Background: Sexual distress is a critical element in diagnosing sexual dysfunction. Recent research using a cross-sectional design has supported the adequacy of a transdiagnostic approach for its understanding.
Aim: This exploratory study aimed to investigate the mediating role of repetitive negative thinking between difficulties in emotional regulation and sexual and psychological distress in a community sample.
Methods: We used a quantitative longitudinal design with measures including a sociodemographic questionnaire, the Difficulties in Emotion Regulation Scale-Short Form, the Persistent and Intrusive Negative Thoughts Scale, the Sexual Distress Scale-Revised, and the Kessler Psychological Distress Scale.
Outcomes: Data were collected from 64 partnered individuals (85.9% women; age: M = 31.20, SD = 6.46).
Results: Correlational analysis across time revealed significant associations among difficulties in emotion regulation (T1 r = 0.37, T2 r = 0.32), repetitive negative thinking (T1 r = 0.30, T2 r = 0.27), psychological distress (T1 r = 0.37, T2 r = 0.55), and sexual distress (all at P < .01). The total effect of difficulties in emotion regulation on sexual distress was found to be positive (β = 0.20, P = .008) after controlling for frequency of sexual activity (r = -0.25, P < .05). Longitudinal mediation analysis indicated a significant negative indirect effect from difficulties in emotion regulation on sexual distress via repetitive negative thinking (β = -0.04, 95% CI [-0.008, -0.001]), suggesting a buffering effect over time on sexual distress.
Clinical implications: These results highlight the significance of recognizing difficulties in emotion regulation and repetitive negative thinking as coping strategies when examining sexual distress, emphasizing the need to explore the putative efficacy of therapeutic interventions focused on addressing these cognitive processes to decrease adverse sexual-related outcomes.
Strengths and limitations: These findings highlight the importance of acknowledging difficulties in emotion regulation and repetitive negative thinking as coping strategies in the study of sexual distress. However, the small sample size and the predominance of women participants limit generalizability. Further research with clinical samples and more diverse populations is needed to better understand the relevance of these aspects in assessment and therapy.
Conclusions: The findings imply that repetitive negative thinking may have potentially adaptive effects, indicating a nuanced role in coping strategies within the context of the study.
Introduction: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a condition of persistent or recurrent, unwanted or intrusive sensation of genital arousal that is usually associated with a distressing feeling and has a great impact on patients' daily life. Pelvic floor physical therapy is one of the effective conservative treatment options that deserves increased attention.
Aims: This case report aims to provide a comprehensive pelvic floor physical therapy evaluation and treatment plans for a patient with PGAD/GPD that resulted in a complete resolution of symptoms.
Methods: The patient is a 63-year-old female who suffered from persistent and uncontrolled sexual arousal over 3 months. Despite her efforts, the symptoms gradually worsened and never completely resolved, resulting in significant distress and despair. Her examination findings include myofascial restrictions on superficial pelvic floor structures, hypertonic pelvic floor muscles with trigger points, radiating pain along with genitofemoral nerve innervated areas, and lack of pelvic floor muscle strength and coordination. Physical therapy treatment plan included patient education, manual therapy, muscle strengthening exercises, and home exercise programs.
Results: The patient's symptoms were completely resolved after a total of four pelvic floor physical therapy sessions. Home exercise program was able to maintain satisfactory treatment outcomes 3 months post treatment. No complaints were reported at the 6-month and 1-year follow-ups.
Conclusion: Genitofemoral nerve pathology may be a potential etiology for PGAD/GPD. Pelvic floor physical therapy can an effective medical treatment for PGAD/GPD originating from the pelvic and perineum region. A comprehensive pelvic floor examination and an evidence-based treatment plan will be able to improve symptoms and potentially resolve them completely.
Background: Erectile dysfunction (ED) is a significant health issue affecting the global male population, with a complex and multifaceted etiology. High-fat diet (HFD) is known to impair endothelial function and promote the development of ED. Hinokiflavone (HINO), a naturally occurring biflavonoid, has garnered attention for its notable antioxidant and anti-inflammatory activities, suggesting its potential therapeutic role in treating ED.
Aim: This study aims to investigate the therapeutic effects and underlying mechanisms of HINO in HFD-induced ED.
