender women group than in the TTW and cisgender men groups. Additionally, both transgender groups exhibited lower bilateral insular GMVs than the cisgender women group. Our results highlight differences in the insula in both transgender groups; such differences may be characteristic of TW. Furthermore, these alterations in the insula could be related to the neural network of body perception and reflect the distress that accompanies gender dysphoria.

A sexualidade de mulheres mais velhas / The sexuality of older women

A população mundial tem vivido mais e deve manter uma boa saúde durante o processo de envelhecimento. Idosos expressam o desejo de preservar a vida sexual ativa, porém, mesmo com evidências de que o bem-estar sexual desempenha papel importante no sucesso dessa etapa de vida, os elementos facilitadores dessa condição têm sido pouco estudados. A diminuição e a interrupção dessa atividade entre as mulheres estão associadas à presença de disfunção erétil e/ou adoecimento do parceiro, entre outros fatores. Considerando a importância da satisfação sexual de mulheres em processo de envelhecimento, esse texto tem como objetivo discutir os elementos facilitadores dessa satisfação, na população idosa, visto que a manutenção da satisfação sexual é um forte preditor do envelhecimento saudável, assim como a atividade social e a saúde geral. Os estereótipos sociais, os preconceitos de familiares e pessoas com quem convivem, a falta de privacidade e a crença de que a viuvez encerra a vida sexual são algumas das barreiras à expressão do desejo sexual dessas mulheres. A maioria das mulheres mais velhas gostariam de permanecer sexualmente ativas, inclusive aquelas sem parceria. Por isso, os profissionais de saúde precisam estar conscientes da importância de novas referências sobre a sexualidade das mulheres em qualquer fase da vida. A diversidade de possibilidades de função e desempenho sexual ao longo do envelhecimento deve ser discutida para incentivá-las a serem sexualmente ativas e fortalecerem a resposta aos estímulos sexuais.

Estressores financeiros e o comprometimento da saúde mental e sexual / Financial stressors and compromised mental and sexual health

Em geral, maior nível de estresse durante a pandemia agravou a saúde mental e sexual. Estresse financeiro refere-se à ausência de renda satisfatória e insatisfação com essa condição. Piores condições econômicas geraram o estresse financeiro e o comprometimento da qualidade de vida dos casais. O objetivo desse texto é discutir a influência de estressores financeiros no relacionamento conjugal e na saúde mental e sexual. Embora os casais iniciem a vida conjugal com expectativas positivas, dificuldades financeiras preveem aumento de depressão, diminuição da satisfação conjugal e aumento dos conflitos, com maior probabilidade de divórcio. A administração conjunta da renda tem sido associada a uma melhor qualidade e coesão nos relacionamentos, especialmente para as mulheres, enquanto contas individuais podem minar a satisfação feminina, reduzindo sentimentos de intimidade, compatibilidade sexual e satisfação com a resolução de conflitos. Na abordagem de relacionamento conjugal e saúde sexual, as percepções podem desempenhar um papel mais importante do que os fatos objetivos. A percepção da satisfação financeira e sexual prevê melhor a estabilidade conjugal do que os recursos financeiros objetivos ou a frequência de relações sexuais. O estresse financeiro está associado não só a maior insatisfação financeira como também sexual, levando a maior instabilidade conjugal. Habilidades comunicacionais saudáveis, para comunicação financeira e relacional, facilitam a abordagem de questões relativas a dinheiro e sexo, adequando a percepção dessas questões. Gestão financeira, percepção de satisfação sexual e habilidades comunicacionais juntas desempenham um papel preponderante na qualidade da vida conjugal.

Analysis of sexual function of patients with dermatomyositis and polymyositis through self-administered questionnaires: a cross-sectional study.

INTRODUCTION: To date, there are no descriptions in the literature on gynecologic and sexual function evaluation in female patients with dermatomyositis (DM) and polymyositis (PM). OBJECTIVE: To assess sexual function in female patients with DM/PM. PATIENTS AND METHODS: This is a monocentric, cross-sectional study in which 23 patients (16 DM and 7 PM), with ages between 18 and 40 years, were compared to 23 healthy women of the same age group. Characteristics on sexual function were obtained by applying the questionnaires Female Sexual Quotient (FSQ) and Female Sexual Function Index (FSFI) validated for the Brazilian Portuguese language. RESULTS: The mean age of patients was comparable to controls (32.7±5.3 vs. 31.7±6.7 years), as well as the distribution of ethnicity and socioeconomic class. As for gynecological characteristics, patients and healthy controls did not differ with respect to age at menarche and percentages of dysmenorrhea, menorrhagia, premenstrual syndrome, pain at mid-cycle, mucocervical secretion, and vaginal discharge. The FSQ score, as well as all domains of the FSFI questionnaire (desire, arousal, lubrication, orgasm and satisfaction), were significantly decreased in patients vs. controls, with 60.9% of patients showing some degree of sexual dysfunction. CONCLUSIONS: This was the first study to identify sexual dysfunction in patients with DM/PM. Therefore, a multidisciplinary approach is essential for patients with idiopathic inflammatory myopathies, in order to provide prevention and care for their sexual life, providing a better quality of life, both for patients and their partners.

Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury.

INTRODUCTION: Spinal cord injury (SCI) is usually a sudden traumatic event and has a negative effect on sexual function. AIM: To evaluate the characteristics of sexual activity in men with SCI and identify predictors of being sexually active and having a satisfactory sex life. METHODS: We assessed sexual activity profiles of men with SCI from a Brazilian tertiary rehabilitation center from February to August 2012. All patients older than 18 years with SCI for longer than 1 year were invited to participate. We analyzed age, time since SCI, patient age at SCI, employment status, partner status, completeness of lesion, functional independence, urinary continence, and Sexual Health Inventory for Men (SHIM) score. MAIN OUTCOME MEASURES: The SHIM was used to assess erectile function (EF). Satisfaction with sex life was analyzed as a dichotomous variable. Predictors of an active and satisfactory sex life were identified using univariable and multivariable analyses. RESULTS: We evaluated 295 men with mean age of 40.7 ± 14.5 years. Most patients had a complete SCI (65.1%) and 159 (53.9%) were incontinent. The median SHIM score was 5 (interquartile range = 0-16) and only 71 men (24.1%) had a SHIM score of at least 17. Of these men, 159 (53.9%) were sexually active. Only 63 men (39.6%) were satisfied with their sex life after SCI. In univariable analysis, all variables were associated with an active sex life. Those with a SHIM score of at least 17 had a greater likelihood of being sexually active (odds ratio = 116, 95% confidence interval = 14-432). EF was the only parameter associated with a satisfactory sex life (odds ratio = 1.3, 95% confidence interval = 1.2-1.4). CONCLUSIONS: Most men with SCI were sexually inactive and/or dissatisfied with their sex life. Age, duration of SCI, completeness of SCI, continence, having a partner, and good EF were identified as predictors of an active sex life. However, only EF was a predictor of a satisfactory sex life. Gomes CM, Miranda EP, de Bessa J, et al. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017;5:e148-e155.

[Erectile dysfunction: results of the Brazilian Sexual Life Study]. / Disfunção erétil: resultados do Estudo da Vida Sexual do Brasileiro.

OBJECTIVE: To estimate the prevalence of ED and related risk factors in a sample of the Brazilian male population. METHODS: Cross-sectional study was carried out with a convenience sample of 2,862 men, 18 years of age or older, using an anonymous self-administered questionnaire. ED prevalence in the sample was obtained by a general question which was directly derived from the ED definition. Data were submitted to chi-square or Student's t tests. Logistic regression analyses were used for risk factor calculations. RESULTS: The prevalence of ED was 45.1% (31.2% mild, 12.2% moderate and 1.7% complete). Subjects with ED presented lower self-esteem, hindered interpersonal relationships, fewer sexual intercourses per week, more extra-marital relationships, complaints of lack of libido and premature ejaculation. When compared with men aged 18-39 years, men aged 60-69 presented 2.2 higher risk of ED (95% CI; 1.4-3.4; p < 0.01), whereas men aged 70 or older presented 3.0 higher risk of ED (95% CI; 1.4-6.3; p < 0.01). Level of education was inversely proportional to risk of ED. Yellow race, unemployment, religious affiliation, prostate tumor, hypertension and depression were variables that increased ED risk. CONCLUSION: The prevalence of ED was high and comparable to that found in other studies. Subjects with ED suffer from less sexual activity and poorer quality of life. Age and lower socioeconomic level are directly proportional to ED risk. Therapeutic and preventive measures should be implemented to minimize the negative impact of this condition, especially in developing countries.

The impact of ejaculatory dysfunction upon the sufferer and his partner.

