Background: The hormonal composition of amniotic fluid during prenatal development, particularly the androgen-to-estrogen ratio, may influence neuronal differentiation related to sexual response patterns and the capacity to control impulsive sexual behaviors in later life.
Aim: This study aims to assess sexual behaviors and characterize sexual responses in women with borderline personality disorder (BPD) compared to a control group.
Methods: The study included 33 women diagnosed with BPD and 56 women in a control group. BPD diagnoses were based on clinical psychiatric evaluation and the Structured Clinical Interview for DSM-IV. Elements of sexual response were measured using the Arizona Sexual Experience Scale (ASEX). The digit ratio (2D:4D) served as a biomarker for testosterone and estrogen exposure during early prenatal development.
Main outcomes: ASEX results were analyzed in the categories of "desire," "arousal," and "vaginal lubrication" subscales, along with the 2D:4D digit ratio for both hands.
Results: Lower values for the right-hand digit ratio were observed in the BPD group compared to the control group (0.989, SD = 0.034 vs. 1.016, SD = 0.039; P = 0.0014), potentially indicating higher prenatal testosterone levels. Significant correlations were found in the BPD group between the right-hand digit ratio and scores on the ASEX subscales, specifically "sexual arousal" (r = 0.406, P = 0.019) and "vaginal lubrication" (r = 0.362, P = 0.038).
Clinical implications: These results may support biological hypotheses regarding the origins of sexual dysfunction in women with BPD.
Strengths and limitations: This study is a pioneering attempt to explore the indirect impact of early amniotic hormone composition on the neurobiological conditioning of sexual response and behavior in women with BPD. Limitations include the preliminary nature of the findings, a small sample size, and results that may not be generalizable across all genders.
Conclusions: Physiological aspects of sexual response, such as arousal and vaginal lubrication, in women with BPD appear to be significantly correlated with prenatal testosterone levels, as indicated by the 2D:4D digit ratio.
Background: Sexual health among Chinese men living and working in Guinea has not been adequately studied.
Aim: To assess sexual health issues and related factors among Chinese men in Guinea.
Methods: A cross-sectional study was conducted using an anonymous questionnaire, with 258 Chinese male respondents living and working in Guinea. The survey collected data on demographics, lifestyle habits, sexual activity, condom use, and knowledge of sexually transmitted diseases (STDs).
Outcomes: The primary outcomes included levels of sexual activity, condom use, and STD awareness.
Results: Of the respondents, 89.1% reported sexual needs, but only 11.6% were sexually active during their stay. Younger age, urban residence, and non-smoking were positively associated with sexual activity. Among those who were sexually active, 80% had multiple sexual partners, and 60% consistently used condoms, while 13.3% never used them. Condom use was found to be lower among older, married, and less educated individuals. Awareness of STDs was generally low, with an average score of 8.03 out of 12. Younger respondents, those with higher education, those who were sexually active and those who considered themselves familiar with STD knowledge had a relatively higher level of awareness. Most respondents (93%) believed that promoting sexual health education is necessary.
Clinical implications: Findings suggest a need for targeted sexual health education and intervention programs, especially among high-risk groups.
Strengths & limitations: The study provides valuable data on a previously unexamined population; however, its cross-sectional design and reliance on self-reported data may limit the ability to establish causal relationships.
Conclusion: The study highlights unmet sexual health needs and knowledge gaps among Chinese men in Guinea, suggesting the importance of health education and preventive measures in this population.
Introduction: Priapism is an emergency condition treated by emergency medicine (EM) physicians and urologists/andrologists. EM physicians are the first-line healthcare providers for this condition, and their knowledge, attitudes, and practices regarding priapism remain unclear.
Aim: The aim of this study was to understand emergency physicians' perspectives regarding priapism to help re-structure EM programs.
Methods: This cross-sectional study on knowledge, attitude, and practice (KAP) surveyed emergency physicians from a university and other hospitals in the Ismailia governorate, Egypt. A validated questionnaire was sent via an online e-survey following the CHEERIES guidelines. Bivariate analysis of demographic characteristics and KAP was performed using by odds ratios and 95% confidence intervals. Spearman's rho was used to measure the correlation between knowledge, attitude, and practice. A P <0.05 was considered statistically significant.
Main outcome measure: Emergency physicians completed an e-survey of their knowledge, attitudes, and practices regarding priapism.
