Background: Spinal Cord Injury (SCI) can impact sexual function negatively, and although most people continue to be sexually active post-injury, they often report decreased satisfaction in various aspects of sexual life.
Aim: To gain insight into the sexual experience and functioning of people assigned female at birth (AFAB) with a SCI.
Methods: This study is part of an international observational questionnaire examining the reproductive health outcomes of individuals AFAB with SCI. The questionnaire was distributed to SCI organizations and support groups in 33 countries in four languages between 2019 and 2021. A total of 557 individuals AFAB with SCI, between the ages of 18 and 50, who completed the sexual health questions were included in this analysis.
Outcome: Scores of Female Sexual Function Index (FSFI-6) in relation to the severity of the SCI based on the American Spinal Injury Association (ASIA) impairment scale, level, and duration of SCI.
Results: Nearly 65% (170/263) of the study population within 10 years of injury had sexual dysfunction (SD) (FSFI-6 score less than or equal to 19), and participants with ASIA A had the most dysfunction (Mean score 15.95 + 7.52). Interestingly, although half of the study population scores as experiencing SD, only one-third describe SD as a concern associated with SCI. Though most of the changes were of a physical nature (inability to orgasm, pain during penetration, spasticity, barriers related to bowel/bladder problems and episodes of autonomic dysreflexia), psychosocial factors like the presence of concomitant anxiety/depression and sexual violence from a partner affected their sexual lives adversely. We attempt to elucidate the strategies adopted to improve sexual satisfaction that can help professionals involved in the SCI rehabilitative process.
Clinical implications: Our results provide insight into the degree of SD, factors impacting sexual satisfaction and areas which need to be emphasized during the rehabilitation process of people AFAB with SCI.
Strength and limitations: This study is one of the largest of its kind, attempting to understand sexual functioning and factors impacting the sexual life of people AFAB post-SCI using a standardized tool, the FSFI score. As a voluntary survey, those who responded may not be fully representative of the population.
Conclusion: Sexual health is an essential component of rehabilitation for individuals AFAB with SCI. Enhancing their sexual satisfaction requires a comprehensive approach that considers their physical, psychological and interpersonal circumstances.
Background: Low-dose sublingual estradiol gender-affirming hormone therapy (GAHT) in treatment-naive transgender women effectively suppresses testosterone and initiates breast development, comparable to oral estradiol with cyproterone acetate; however, its impact on body composition remains unstudied.
Aim: To assess early body composition changes with low-dose estradiol, compare sublingual versus oral administration efficacy, and evaluate bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) agreement in transgender women undergoing GAHT.
Methods: In this 6-month prospective study, 22 treatment-naïve transgender women received either 2 mg/day sublingual estradiol (SLE) or combined oral (CO)-2 mg/day oral estradiol plus 10 mg/day cyproterone acetate. Body composition was assessed using DXA and BIA at baseline and after 6 months.
Outcomes: Changes in body composition, including lean body mass, fat mass, visceral fat area, waist-to-hip ratio, and android-to-gynoid fat ratio.
Results: BIA and DXA measurements showed good agreement. Both groups experienced decreased lean body mass and increased fat mass. The SLE group showed less increase in total and segmental body fat, and visceral fat area compared to CO. Both treatments decreased waist-to-hip ratio and android-to-gynoid fat ratio, indicating early achievement of a more feminine body shape.
Clinical implications: These findings may help optimize GAHT protocols, improve patient satisfaction with treatment, and enable monitoring outcome assessment in transgender women.
Strengths and limitations: This study provides valuable insights into early body composition changes with low-dose estradiol administration via different administration routes and validates BIA as an alternative to DXA. However, the sample size was relatively small, the study arm allocation was not randomized, and the study duration was only 6 months.
Conclusion: Low-dose estradiol induces significant feminizing body composition changes within 6 months of GAHT, with sublingual administration potentially limiting fat accumulation while achieving a feminine body shape.
Study registration: ISRCTN15726488 Entire data set found at: https://doi.org/10.17605/OSF.IO/VNC54.