Ejaculatory function cannot be evaluated outside the dyadic process and without taking into account the men's and women's cognition of the condition and how their subjective perception impacts on the evaluation of the relationship and sexual quality. Although the distress of the sufferer and his partner has been a motivating factor in leading men with ejaculatory dysfunction to seek medical help, few objective or prospective evaluations of the effects on the couple have been reported. Specialized literature has been dealing with ejaculatory disorders in a heterogeneous manner. Comparatively, there are far more studies on premature ejaculation (PE) than on delayed ejaculation (DE) and even fewer studies on other male orgasm disorders. Therefore, the review focuses on the literature of the two most studied ejaculatory disorders. The matter presented in this article can also be considered for other ejaculatory disorders, since all of them relate to a failure of control, changing the intravaginal ejaculatory latency time (IELT), with consequences for men and their partners. There are multiple psychological explanations as to why a man develops PE or DE. Unfortunately, none of the theories evolve from evidence-based studies. The common final pathway of these factors is the irrational fear of ejaculating intravaginally. These sexual disorders may also cause personal distress for the sexual partner and decreased sexual satisfaction for the couple. An association between pre-existing anxiety disorders and sexual performance anxiety has been found in men and couples with ejaculatory dysfunction. This could reflect a process in which pre-existing anxiety triggers sexual dysfunction, causing performance anxiety and leading to a vicious cycle: anxiety, sexual dysfunction, more anxiety. Men with DE are similar to men with other sexual dysfunctions. They show the same elevated level of sexual dissatisfaction and they also show lower levels of coital frequency. To a lower extent, they use more masturbatory activity relative to controls. The burden of PE for the patient is revealed in three different levels: the emotional burden, the health burden, and the burden on the relationship. In terms of the emotional burden, there is often a sense of embarrassment and shame at not being able to satisfy their partner, and patients often have low self-esteem, feelings of inferiority, anxiety, anger, and disappointment. Men feel frustrated about their PE and how it affects their intimacy with their partners and the sexual relationship. In conclusion, ejaculatory dysfunction has a negative impact on both the man and his female partner and, consequently, it has implications for the couple as a whole. Additionally, ejaculatory dysfunction extending beyond a year elevates the risk of depression in these patients. Although partner perceptions of PE generally indicated less dysfunction than those of subjects, partner outcomes measures play a part in the assessment of PE. Ejaculatory dysfunction involves the integration of physiological, psychobehavioral, cultural, and relationship dimensions. All these elements need to be considered in the treatment.

Infertilidade e relevância de acompanhamento especializado para minimizar disfunções sexuais / Infertility and relevance of specialized monitoring to minimize sexual dysfunctions

Infertilidade é uma condição que afeta muitos casais. Entre 30% e 40% de mulheres em fertilização assistida apresentam depressão e ansiedade. O relacionamento conjugal também é atingido. Fatores psicossociais que podem tornar indivíduos inférteis mais vulneráveis ao estresse são: características de personalidade, sentimentos de ameaça ou de perda relacionados à infertilidade, percepção de pouco controle sobre a condição de infertilidade e o resultado do tratamento, utilização frequente de estratégias de enfrentamento caracterizadas por evitação e fuga, insatisfação conjugal e dificuldade de comunicação do casal e rede de apoio social insuficiente. Observou-se pequena associação, mas significativa, entre estresse e angústia e a redução das chances de gravidez com o tratamento. A infertilidade e as abordagens terapêuticas para fertilização provocam mudanças na autoestima, no relacionamento e na função sexual. As disfunções sexuais atingem as mulheres (43% a 90%) e os homens (48% a 58%). Além do sofrimento psíquico nas mulheres e em seus parceiros, o comprometimento da vida sexual do casal pode afetar a continuidade do relacionamento, inclusive para o enfrentamento dos desafios do casal que se torna pai e mãe, quando o tratamento é bem-sucedido. A confirmação de que a resiliência pode desempenhar função de proteção nesse percurso, fortalece a importância do acompanhamento psicológico, visando otimizar todos os recursos para melhor superação dessa fase da vida dos casais.

Desafios e importância da avaliação pré-operatória na doença de Peyronie / Challenges and importance of the preoperative evaluation in Peyronie's disease

A doença de Peyronie, notória desde 1743, segue sendo um grande desafio na prática médica, com prevalência relevante e grande impacto na vida sexual dos casais. O tratamento cirúrgico é a principal modalidade terapêutica capaz de restabelecer a vida sexual nos pacientes com doença de Peyronie significativa. A escolha do momento de implementação do tratamento cirúrgico, bem como a escolha da técnica a ser empregada, varia de acordo com três pontos centrais: a fase da doença, a deformidade apresentada e a função erétil. Estes pilares para a decisão terapêutica do paciente com doença de Peyronie possuem nuances, não sendo simples a caracterização destes fatores em muitos casos. Uma avaliação pré-operatória criteriosa, fundamental para a melhor escolha terapêutica, exige experiência e um conhecimento aprofundado sobre o tema. O objetivo do presente artigo é promover uma ampla discussão acerca de fatores primordiais da avaliação pré-operatória de pacientes com doença de Peyronie.