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Neurological Sciences : Official... May 2020Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of...
BACKGROUND
Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS.
METHODS
This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis.
RESULTS
Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002).
CONCLUSION
According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.
Topics: Adult; Cross-Sectional Studies; Female; Humans; Iran; Multiple Sclerosis; Prevalence; Sexual Dysfunction, Physiological; Surveys and Questionnaires
PubMed: 31897948
DOI: 10.1007/s10072-019-04222-6 -
Journal of Sex Research Feb 2021Sex is a defining feature of marriage with important implications for marital success. Nevertheless, frequency and quality of sex decline across the early years of...
Sex is a defining feature of marriage with important implications for marital success. Nevertheless, frequency and quality of sex decline across the early years of marriage. Given many modern-day couples in the U.S. are delaying marriage and thus experiencing many traditional aspects of marriage before their nuptials, the current research explored the extent to which premarital factors such as courtship duration, cohabitation, and children are associated with trajectories of couples' sexual relationships during the early years of marriage. Using a 4-year longitudinal study of newlywed couples, results demonstrated that couples with longer (versus shorter) courtships or who did (versus did not) cohabit engaged in less frequent sex at the start of marriage; interestingly, couples with longer (versus shorter) courtships or with (versus without) children prior to marriage experienced less steep declines in frequency of sex over time. Couples who did (versus did not) cohabit were less sexually satisfied initially and over time; couples with longer (versus shorter) courtships experienced less steep declines in sexual satisfaction over time. Notably, each of these associations emerged independent of related individual differences and marital quality. These findings highlight the notion that premarital factors can explain, at least in part, differences in newlywed couples' sexual relationships.
Topics: Child; Heterosexuality; Humans; Longitudinal Studies; Marriage; Orgasm; Personal Satisfaction; Sexual Behavior
PubMed: 31833785
DOI: 10.1080/00224499.2019.1695722 -
European Urology Jan 2020
Re: The Association Between In-Utero Exposure to Stressful Life Events During Pregnancy and Male Reproductive Function in a Cohort of 20-year-old Offspring: The Raine Study.
Topics: Adult; Cohort Studies; Female; Humans; Male; Orgasm; Pregnancy; Prenatal Exposure Delayed Effects; Young Adult
PubMed: 31706695
DOI: 10.1016/j.eururo.2019.10.011 -
Clinical Anatomy (New York, N.Y.) Jan 2020Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal... (Review)
Review
Stimulating the clitoris activates the brain to instigate changes in the female genital tract, namely, the enhancement of vaginal blood flow that increases vaginal luminal pO , vaginal transudate (lubrication) facilitating painless penile penetration and partial neutralization of the basal luminal acidic pH, vaginal tenting, and ballooning delaying sperm transport and allowing semen de-coagulation and capacitation (sperm activation) factors to act until arousal ends (often by orgasm induction). All these genital changes taken together are of major importance in facilitating the possibility of reproductive success (and thus gene propagation) no matter how or when the clitoris is stimulated-they reveal its overlooked reproductive function. Of course, also commensurate with these changes, is its activation of sexual pleasure. The clitoris thus has both procreative (reproductive) and recreative (pleasure) functions of equal importance. Clitoridectomy creates not only sexual disability but also a reproductive disability. Clin. Anat. 32:136-145, 2019. © 2019 Wiley Periodicals, Inc.
Topics: Arousal; Circumcision, Female; Clitoris; Female; Fertility; Humans; Reproduction; Sexual Behavior; Vagina
PubMed: 31691374
DOI: 10.1002/ca.23498 -
Sexual Medicine Reviews Jul 2020Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being... (Review)
Review
INTRODUCTION
Many men experience distressing issues regarding the timing of orgasm and ejaculation, such as premature ejaculation (PE) and delayed ejaculation (DE). Despite being highly prevalent, both PE and DE are poorly understood and present a management challenge for sexual medicine specialists.
AIM
To summarize existing data on the medical management of PE and DE.
METHODS
A comprehensive literature review pertaining to the management of PE and DE was conducted using PubMed and clinicaltrials.gov for data published up until May 2019. Our focus was on double-blind, placebo-controlled trials and meta-analyses of such studies.
MAIN OUTCOME MEASURE
Peer-reviewed studies on treatment options for PE and DE were critically analyzed for results and methodological rigor.
