Background: The 6-item Female Sexual Function Index (FSFI-6) is the shortened version of the widely used 19-item FSFI-19, designed for efficient screening of female sexual dysfunction in outpatient settings. However, this shorter FSFI-6 tool has not yet been validated for use in Bangladesh.
Aim: The purpose of this study was to culturally adapt and validate the FSFI-6 in Bangla.
Methods: The FSFI-6 was translated into Bangla using standard adaptation protocols. We interviewed 100 married, sexually active women aged 18 years and over from the outpatient and psychiatric sex clinic of a psychiatry department. Of these women, 50 were clinically diagnosed with sexual disorders based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, criteria. After obtaining written informed consent, participants completed a semi-structured questionnaire to provide sociodemographic information and the Bangla-adapted version of the FSFI-6. We assessed reliability and construct validity using the Statistical Package for Social Sciences, version 25, along with Classical and Bayesian Instrument Development software.
Outcome: Study outcomes were internal consistency, factor structure, and sensitivity and specificity.
Results: The study involved 100 participants with a mean ± SD age of 30 ± 5.4 years, ranging from 18 to 48 years. The majority of respondents (54.34%) reported issues related to sexual desire. The overall mean score on the Bangla-adapted FSFI-6 was 18.4 ± 5.4. Reliability analysis showed a high internal consistency, with a Cronbach's alpha of 0.887 indicating robust reliability. Both inter-item correlations and item-total correlations were within the acceptable range. A cutoff value of 19 for the FSFI-6 demonstrated high discriminative power, effectively distinguishing between individuals with sexual disorders and those without sexual disorders or with other psychiatric conditions. The sensitivity at this cutoff was 96%, with a specificity of 100%.
Clinical implications: The FSFI-6 Bangla version can be used to screen patients for female sexual dysfunction in an outpatient setting.
Strengths and limitations: The internal consistency of this study, indicated by a Cronbach's alpha of 0.887, was robust. The instrument is time efficient, user friendly, and well suited for outpatient settings. However, the sampling technique utilized was nonrandomized, confined to a single institution, and did not incorporate assessments for concurrent validity or test-retest reliability.
Conclusion: The FSFI-6 Bangla version showed good reliability and validity in this study, supporting its usability as a valuable tool for screening sexual dysfunction in female.
Background: Negative genital self-image is associated with sexual unresponsiveness and dysfunction.
Aim: This study aims to determine the relationship between men's genital self-image and premature ejaculation, with identifying influencing factors.
Methods: The research is designed as a descriptive and correlational study. The sample consists of 188 men aged 18 to 60 years who volunteered to participate in the study.
Outcomes: A negative correlation was observed between genital self-image and premature ejaculation (P < .05).
Results: The average age of the participating men was 39.5 ± 9.79 years (mean ± SD), with 91.5% being married. The average age of the participants' first sexual encounter was 20.43 ± 4.01 years, and 38.3% reported experiencing premature ejaculation. The mean score for the Male Genital Self-image Scale was 21.10 ± 5.59, and that for the Premature Ejaculation Diagnostic Tool was 6.96 ± 3.73. As a result of the study, it was revealed that participants who experienced premature ejaculation were not at peace with their bodies and were dissatisfied with their sexual experiences and their genital size and function, with significantly lower levels of genital self-image (P < .05).
Clinical implications: Identifying factors that affect men's genital self-image is crucial for maintaining sexual functions.
Strengths and limitations: In Turkey, sexuality is a taboo subject, often considered shameful and rarely discussed, making it challenging to find participants willing to engage in research.
Conclusion: Men's genital self-image influences the characteristics of premature ejaculation.
Background: Research demonstrates significant gender- and sexual orientation-based differences in orgasm rates from sexual intercourse; however, this "orgasm gap" has not been studied with respect to age.
Aim: The study sought to examine age-related disparities in orgasm rates from sexual intercourse by gender and sexual orientation.
Methods: A survey sample of 24 752 adults from the United States, ranging in age from 18 to 100 years. Data were collected across 8 cross-sectional surveys between 2015 and 2023.
Outcomes: Participants reported their average rate of orgasm during sexual intercourse, from 0% to 100%.