Methods: Network pharmacology and molecular dynamics simulation were employed to predict relevant targets and analyze their binding kinetics. Rat corpus cavernosum endothelial cells (RCCECs) were treated with palmitic acid in vitro to induce metabolic dysfunction. The ED model was established in vivo by feeding male rats an HFD (60 kcal% fat).
Outcomes: The primary outcomes were the target genes and pathways associated with HINO and the evaluation of its therapeutic potential in HFD-induced ED.
Results: Bioinformatics analyses identified the epidermal growth factor receptor (EGFR) and protein kinase B (Akt) as key molecular targets of HINO. Treatment with HINO promoted RCCEC proliferation, enhanced antioxidant activities, and increased nitric oxide production. The administration of HINO ameliorated erectile dysfunction, improved serum lipid profiles, and reduced oxidative stress in HFD-fed rats. The protective effects of HINO against endothelial dysfunction and impaired cell viability were mediated through modulation of the EGFR/PI3K/Akt/eNOS signaling pathway.
Clinical translation: The results provide a strong rationale for further investigation of HINO as a novel therapeutic agent for ED, with promising implications for future clinical applications.
Strengths and limitations: In this study, we found that HINO could mitigate HFD-induced ED. Limitations of the study include that the alternative mechanisms of HINO were not fully explored in these settings.
Conclusions: Our findings underscore the pharmacological properties of HINO in the management of ED, particularly through the modulation of critical targets such as EGFR.
Background: There is a dearth of data on the impact of residency on resident sexual health. What exists utilizes the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF), which primarily assess function and often refer to sexual activity as penetrative sexual intercourse. This presents a limited view on sexual activity and sexuality.
Aim: The objective of this study was to evaluate the effect of obstetrics and gynecology (OBGYN) residency on resident sexual satisfaction using the gender and relationship neutral New Sexual Satisfaction Scale (NSSS).
Methods: Between July 2022 and August 2023, 137 current US OBGYN residents were recruited and completed questionnaires at three timepoints (baseline, 6 months, and 12 months) assessing their demographic data, city and level of training, work hours, gender identity, sexual orientation, relationship status, and the NSSS.
Outcomes: We hypothesized that OBGYN residents in later years of residency would report lower sexual satisfaction than post graduate year one residents (PGY-1 s) and that sexual satisfaction would decrease later in OBGYN residency due to the cumulative effect of work stress.
Results: There was a significant increase in NSSS total scores from baseline (M = 67.5) to 12 month follow-up (M = 72.1) in all residents. However, when the sample was stratified by year of residency, postgraduate year one residents (PGY-1 s) had a decrease in their NSSS total and subscale scores over time as compared to postgraduate year two residents and above who had an overall increase in their NSSS total and subscale scores over time.
Clinical implications: This data presents evidence to support initiatives by OBGYN residency programs to support sexual health and resilience training and opens avenues for further research into sexual satisfaction in other medical subspecialities.
Strengths & limitations: Strengths include utilizing a validated, gender neutral survey. Limitations include small sample size and opt-in study design.
Conclusion: The increase in sexual satisfaction in later years of OBGYN residency may be due to increased resilience over the course of residency. However, the unique stress of the transition from medical school to residency may be highlighted in the decrease in sexual satisfaction scores over time demonstrated in the PGY-1 s.
Background: Erectile dysfunction (ED) is a prevalent condition with current treatments limited by suboptimal efficacy and adverse effects. Mendelian randomization (MR) offers a promising approach to identify potential genetic targets for novel therapies.
Aim: We performed a genome-wide MR study on druggable genes to find ED therapies.
Methods: We collected data on drug-targetable genes and their impact on blood expression quantitative trait loci (eQTLs). Using two-sample MR with genome-wide association studies data, we pinpointed genes linked to ED and conducted enrichment analysis. We also built protein networks and predicted drugs to support treatment development.
Outcomes: This comprehensive strategy provides a robust framework for the advancement of more efficacious and precisely targeted treatments for ED.
Results: The MR analysis identified 124 genes significantly associated with ED. Enrichment analysis revealed these genes are involved in signal transduction, protein phosphorylation, plasma membrane, cytoplasm, ATP binding, and the PI3K-Akt signaling pathway. We identified the top 10 hub genes: PRKCA, IFNG, ITGB1, PPARG, PTK2, LAMA5, BCL2L1, CD3D, CD3E, and CD27. Our study highlighted three potential drugs targeting three of these hub genes: benztropine for CD27, teplizumab for CD3E, and natalizumab for ITGB1.
