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Concept: Sexual dysfunction

170

Reduced libido is widely considered the most prominent symptomatic reflection of low testosterone (T) levels in men. Testosterone deficiency (TD) afflicts approximately 30% of men aged 40-79 years. This study seeks to evaluate the effect of a new natural compound “tradamixina "in order to improve male sexual function in elderly men, particularly libido and possible erectile dysfunction, versus administration of tadalafil 5 mg daily.

Concepts: Sociology, Testosterone, Group, Ageing, Erectile dysfunction, Hypogonadism, Sexual function, Sexual dysfunction

88

Research on multidimensional sexual perfectionism differentiates four forms: self-oriented, partner-oriented, partner-prescribed, and socially prescribed. Self-oriented sexual perfectionism reflects perfectionistic standards people apply to themselves as sexual partners; partner-oriented sexual perfectionism reflects perfectionistic standards people apply to their sexual partner; partner-prescribed sexual perfectionism reflects people’s beliefs that their sexual partner imposes perfectionistic standards on them; and socially prescribed sexual perfectionism reflects people’s beliefs that society imposes such standards on them. Previous studies found partner-prescribed and socially prescribed sexual perfectionism to be maladaptive forms of sexual perfectionism associated with a negative sexual self-concept and problematic sexual behaviors, but only examined cross-sectional relationships. The present article presents the first longitudinal study examining whether multidimensional sexual perfectionism predicts changes in sexual self-concept and sexual function over time. A total of 366 women aged 17-69 years completed measures of multidimensional sexual perfectionism, sexual esteem, sexual anxiety, sexual problem self-blame, and sexual function (cross-sectional data). Three to six months later, 164 of the women completed the same measures again (longitudinal data). Across analyses, partner-prescribed sexual perfectionism emerged as the most maladaptive form of sexual perfectionism. In the cross-sectional data, partner-prescribed sexual perfectionism showed positive relationships with sexual anxiety, sexual problem self-blame, and intercourse pain, and negative relationships with sexual esteem, desire, arousal, lubrication, and orgasmic function. In the longitudinal data, partner-prescribed sexual perfectionism predicted increases in sexual anxiety and decreases in sexual esteem, arousal, and lubrication over time. The findings suggest that partner-prescribed sexual perfectionism contributes to women’s negative sexual self-concept and female sexual dysfunction.

Concepts: Sexual intercourse, Longitudinal study, Cross-sectional study, Sociology, Orgasm, Sexual arousal, Sexual function, Sexual dysfunction

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Traditional factors that once explained men’s sexual difficulties appear insufficient to account for the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40. This review (1) considers data from multiple domains, e.g., clinical, biological (addiction/urology), psychological (sexual conditioning), sociological; and (2) presents a series of clinical reports, all with the aim of proposing a possible direction for future research of this phenomenon. Alterations to the brain’s motivational system are explored as a possible etiology underlying pornography-related sexual dysfunctions. This review also considers evidence that Internet pornography’s unique properties (limitless novelty, potential for easy escalation to more extreme material, video format, etc.) may be potent enough to condition sexual arousal to aspects of Internet pornography use that do not readily transition to real-life partners, such that sex with desired partners may not register as meeting expectations and arousal declines. Clinical reports suggest that terminating Internet pornography use is sometimes sufficient to reverse negative effects, underscoring the need for extensive investigation using methodologies that have subjects remove the variable of Internet pornography use. In the interim, a simple diagnostic protocol for assessing patients with porn-induced sexual dysfunction is put forth.