Results: Orgasm rate was associated with age but with minimal effect size. In all age groups, men reported higher rates of orgasm than did women. Men's orgasm rates ranged from 70% to 85%, while women's ranged from 46% to 58%. Men reported orgasm rates between 22% and 30% higher than women's rates. Sexual orientation impacted orgasm rates by gender but not uniformly across age groups.
Clinical translation: The persistence of the orgasm gap across ages necessitates a tailored approach in clinical practice and education, focusing on inclusive sexual health discussions, addressing the unique challenges of sexual minorities and aging, and emphasizing mutual satisfaction to promote sexual well-being for all.
Strengths and limitations: This study is the first to examine the orgasm gap with respect to age, and does so in a large, diverse sample. Findings are limited by methodology, including single-item assessments of orgasm and a sample of single adults.
Conclusion: This study revealed enduring disparities in orgasm rates from sexual intercourse, likely resulting from many factors, including sociocultural norms and inadequate sex education.
Background: Cardiovascular diseases (CVDs) and erectile dysfunction (ED) frequently co-occur, significantly affecting the quality of life of individuals.
Aim: To assess the impact of cardiac rehabilitation (CR) on ED in patients with CVD through a systematic review and meta-analysis.
Methods: This study analyzed randomized controlled trials and other studies comparing CR with usual care for adult males (≥18 years) with any cardiac disease. Literature searches were extensive, and the risk of bias was evaluated by the Cochrane Collaboration tool. Data from 6 studies involving 668 participants were included in the meta-analysis.
Outcomes: The primary outcome was the improvement in ED, as measured with the International Index of Erectile Function.
Results: A statistically significant improvement in erectile function was observed across 6 studies, with a Morris dppc2 effect size of 0.38 (95% CI, 0.17-0.59). Despite initial high heterogeneity (I 2 = 95.7%), identification and correction for selective outcome reporting bias mitigated this issue.
Clinical translation: CR has a modest but statistically significant impact on improving ED in patients with CVD, indicating its potential positive contribution to the quality of life of this group.
Strengths and limitations: The study's strengths include a comprehensive literature search and a rigorous methodological approach. Limitations involve high heterogeneity among studies and a low level of evidence due to small sample sizes and study quality; however, the source of heterogeneity was identified and mitigated following risk-of-bias assessment.
Conclusion: The results suggest that CR has a statistically significant but modest impact on improving ED in patients with CVD. Clinicians should consider the integration of CR into the clinical management of these individuals. This study underscores the potential for CR to contribute positively to the quality of life for patients with CVD by addressing associated ED (PROSPERO: CRD42022374625).
Background: Breast cancer (BC) is considered a risk factor for sexual dysfunction, which may be associated with the diagnosis itself or with oncological treatments. However, sexual dysfunction often remains underdiagnosed and unaddressed among BC survivors.
Aim: The study sought to evaluate the sexual function of postmenopausal BC survivors compared with postmenopausal women without BC.
Methods: This case-control study included 178 postmenopausal BC survivors (stages I-III), 45 to 70 years of age, with amenorrhea for ≥12 months and sexually active. They were compared with 178 women without BC, matched (±2 years) for age and time since menopause in a 1:1 ratio. Sexual function was evaluated using the Female Sexual Function Index (FSFI), which consists of 6 domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), with a total score ≤26.5 indicating risk of sexual dysfunction. Statistical analysis included Student's t test, chi-square test, and logistic regression (odds ratio [OR]).
Outcomes: Evaluation of sexual function in postmenopausal women treated for BC.
Results: Postmenopausal BC survivors showed poorer sexual function in the desire domain (P = .002). No significant differences were observed between groups in the other FSFI domains and total score (P > .05). Postmenopausal BC survivors had a higher prevalence of risk of sexual dysfunction (64.6% with a total score ≤26.5) compared with the control group (51.6%) (P = .010). Adjusted risk analysis for age and time since menopause revealed a higher risk of sexual dysfunction in BC survivors compared with women without cancer (OR, 1.98; 95% confidence interval, 1.29-2.96; P = .007). Among BC survivors, the use of hormone therapy was associated with a higher risk of sexual dysfunction (OR, 3.46; 95% confidence interval, 1.59-7.51; P = .002).