RESULTS
The peer-reviewed data on PE management continue to evolve. Psychotherapy, pharmacotherapy, and procedural interventions have all been associated with some degree of efficacy. A strong evidence base supports the off-label use of selective serotonin reuptake inhibitors and local anesthetics in PE given consistent increases in ejaculation latency time. Education and mental health assessments remain important components of PE management despite a dearth of peer-reviewed data on these interventions. Numerous treatment strategies have been evaluated for DE; limited data support psychotherapy, pharmacotherapy, and/or penile vibratory stimulation as management options.
CONCLUSION
A number of management options for PE or DE exist but none has been formally approved by the US Food and Drug Administration. New and novel treatments would be of great value in managing issues regarding the timing of ejaculation/orgasm. Martin-Tuite P, Shindel AW. Management Options for Premature Ejaculation and Delayed Ejaculation in Men. Sex Med Rev 2020; 8:473-485.
Topics: Ejaculation; Humans; Male; Premature Ejaculation; Selective Serotonin Reuptake Inhibitors; Sexual Dysfunction, Physiological
PubMed: 31668585
DOI: 10.1016/j.sxmr.2019.09.002 -
The Journal of Sexual Medicine Aug 2019Mechanisms underlying delayed orgasm (DO) are poorly understood; however, known effects of psychotropic medications on sexual function provides a rationale for aberrant...
Functional Magnetic Resonance Imaging Detects Between-Group Differences in Neural Activation Among Men with Delayed Orgasm Compared with Normal Controls: Preliminary Report.
BACKGROUND
Mechanisms underlying delayed orgasm (DO) are poorly understood; however, known effects of psychotropic medications on sexual function provides a rationale for aberrant central nervous system signaling as a cause.
AIM
To compare brain activation between men with normal orgasm and those with lifelong DO during sexual stimulation using brain fMRI algorithms.
METHODS
3 subjects with self-reported life-long DO and 6 normal controls were included in this study. The International Index of Erectile Function, Male Sexual Health Questionnaire, and self-reported time to orgasm were used to assess sexual function. Subjects underwent a 3-T fMRI study while viewing 3 video clips: a neutral control (NC), a positive emotional control (EC), and a sexual condition (SC). Each video sequence was repeated 5 times, with 50-second clips presented in a randomized fashion. fMRI data were analyzed in a block design manner to determine areas of differential brain activation between groups. The Allen Brain Atlas of gene expression in the human brain was used to identify signaling pathways in the areas of differential fMRI activation between the DO and control groups.
OUTCOMES
The primary outcome was differential activation of fMRI neural activation between groups.
RESULTS
Analysis of differential activation in the SC compared with the NC and EC revealed increased activation in the right frontal operculum (P = .003), right prefrontal gyrus (P = .003), and inferior occipital gyrus (P = .003). Increased activation in the right fusiform gyrus of the occipital lobe and the right hippocampus (P = .0004) was seen in the DO group compared with controls. Using the Allen Atlas of Human Brain Expression, we identified corresponding neurotransmitter receptors to this region, including adenosine receptors, muscarinic and nicotinic cholinergic receptors, cannabinoid receptors, and dopamine receptors, among others.
CLINICAL IMPLICATIONS
Lifelong DO in men may be due to abnormal neurotransmitter signaling leading to poor progression of arousal due to aberrant processing of sexual cues. Identification of neurotransmitter pathways by fMRI will aid the development of pharmacotherapeutic agents.
STRENGTHS & LIMITATIONS
Strengths of this study include the novel application of functional neuroimaging to investigate the pathogenesis of DO. Limitations include the small sample size, making this study exploratory in nature.
CONCLUSION
This study revealed differences in brain activation on visualization of sexual stimuli in men with a history of DO compared with controls. Identified regions are rich in numerous neurotransmitter receptor subtypes and may be amenable to pharmacologic targeting to identify novel therapies for these men. Flannigan R, Heier L, Voss H, et al. Functional Magnetic Resonance Imaging Detects Between-Group Differences in Neural Activation Among Men with Delayed Orgasm Compared with Normal Controls: Preliminary Report. J Sex Med 2019:16;1246-1254.
Topics: Adult; Algorithms; Arousal; Brain; Case-Control Studies; Emotions; Female; Functional Neuroimaging; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Orgasm; Sexual Behavior; Sexual Dysfunctions, Psychological; Young Adult
PubMed: 31303572
DOI: 10.1016/j.jsxm.2019.05.007