Concepts: Sexual intercourse, Erectile dysfunction, Orgasm, Penis, Premature ejaculation, Erection, Sexual arousal, Sexual dysfunction

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Introduction: Synaesthesia is a phenomenon in which a certain stimulus induces a concurrent sensory perception; it has an estimated prevalence of 4%. Sexual arousal as an inducer for synaesthetic perceptions is rarely mentioned in the literature but can be found sometimes in case reports about subjective orgasmic experiences. Aims: To examine whether synaesthetic perceptions during sexual intercourse have an impact on the sexual experience and the extent of sexual trance compared to non-synaesthetes. Methods: In total, 19 synaesthetes with sexual forms of synaesthesia (17 female; 2 male) were included as well as corresponding control data of 36 non-synaesthetic subjects (n = 55). Two questionnaires were used to assess relevant aspects of sexual function and dysfunction (a German adaption of the Brief Index of Sexual Functioning, KFSP) as well as the occurrence and extent of sexual trance (German version of the Altered States of Consciousness Questionnaire, OAVAV). Additionally qualitative interviews were conducted in some subjects to further explore the nature of sexual experiences in synaesthetes. Main Outcome Measures: Sexual experience and extent of sexual trance during intercourse. Results: Synaesthetes depicted significantly better overall sexual function on the KFSP with increased scores for the subscale “sexual appetence” but coevally significant lower subscale scores for “sexual satisfaction.” Sexual dysfunction was not detected in this sample. Synaesthetes depicted significantly higher levels of the subscales “oceanic boundlessness” and “visionary restructuralization” than controls using the OAVAV. Qualitative interviews revealed varying synaesthetic perceptions during the different states of arousal. Furthermore, synaesthetes reported an unsatisfactory feeling of isolation caused by the idiosyncratic perceptions. Conclusions: Synaesthetes with sexual forms of synaesthesia seem to experience a deeper state of sexual trance without, however, enhanced satisfaction during sexual intercourse.

Concepts: Sexual intercourse, Orgasm, Qualia, Sexuality, Erection, Sexual arousal, Sexual function, Sexual dysfunction

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In August 2015, the US Food and Drug Administration (FDA) approved flibanserin as a treatment for hypoactive sexual desire disorder (HSDD) in premenopausal women, despite concern about suboptimal risk-benefit trade-offs.

Concepts: Evidence-based medicine, Systematic review, Estrogen, Meta-analysis, Food and Drug Administration, Sexual dysfunction, Hypoactive sexual desire disorder

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INTRODUCTION: Erectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed. AIM: Assessing sociodemographic and clinical characteristics of young men (defined as ≤40 years) seeking first medical help for new onset ED as their primary sexual disorder. METHODS: Complete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). MAIN OUTCOME MEASURE: Descriptive statistics tested sociodemographic and clinical differences between ED patients ≤40 years and >40 years. RESULTS: New onset ED as the primary disorder was found in 114 (26%) men ≤40 years (mean [standard deviation [SD]] age: 32.4 [6.0]; range: 17-40 years). Patients ≤40 years had a lower rate of comorbid conditions (CCI = 0 in 90.4% vs. 58.3%; χ(2) , 39.12; P < 0.001), a lower mean body mass index value (P = 0.005), and a higher mean circulating total testosterone level (P = 0.005) as compared with those >40 years. Younger ED patients more frequently showed habit of cigarette smoking and use of illicit drug, as compared with older men (all P ≤ 0.02). Premature ejaculation was more comorbid in younger men, whereas Peyronie’s disease was prevalent in the older group (all P = 0.03). At IIEF, severe ED rates were found in 48.8% younger men and 40% older men, respectively (P > 0.05). Similarly, rates of mild, mild-to-moderate, and moderate ED were not significantly different between the two groups. CONCLUSIONS: This exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters. Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, and Salonia A. One patient out of four with newly diagnosed erectile dysfunction is a young man-worrisome picture from the everyday clinical practice. J Sex Med **;**:**-**.

Concepts: Testosterone, Mental disorder, Prevalence, Erectile dysfunction, Comorbidity, Penis, Premature ejaculation, Sexual dysfunction

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Tribulus terrestris as a herbal remedy has shown beneficial aphrodisiac effects in a number of animal and human experiments. This study was designed as a randomized double-blind placebo-controlled trial to assess the safety and efficacy of Tribulus terrestris in women with hypoactive sexual desire disorder during their fertile years. Sixty seven women with hypoactive sexual desire disorder were randomly assigned to Tribulus terrestris extract (7.5 mg/day) or placebo for 4 weeks. Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured at baseline and after 4 weeks after the end of the treatment by using the Female Sexual Function Index (FSFI). Two groups were compared by repeated measurement ANOVA test.