Introduction: Chemsex, or the use of specific psychoactive substances to enhance or prolong sexual encounters, is increasingly prevalent among sexual minority men and is linked to adverse health outcomes.
Aim: This study examines the co-occurrence of chemsex and compulsive sexual behavior disorder (CSBD) among sexual minority men and whether this co-occurrence is connected to mental and sexual health concerns.
Methods: A sample of 289 sexual minority men (223 gay men and 66 bisexual men), recruited primarily through the dating/hookup application Grindr, completed measures of chemsex participation, CSBD, substance use disorder symptoms, and health outcomes. CSBD was measured with the Compulsive Sexual Behavior Disorder Scale-7 (CSBD-7), which uses a psychometrically validated cut-off for identifying individuals who are at high risk of experiencing CSBD.
Results: Chemsex participation (15.2%) and falling above the CSBD-7 cut-off (34.3%) were prevalent, with 9.3% of participants endorsing both. Chemsex, compared to alcohol and marijuana use during sex, was more strongly associated with sexual and mental health outcomes. Individuals reporting chemsex and/or falling above the CSBD-7 cut-off, experienced greater depression and anxiety compared to those without these concerns. However, only individuals reporting the co-occurrence of chemsex and CSBD endorsed greater sexual health concerns, such as condomless anal sex and HIV infection. Participants only endorsing chemsex were not included in the analyses due to low frequency.
Discussion: This study suggests that chemsex and CSBD co-occur and are connected to negative health outcomes, such as depression and condomless anal sex. Notably, differences in sexual health concerns (i.e., condomless anal sex, HIV infection, and the use of poppers and erectile dysfunction medications during sex) were only identified when participants endorsing chemsex were included in analyses, suggesting that CSBD's connection to sexual risk may arise from a subset of individuals struggling with chemsex. Lastly, chemsex, popper use, and erectile dysfunction medication use during sex appear more strongly connected to CSBD than marijuana or alcohol use during sex. Future research is needed using larger samples, longitudinal approaches, and more refined measures of chemsex.
Background: Prostate cancer (PCa) significantly impacts patients' sexual functioning and quality of life. Patient-reported outcome measures (PROMs) are essential for accurately assessing these issues, yet a comprehensive evaluation of their psychometric properties in PCa patients is lacking.
Aims: This systematic review aimed to provide a comprehensive evaluation of all generic and specific PROMs used to assess sexual functioning in PCa patients and make recommendations the application of PROMs in this patient group.
Methods: Six electronic databases were searched from up to May 5, 2024. Studies reporting the development and/or validation of PROMs for PCa patients or generic instruments administered to this population were included. The COSMIN risk of bias checklist was adopted to assess the methodological quality and psychometric properties of included PROMs. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline.
Outcomes: The main outcome was to identify the appropriate PROM that can be adopted and used for assessing sexual functioning in PCa patients in clinical setting.
Results: A total of 10 PROMs were identified across 32 studies, primarily focusing on localized PCa patients after radical prostatectomy. The Expanded Prostate Cancer Index Composite (EPIC-26) was the most frequently evaluated and widely used PROM in clinical practice. EPIC-26 (Spanish, Italian, Chinese versions) and UCLA Prostate Cancer Index (UCLA-PCI) demonstrated better psychometric properties compared to other scales. However, no PROM met all COSMIN standards.
Clinical implications: In a clinical setting, it is crucial to utilize well-validated PROMs with good psychometric properties to effectively identify patients with PCa experiencing sexual difficulties who may require additional support.
Strengths and limitations: We applied strict inclusion criteria related to study design and study population, ensuring the assumption of transitivity and the consistency of the analysis.
Conclusion: Although EPIC-26 is a shortened version with strong psychometric properties, it may still be too lengthy for patients with significant health issues. Furthermore, the included PROMs do not address issues related to partner relationships, or the psychological impact of sexual dysfunction in sufficient detail. Future research should aim to develop and validate new PROMs that fill these gaps. These tools should be both psychometrically robust and practical for routine use, enabling real-time monitoring and improved care delivery.