Results: A total of 149 participants were surveyed. 140 (93%) of EM physicians believed priapism was a medical emergency. 139 (93%) respondents were aware of the long-term complications of priapism. Further, 136 (91.3%) respondents strongly supported the multidisciplinary approach. Of these, 79 (53%) gave intra-cavernous sympathomimetic therapy and 75 (50.3%) did aspiration with irrigation. EM physicians <30 years of age had significantly better knowledge about priapism (OR = 2.47 (1.23-4.96); P = 0.01). Similarly, young physicians had better attitudes (OR = 3.24 (1.31-8.02); P = 0.01) and female physicians demonstrated better practice (OR = 3.36 (1.65-6.82); P = 0.001) toward priapism. A significant positive correlation was observed between knowledge and attitude (r = 0.487), and knowledge and practice (r = 0.281) at P <0.001.
Clinical implications: EM physicians agreed that EM-based therapy is appropriate for straightforward cases of acute ischemic priapism. Existing educational programs for EM physicians may not adequately equip them in handling priapism in practice.
Strengths and limitations: This study is the first to investigate EM knowledge, attitude, and practice (KAP) for priapism handling. The study identified areas for improvement in this regard. However, the cross-sectional design, single governorate setting, and self-administered questionnaire limit its generalizability.
Conclusion: Despite the satisfactory knowledge and attitudes of EM physicians regarding priapism and infection control, this study identified potential areas for improvement in the use of guidelines on invasive treatment.
Background: Erectile dysfunction (ED) is a prevalent condition with significant psychological and physiological impacts. Recently, a new concept called movement-based behaviors (MBB) has been proposed, which includes four types of PA: vigorous PA (VPA), moderate-intensity PA (MPA), walking/cycling, and muscle-strengthening activities (MSA), and uses an MBB index (range 0-4) to estimate the combined effects of these activities on health outcomes.
Aim: This study aims to evaluate the relationship between different types of physical activities (PA) and ED using the MBB index in a nationally representative sample of U.S. men.
Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2001-2004, including 3435 male participants. Multivariate logistic regressions were performed to explore the associations, supplemented with subgroup analysis and sensitivity analysis.
Outcomes: The assessment of PA in this study is based on four self-reported questions from the NHANES Mobile Examination Center interview, including VPA, MPA, walking/cycling, and MSA. The MBB index, ranging from 0 to 4, was used to assess combined PA types. ED was evaluated using a single-question self-assessment.
Results: Higher MBB index values were associated with lower ED risk. Participants with an MBB index of 2 had a significantly lower risk of ED in Model 3 (OR = 0.65, 95% CI: 0.43-0.97, P = 0.04). Those with an MBB index of 3 or 4 had the lowest risk of ED across all models, with OR_Model1 = 0.29 (95% CI: 0.21-0.40, P < 0.0001), OR_Model2 = 0.52 (95% CI: 0.37-0.73, P < 0.001), and OR_Model3 = 0.61 (95% CI: 0.41-0.90, P = 0.02). However, this relationship was not significant in subgroups with severe ED or comorbid conditions.
Clinical implications: Our findings can provide clinicians with guidance to help patients personalize their selection of different exercise combinations.
Strengths and limitations: We explored the impact of different exercise combinations on reducing ED risk and innovatively proposed the MBB index for a comprehensive assessment of exercise benefits, supported by a large sample size and multivariable adjustments. However, the limitations of cross-sectional design and recall bias cannot be overlooked.
Conclusion: The MBB index effectively demonstrates that combined PA can reduce ED risk, supporting tailored exercise recommendations for patients.
Introduction: Vasectomy is a widely used, safe, effective method of permanent contraception and contributes to healthy sexuality.
Aims: We have conducted a 3-step observational clinical study to develop a vasectomy regret risk score and guide patients and clinicians when discussing a vasectomy.
Methods: A 3-step approach has been followed. First, experts involved in male health have proposed risk factors for regret (remorse) after vasectomy, defined by a vasectomy reversal surgery or medically assisted reproduction. The selected factors were evaluated in 1200 patients vasectomized in the last 15 years. Finally, the expert panel has constructed a score for predicting regret after vasectomy.