Concepts: Sexual intercourse, Test method, Sexual arousal, Sexual dysfunction, Hypoactive sexual desire disorder, Aphrodisiac, Libido, Tribulus terrestris

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Sexual dysfunction is highly prevalent in the general population and associated with psychological distress and impaired sexual satisfaction. Psychological interventions are promising treatment options, as sexual dysfunction is frequently caused by and deteriorates because of psychological factors. However, research into the efficacy of psychological interventions is rather scarce and an up-to-date review of outcome studies is currently lacking. Therefore, we conducted a systematic review and meta-analysis of all available studies from 1980 to 2009 to examine the efficacy of psychological interventions for patients with sexual dysfunction. A total of 20 randomized controlled studies comparing a psychological intervention with a wait-list were included in the meta-analysis. The overall post-treatment effect size for symptom severity was d = 0.58 (95 % CI: 0.40 to 0.77) and for sexual satisfaction d = 0.47 (95 % CI: 0.27 to 0.70). Psychological interventions were shown to especially improve symptom severity for women with Hypoactive Sexual Desire Disorder and orgasmic disorder. Our systematic review of 14 studies comparing at least two active interventions head-to-head revealed that very few comparative studies are available with large variability in effect sizes across studies (d between -0.69 and 2.29 for symptom severity and -0.56 and 14.02 for sexual satisfaction). In conclusion, psychological interventions are effective treatment options for sexual dysfunction. However, evidence varies considerably across single disorders. Good evidence exists to date for female hypoactive sexual desire disorder and female orgasmic disorder. Further research is needed on psychological interventions for other sexual dysfunctions, their long-term and comparative effects.

Concepts: Medical statistics, Systematic review, Randomized controlled trial, Effectiveness, Effect size, Meta-analysis, Sexual dysfunction, Hypoactive sexual desire disorder

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The decreased sexual desire screener is a brief diagnostic instrument for generalized acquired hypoactive sexual desire disorder in women. During the screening visit of 2 clinical trials, the authors assessed sensitivity of the decreased sexual desire screener in premenopausal women presenting with decreased sexual desire. The authors compared diagnoses of generalized acquired hypoactive sexual desire disorder made by clinicians who were not trained or specialized in the diagnosis of female sexual dysfunction using the decreased sexual desire screener with diagnoses made by expert clinicians after an extensive diagnostic interview. The sensitivity of the decreased sexual desire screener was 0.946 in a North American trial and 0.960 in a European trial.

Concepts: Medical terms, Diagnosis, Sexual arousal, Sexual dysfunction, Hypoactive sexual desire disorder

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Premature ejaculation (PE) is the most common sexual disorder. It affects 20%-30% of adult men; the aetiology of this condition has not yet been elucidated. The aim of this study is to evaluate the efficacy, safety, tolerability, undesirable effects and improved satisfaction with sexual intercourse with tramadol hydrochloride at different dosages for the treatment of PE. A total of 300 patients who presented with lifelong (primary) PE were included in this study. The study was performed for 28 weeks, in which placebo (starch tablet) was given for 4 weeks, and active ingredient (tramadol hydrochloride) was administered at different therapeutic dosages for 24 weeks. Patients were divided into three equal groups, each consisting of 100 patients. The first group (A) was given tramadol hydrochloride capsule 25 mg. The second group (B) was given tramadol hydrochloride capsule 50 mg. The third group © was given tramadol hydrochloride capsule 100 mg. All of the 300 participants included completed the study voluntarily. The age of the patients varied from 25 to 50 years. After the treatment period, the recorded data were collected for each group and analysed. The results showed a highly significant increase in the mean intravaginal ejaculatory latency time (IELT) in all groups compared to baseline data (P<0.0001). We concluded that using tramadol hydrochloride at different doses on demand for the treatment of PE is effective, safe and tolerable, with minimal undesirable effects, and approval for this indication should be sought.

Concepts: Effectiveness, Selective serotonin reuptake inhibitor, Orgasm, Ejaculation, Penis, Premature ejaculation, Sexual dysfunction, Intravaginal ejaculation latency time