Background: Hypertonicity of the pelvic floor muscles is commonly associated with provoked vestibulodynia (PVD); therefore, patients may benefit from treatments that relax the pelvic floor.
Aim: To define optimal (safe and efficacious) doses of abobotulinumtoxinA (aboBoNT-A) for the treatment of PVD associated with hypertonic pelvic floor muscle dysfunction and to explore use of a novel endpoint for pain assessment for PVD.
Methods: This phase 2, randomized, placebo-controlled study comprised two steps: dose escalation (Stage 1) and dose expansion (Stage 2). Stage 1 included up to four treatment cycles; Cycle 1 was double blind, Cycles 2-4 open label. Patients were assessed for retreatment every 6 weeks. Stage 2 was not conducted because of early study termination by the sponsor, unrelated to observed safety signals. Enrolled patients-premenopausal women with PVD with associated pelvic-floor hypertonia-were randomized (n = 60) 4:1 to receive aboBoNT-A (doses: 100, 300, 400, or 500 units [U]) or placebo.
Outcomes: The primary endpoint was safety. Additionally, a novel composite endpoint, dilator maximum tested size was evaluated. This endpoint combined assessment of vaginal-dilator tolerability with patient-reported pain assessment on an 11-point numeric rating scale, used as a surrogate measure of sexual activity in this study.
Results: All treatment-emergent adverse events (AEs) were mild or moderate in intensity, with no serious AEs or AEs leading to withdrawal reported in the double-blind period. AEs of special interest (urinary incontinence, anal sphincter atonia) were observed at low incidence and predominantly with higher aboBoNT-A doses. The dilator test composite score might be a useful endpoint for pain assessment, with a greater reduction in pain score noted for the 300 U dose group compared with other dose groups and placebo.
Clinical implications: aboBoNT-A was well tolerated in patients with PVD and a novel method for assessing dilator-induced pain was introduced.
Strengths and limitations: The study provided valuable data on use of aboBoNT-A in women with primary or secondary PVD and introduced a novel composite endpoint for assessing dilator-induced pain. Study limitations included the small sample size, limiting formal statistical analysis.
Conclusion: aboBoNT-A was well tolerated in patients with PVD with no safety signals reported. Further studies are warranted to demonstrate clinically meaningful benefits with repeated treatment.
Clinical trial registration number: NCT03598777.
Background: Previous studies have explored protective factors against gender minority stress among lesbian, gay, bisexual, transgender, queer, and other gender and sexually diverse (LGBTQ+) individuals. However, many of these studies have relied on self-report data, which may limit the validity of their findings due to potential common method bias.
Aim: The present study seeks to understand the biological and psychological underpinnings of the stress-buffering mechanism among LGBTQ+ individuals, specifically examining the protective role of testosterone.
Methods: A total of 107 LGBTQ+ individuals completed a survey on gender-related discrimination, loneliness, and well-being. Additionally, they provided a saliva sample, which was used to derive their endogenous testosterone levels.
Outcomes: The main outcome was well-being, measured using the World Health Organization-Five Well-Being Index.
Results: The findings revealed that gender-related discrimination was associated with heightened levels of loneliness, which in turn were associated with reduced well-being. Testosterone levels significantly moderated the association between gender-related discrimination and well-being. Specifically, among individuals with higher levels of testosterone, the negative association between discrimination and well-being was not significant.
Clinical implications: These results suggest that higher levels of testosterone may protect against the psychological consequences of gender-related discrimination.
Strengths and limitations: This study represents a pioneering effort to gather empirical evidence on the protective role of testosterone among LGBTQ+ individuals, but it is unlikely that a single biomarker (testosterone) can fully capture the complexity of resilience. Understanding the biological and psychological foundations of minority stress necessitates the integration of multiple biological factors. Such an approach would provide a more comprehensive understanding of the stress-buffering mechanisms operating among LGBTQ+ individuals.
Conclusion: The study suggests that testosterone may play a significant role in reflecting and regulating the response to gender minority stress.
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