Clinical translation: The study identifies high-priority targets for ED therapy, including approved drugs amenable to rapid repurposing trials.
Strengths and limitations: Multi-omics integration enhanced causal validity; drug predictions leveraged existing therapeutic knowledge. Tissue-specific expression quantitative trait loci confounders and lack of experimental validation for prioritized drugs require caution.
Conclusion: This work advances ED research by mapping druggable genes (PRKCA, IFNG, ITGB1) and pathways via MR, offering precision medicine opportunities and actionable drug repurposing candidates.
Background: The Female Sexual Function Index (FSFI) is widely used to assess female sexual function, but its applicability in Lebanon is limited due to linguistic and cultural barriers.
Aim: This study aimed to develop and validate a Lebanese Arabic version of the FSFI (FSFI-LB) to improve accessibility for clinical and research use.
Methods: A study was conducted with 119 Lebanese women between April 2023 and June 2024 at Hôtel-Dieu de France Hospital, Beirut. The FSFI was translated, back-translated, and psychometrically validated using exploratory factor analysis, Cronbach's alpha, test-retest reliability, and factor correlations.
Outcomes: The FSFI-LB showed excellent internal consistency (Cronbach's alpha = 0.973) and test-retest reliability (r = 0.9997), with a Kaiser-Meyer-Olkin value of 0.925 and significant Bartlett's test of sphericity (P < .001). Test-retest reliability was assessed in a subsample of 42 participants after 4 weeks and demonstrated high consistency across all domains (r > 0.99) and total scale reliability (r = 0.9997).
Results: A six-factor model was retained for the FSFI-LB, aligning with the original FSFI, with the pain domain showing the weakest correlations with other domains. The questionnaire included English translations alongside Arabic terms for improved comprehension.
Clinical translation: The FSFI-LB is a reliable tool for assessing female sexual function in Lebanon, ensuring cultural and linguistic sensitivity for diverse populations.
Strengths and limitations: The study's strengths include robust psychometric validation and the adaptation of a widely used instrument. The limitations include the focus on a specific Lebanese population, which may limit generalizability to other Arabic-speaking communities.
Conclusion: The FSFI-LB is a valid and reliable tool for assessing female sexual function, contributing to the development of culturally appropriate measures in sexual health research and clinical practice.
Background: Premature ejaculation (PE) is a common male sexual dysfunction with limited long-term therapeutic options. Pharmacological and behavioral treatments often yield only temporary improvement, and alternative neuromodulatory strategies remain underexplored. Functional neurology, which targets autonomic and sensory-motor regulation, may offer a novel approach.
Aim: To evaluate the effect of a single functional neurology intervention on genital thermoregulation and ejaculatory latency in men with PE.
Methods: Fifty-two men diagnosed with PE participated in a pre-post intervention study. Each underwent a single session of functional neurology aimed at modulating nociceptor and mechanoreceptor pathways. Genital thermoregulation was assessed using infrared thermography, and ejaculatory function was measured via intravaginal ejaculatory latency time (IELT) and self-report at baseline, after the first post-treatment sexual encounter, and at 1-month follow-up. Statistical analyses included repeated-measures ANOVA, paired t-tests, Pearson correlation, and multiple regression.
Outcomes: Significant improvements in IELT and genital temperature were expected following the intervention, supporting its role in enhancing autonomic regulation and microvascular circulation.
Results: Intravaginal ejaculatory latency time increased significantly from a baseline of 20.4 ± 11.5 seconds to 439.2 ± 214.5 seconds post-treatment, with sustained effects at 1 month (498.0 ± 171.6 seconds; P < .001). Infrared thermography revealed significant increases in temperature in the glans, testicles, and abdomen (all P < .001), indicating enhanced peripheral circulation. Glans temperature change was the strongest predictor of testicular thermoregulation (β = 0.513, P < .001). Principal component analysis highlighted that glans and testicular areas contributed most to thermal variance post-treatment. A ≥1 °C increase in genital temperature was observed in 60% of participants.
Clinical implications: Functional neurology may be a non-invasive, fast-acting intervention for improving ejaculatory control in PE by promoting autonomic balance and vascular function. Thermography proved useful as a biomarker for physiological changes and treatment efficacy.