Results: Fifty-two international experts identified 17 risk factors for vasectomy regret. Five of the risk factors were significant: an age <35 years old, a high Barrat Impulsivity Score, a low level of education, and a patient who didn't understand that the vasectomy might not be reversible or for whom the contraception responsibility is ideally feminine, or no responsible partner. On multivariate analysis, 3 risk factors and 2 "sine qua non" conditions were used to build the decision algorithm. A risk score ≥ 4 required information on sperm cryopreservation before vasectomy, and those with a risk score ≥ 7 required extra time for reflection. The scoring system was proposed to 52 international experts and accepted with 86.7% strongly agreeing. The model's sensitivity and specificity were 0.98 and 0.53, respectively.
Conclusion: A decisional algorithm was established to identify patients requiring information on sperm cryopreservation before vasectomy or additional time for reflection to reduce the risk of vasectomy regret. The algorithm contains 3 risk factors and 2 "sine qua non" conditions.
Background: Compulsive Sexual Behavior Disorder is a new category in the 11th version of the International Classification of Diseases and is showing neuropsychological similarities to substance dependencies and behavioral addictions.
Aims: This experimental study aims to further our knowledge on implicit associations in Compulsive Sexual Behavior (CSB) with a clinical sample.
Methods: Participants completed an Implicit Association Test modified with pornographic pictures. In addition, problematic sexual behavior and sensitivity toward sexual excitation were assessed.
Outcomes: We collected data on implicit associations from 47 heterosexual men with CSB (age, M = 36.51, SD = 11.47) and a control group of 38 men without the condition (age: M = 37.92, SD = 12.33).
Results: Results show significantly more positive relationships between implicit associations of pornographic pictures with positive emotions, as well as with problematic sexual behavior and sensitivity toward sexual excitation, in men with CSB vs. men without CSB. Furthermore, implicit associations, sexual excitation, and sexual inhibition due to threat of performance consequences differentiated significantly between groups using a binary stepwise logistic regression analysis. The findings are in line with those of previous subclinical investigations and support the assumption of pronounced positive implicit associations in CSB. Moreover, as suggested by the I-PACE model of addictive behaviors, implicit associations may be crucial to the maintenance of behavioral addictions.
Clinical implications: Implicit associations could be addressed in therapy to illustrate cognitive processes of those affected and as an outcome measure in research on treatment efficiency.
Strengths & limitations: The present study is the first to investigate implicit associations in CSB in a clinical sample. Findings are limited to heterosexual men.
Conclusion: Findings can be seen in accordance with a proposed classification of CSB as a behavioral addiction.
Background: Spinal cord injury/disease (SCI/D) profoundly affects both sexuality and urinary function. Catheterization is often necessary to manage bladder voiding and it can interfere with sexual activity.
Aim: We aim to investigate the effect of the bladder evacuation method on sexual activity in women with chronic SCI/D.
Methods: This cross-sectional study at a specialized SCI/D rehabilitation center recruited women ≥18 years with chronic SCI/D using intermittent or suprapubic catheterization. We assessed sexual activity and sexual function with the German version of the Sexual Behaviour Questionnaire and the Female Sexual Function Index (FSFI) and a study-specific questionnaire.
Outcomes: The primary outcome was sexual activity and secondary outcomes included factors influencing sexual activity, such as age and SCI/D characteristics.
Results: Around half of the evaluated women were sexually active, regardless of bladder evacuation method. However, significantly (P = .018) more women using intermittent catheterization (IC) (66.7%, 20/30) were sexually active compared to those with a suprapubic catheter (SPC) (29.4%, 5/17). The main concern for women using IC was urinary incontinence during sex (43.3%, 13/30), while those with a SPC struggled with self-image due to the catheter (58.8%, 10/17). Not having a partner was the most common reason for sexual inactivity in both groups (59.1%). The median FSFI total score was significantly (P = .049) greater in the IC group (median 26.4, lower quartiles [LQ] 8.9/upper quartiles [UQ] 28.8) compared to the SPC group (median 11.5, LQ 5.4/UQ 25.5), which represents a lower grade of sexual dysfunction in women using IC.
Clinical translation: Sexual education is crucial and should be adapted to the different types of bladder management.
Strength & limitations: This study shows first data on the effect of catheter on sexual activity in women. Limitation of our study is the small sample size and response bias by the high rejection rate of women with SPC.
Conclusions: Few women with SPC remain sexually active after SCI/D, while the majority of women using IC do, highlighting issues around self-image and urinary incontinence.
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