Clinical implications: Postmenopausal BC survivors should be regularly assessed before and throughout treatment to enable the early detection and diagnosis of sexual dysfunction.
Strength and limitations: The main strength is that this study might contribute to a better understanding of sexual function in postmenopausal BC survivors compared with women without BC. The main limitation is that while the FSFI is a valid and reliable tool for the evaluation of female sexual function, it does not allow a comprehensive diagnosis of sexual dysfunction, as it is not applicable to partners.
Conclusion: Compared with postmenopausal women without BC, postmenopausal BC survivors face a higher risk of sexual dysfunction, especially when treated with adjuvant hormone therapy.
Background: Pelvic floor muscle training can effectively improve pelvic floor muscle strength and activities; however, its impact on sexual function in women with stress urinary incontinence remains unclear.
Aim: The study sought to investigate the impact of pelvic floor muscle training on pelvic floor muscle and sexual function in women with stress urinary incontinence.
Methods: This was a retrospective observational study involving women who visited a urogynecologic clinic at a tertiary medical center. Patients with stress urinary incontinence without pelvic organ prolapse underwent pelvic floor muscle training programs that included biofeedback and intravaginal electrostimulation. Other evaluations included pelvic floor manometry, electromyography, and quality-of-life questionnaires, including the short forms of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire.
Outcomes: Clinical characteristics, vaginal squeezing and resting pressure, maximal pelvic floor contraction, duration of sustained contraction, quality-of-life scores, and sexual function were compared between baseline and after the pelvic floor muscle training programs.
Results: There were 61 women included in the study. The mean number of treatment sessions was 12.9 ± 6.3, and the mean treatment duration was 66.7 ± 32.1 days. The short forms of the Urogenital Distress Inventory (7.7 ± 3.8 vs 1.8 ± 2.1; P < .001) and Incontinence Impact Questionnaire (5.9 ± 4.3 vs 1.8 ± 2.0; P < .001) scores significantly improved after the pelvic floor muscle training program. In addition, all pelvic floor muscle activities significantly improved, including maximal vaginal squeezing pressure (58.7 ± 20.1 cmH2O vs 66.0 ± 24.7 cmH2O; P = .022), difference in vaginal resting and maximal squeezing pressure (25.3 ± 14.6 cmH2O vs 35.5 ± 16.0 cmH2O; P < .001), maximal pelvic muscle voluntary contraction (24.9 ± 13.8 μV vs 44.5 ± 18.9 μV; P < .001), and duration of contraction (6.2 ± 5.7 s vs 24.9 ± 14.6 s; P < .001). Nevertheless, the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score demonstrated no significant improvement (28.8 ± 9.7 vs 29.2 ± 12.3; P = .752).
Clinical implications: Pelvic floor muscle training programs may not improve sexual function in women with stress urinary incontinence.
Strengths and limitations: The strength of this study is that we evaluated sexual function with validated questionnaires. The small sample size and lack of long-term data are the major limitations.
Conclusion: Pelvic floor muscle training can improve pelvic floor muscle activities and effectively treat stress urinary incont
Background: The endothelial glycocalyx is an important barrier that protects the structure and function of endothelial cells. Androgen deficiency is a common factor that causes structural and functional impairment of endothelial cells.
Aim: To investigate changes in the endothelial glycocalyx in the penile corpus cavernosum of the rat with low androgen status and its relationship with erection function.
Methods: Eighteen 10-week-old Sprague-Dawley male rats were randomly divided into 3 groups (n = 6 each): sham operation, castration, and castration + testosterone replacement. The maximum intracavernosal pressure/mean arterial pressure of the penis was measured after modeling for 4 weeks. The expression levels of endothelial nitric oxide synthase (eNOS), phospho-eNOS, syndecan 1, heparanase, and nitric oxide in penile cavernous tissue and the serum levels of heparan sulfate, hyaluronic acid, tumor necrosis factor α, and interleukin 6 were determined. Transmission electron microscopy was used to observe the ultrastructure of the endothelial glycocalyx in penile tissue.
Outcomes: The thickness of the endothelial glycocalyx in the penile corpus cavernosum of castrated rats was significantly lower than that of the control group.