Strengths and limitations: This study is the first to evaluate thermographic and ejaculatory outcomes after a functional neurology intervention in PE. Strengths include objective and subjective measures, while limitations involve the lack of a control group, small sample size, and short-term follow-up. These results should be confirmed through randomized controlled trials.
Conclusion: A single session of functional neurology significantly improved both genital thermoregulation and ejaculatory latency in men with PE. These find
Background: Limitation to the Capacity to Love (CTL) and problematic sexuality could be considered as indicators of psychopathological suffering.
Aim: We aimed to investigate the relationship between problematic sexuality, specifically hypersexuality, and the symptom dimensions of psychoticism and paranoid ideation, with a focus on the role of the CTL, in a non-clinical sample.
Methods: Through an online platform, we recruited a convenience sample of 521 subjects (390 females and 131 males; age span: 18-50).
Outcomes: Recruited subjects completed a psychometric protocol that included completion of the following measurement tools: (1) the Capacity to Love Inventory, (2) the Hypersexual Behavior Inventory, (3) the Brief Symptom Inventory.
Results: Results indicated a significant inverse correlation between CTL and both paranoid ideation and psychoticism, with hypersexuality positively correlated with these symptoms. Linear regression analysis revealed that CTL acts as a protective factor, while hypersexuality is a predictive factor for both psychoticism and paranoid ideation.
Clinical implications: The study highlights the importance of evaluating sexual behavior and subclinical symptomatology in non-clinical populations, and it underscores the potential role of CTL as an indicator of relational functioning.
Strengths and limitations: The strength of this research lies undoubtedly in its innovative inclusion of the construct of CTL in studying the relationship between sexuality, paranoid ideation, and psychoticism.However, the research design reveals a gender imbalance that may limit the significance of the findings. Moreover, the study was conducted on a sample primarily composed of students and individuals from Italian cultural backgrounds, which should be considered when generalizing the results.
Conclusion: The relationship between the limitation of the CTL, hypersexuality and paranoid ideation and psychoticism (assessed with the SCL-90) sheds light on the importance of integrating the assessment of a central aspect of human life, that is, the CTL, with problematic sexuality and psychopathological symptoms, in the clinical practice of prevention of sexual and psychological problems.
Objectives: Good interpersonal relationships are associated with improved functioning, quality of life, and a better prognosis in patients with bipolar disorder (BD). Little information is available regarding relationship satisfaction and sexual satisfaction within couples where 1 partner has BD.
Aim: This cross-sectional study aimed to examine relationship and sexual satisfaction in patients with BD and partners to patients with BD.
Methods: Patients with BD and partners to patients with BD were included, and outcomes were assessed using semi-structured interviews and questionnaires.
Outcomes: Couple satisfaction was measured by the self-reported questionnaire Couple Satisfaction Index (CSI-4), and sexual satisfaction was measured by 3 self-reported questions. Multiple regression analyses were used to compare the groups adjusting for sex, age, mood symptoms, overall functioning, and stress symptoms. The results were compared to general populations.
Results: One hundred eleven patients with BD and 74 partners were included. We found a significant difference between patients with BD and partners concerning relationship satisfaction measured with the CSI, with partners being less satisfied (P = .050). Comparing relationship satisfaction in patients with BD and partners to the general population, we found that the general population was more satisfied in each CSI item (P < .050). In multiple regression analyses adjusted for sex, age, mood symptoms, stress, and function, patients with BD were more satisfied with their sexual life over the last year compared to partners (P = .039). They further rated the importance of a good sexual life higher than partners (P = .006). Finally, more patients with BD and partners rated their sex life the last year as being bad to extremely bad compared to the control group from the general population (partners = 21.1%, BD = 23.4%, general population = 16%).
Clinical implications: In clinical practice, it is essential to focus on relationships including sexual life in patients with BD and partners as both groups have a lower degree of relationship and sexual satisfaction compared to the general population.
Strengths and limitations: The use of validated questionnaires and clinical ratings is a strength, albeit the cross-sectional design is a limitation.
Conclusions: Patients with BD reported a higher degree of satisfaction with their relationship and sexual life compared to their partners. Compared to the general population, both groups expressed lower degree of relationship and sexual satisfaction.
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