Results: In the castrated rats, the endothelial glycocalyx thickness, syndecan 1 level, ratio of phospho-eNOS to eNOS, nitric oxide level, and maximum intracavernosal pressure/mean arterial pressure (3 V, 5 V) were significantly lower than those in the sham group (P < .05). The expression of heparanase and the serum levels of tumor necrosis factor α and interleukin 6 were significantly higher in the castrated group than in the sham group (P < .05).
Clinical translation: Upregulating the expression of the endothelial glycocalyx in the penile corpus cavernosum may be a new method for treating erectile dysfunction caused by low androgen levels.
Strengths and limitations: This study confirms that low androgen status promotes the breakdown of the endothelial glycocalyx. However, further research is needed to determine whether androgens are related to the synthesis of the endothelial glycocalyx.
Conclusion: Low androgen status may suppress the level of nitric oxide in the cavernous tissue of the penis via impairment of the endothelial glycocalyx, resulting in inhibited erection function in rats.
Background: Educational programs that enhance healthcare providers' competence in managing the care of patients with sexual dysfunction following prostate cancer treatments are needed to facilitate comprehensive sexual health treatments for patients and their partners.
Aim: In this study we evaluated the impact of a real-world online sexual health educational intervention called the True North Sexual Health and Rehabilitation eTraining Program. This program is designed to increase healthcare providers' knowledge and self-efficacy in providing sexual healthcare to prostate cancer patients and their partners.
Methods: Healthcare providers were invited to join a 12-week virtual training program. Participants completed precourse surveys (n = 89), retrospective prepost surveys (n = 58), and a 3-month follow-up survey (subset n = 18) to assess retention of relevant outcomes. Additionally, a course satisfaction survey was administered to participants (n = 57) at the end of the course.
Outcomes: The main outcomes focused on participants' perceived knowledge and self-efficacy in conducting assessments and providing interventions for various relevant physical, functional, psychological, and relational domains of sexual dysfunction in prostate cancer patients and their partners.
Results: According to the retrospective analysis of post-then-pre-survey results, graduates perceived that their knowledge of and self-efficacy in providing sexual health counseling improved after completing the course. The 3-month follow-up survey indicated that the course graduate self-efficacy remained high 3 months after the course. Furthermore, the satisfaction survey indicated that a vast majority (98.2%) of participants were satisfied with the educational intervention.
Clinical implications: This real-world sexual health educational intervention can increase self-efficacy and knowledge in healthcare providers who are supporting prostate cancer patients dealing with sexual dysfunction.
Strengths and limitations: The use of a retrospective post-then-pre-survey helped to mitigate response shift bias while minimizing data gaps. However, it is important to note that this investigation was not a traditional research study and lacked a control group, thus limiting causal attributions.
Conclusion: The True North Sexual Health and Rehabilitation eTraining program acts as an accessible and effective resource for healthcare providers seeking specialized training in providing sexual healthcare for prostate cancer patients and their partners.
Background: Although uncommon, some individuals assigned male at birth (AMAB) seek voluntary genital ablative procedures, and others fantasize about it.
Aim: To learn more about the views of genital ablation and injuries in those who aspire to be castrated as compared with those who only fantasize about it.
Methods: A survey was run on the Eunuch Archive internet community. Content analysis was conducted on the responses of 342 AMAB individuals with castration fantasy but no desire for actual surgery (fantasizers) vs 294 AMAB individuals who expressed a desire for genital ablation (aspiring).
Outcomes: Study outcomes were responses to open-ended questions about genital ablations and injury.
Results: Aspiring individuals were more likely to perceive a "physical appearance benefit" from orchiectomy, but fewer could recall how they first learned about the procedure. Some reasons that aspiring persons gave for desiring an orchiectomy included "achieving preferred self" and "health reasons." Fantasizers, in contrast, worried about the potential side effects of orchiectomy, and more believed there to be no benefit to it.
Clinical implications: Psychiatrists and other clinicians need to understand their patients' views on genital ablation to properly diagnose and provide the best personalized care.
Strengths and limitations: Strengths include a large sample of respondents. Limitations include the accuracy of the anonymous survey data.
Conclusions: This study demonstrates divergent interests on genital ablation among AMAB individuals who have not had an any genital ablation yet have intense interest in the topic.
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