Pelvic Floor Biometric Changes Assessed by 4D Translabial Ultrassound in Women With Vulvodynia Submitted to Physical Therapy: A Pilot Study of a Randomized Controlled Trial

BackgroundVulvodynia is a disabling condition in which pelvic floor muscles' (PFM) hypertonicity plays an important role.AimTo evaluate biometric changes in PFM in women with vulvodynia undergoing kinesiotherapy treatment protocol (KTP).MethodsA single-blinded randomized controlled trial of 57 women with vulvodynia randomly assigned to either KTP + amitriptyline or amitriptyline alone (controls) for treatment. Four-dimensional translabial ultrasound assessed PFM regarding symphysis-levator distance at rest, anorectal angle at rest, excursion of the levator plate angle, and levator hiatal narrowing. Volunteers underwent a vaginal examination for a cotton swab test (CST), fulfillment of Friedrich criteria score and PFM power of contraction, and completed a diary of sexual pain and frequency of vaginal intercourse. Outcomes were assessed at baseline and after 8 weeks of treatment.OutcomesPrimary outcomes were differences in biometric parameters assessed by four-dimensional translabial ultrasound after treatment, between groups. Secondary outcomes were changes in clinical variables (CST, Friedrich criteria, PFM power of contraction, frequency of intercourse, and intensity of sexual pain) between groups and correlation analysis between biometric parameters and clinical variables.ResultsOnly the KTP group had statistically significant changes in biometric parameters after treatment (symphysis-levator distance: 0.22 ± 0.2, 95% CI = 0.1–0.4, P = .008; levator hiatal narrowing: −0.33 ± 0.2, 95% CI = −1 to −0.2, P = .04). Comparisons between groups showed that symphysis-levator distance (0.3, 95% CI = 0.2–0.6, P = .005) and excursion of levator plate angle (4.9, 95% CI = −0.4 to 10.1, P = .02) improved significantly after KTP treatment. Clinical variables showed greater improvement in the group treated with KTP for CST (difference of −3.7, 95% CI = −7 to −0.4, P = .01), Friedrich criteria (difference of −1.9, 95% CI = −3.2 to −0.6, P = .003), PFM power of contraction (0.3, 95% CI = 0.1–0.6, P = .05) and intensity of sexual pain (reduction of 1.7, 95% CI = −3.1 to −0.2, P = .01). Some clinical and biometric variables correlated positively, for example, frequency of vaginal intercourse and anorectal angle (P = .04; r = 0.25), or inversely, for example, pain intensity at CST and anorectal angle (P = .004, r = −0.31).Clinical ImplicationsThis study provides evidence on efficiency of a physical therapy protocol for improvement of symptoms of vulvodynia and hypertonicity changes.ConclusionThis pilot study suggests that KTP for women with vulvodynia promoted significant changes in PFM biometric measures, consistent with alterations in hypertonicity and clinical improvement.Bardin MG, Giraldo PC, Martinho N. Pelvic Floor Biometric Changes Assessed by 4D Translabial Ultrassound in Women With Vulvodynia Submitted to Physical Therapy: A Pilot Study of a Randomized Controlled Trial. J Sex Med 2020;17:2236–2246.     

Effectiveness of mind-body exercise via Baduanjin on physical and psychological outcomes in patients with pulmonary ground-glass nodules: A non-randomized controlled pilot study

BackgroundWith the increasing incidence and mortality of lung cancer, ground-glass nodules (GGNs) have become an ongoing public health concern. In clinical practice, the physical and psychological distress of GGN patients is easy to overlook during the follow-up after diagnosis. Such patients typically have limited medical options and few of these options involve mind-body exercises.ObjectiveThe purpose of this pilot study was to explore the effectiveness of the mind-body exercise Baduanjin on physical and psychological outcomes among GGN patients.DesignWe conducted a prospective, non-randomized, controlled, assessor-blinded trial (ClinicalTrials.gov: NCT03420885).SettingThis trial was conducted at three medical sites, both located in Shanghai, China, between April 2017 and January 2020.ParticipantsPatients with GGN.InterventionSixty GGN participants were divided into a health education control group only receiving health education (n = 30) and a Baduanjin intervention group receiving health education plus a Baduanjin training program (n = 30). Both groups were treated for 16 weeks.Outcome measurementsOutcomes were assessed at baseline and week 16. The primary outcomes included pulmonary function (FVC, FVC%, FEV₁, FEV₁/FVC, PEF) and psychological condition (SAS score, SDS score). The secondary outcome was quality of life (SF-36).ResultsCompared with the health education control group, the Baduanjin intervention group had significant improvements in pulmonary function (FVC, FVC%, FEV₁), psychological outcomes (SAS score, SDS score), and quality of life (SF-36). The significant differences in pre-intervention and post-intervention between groups were as follows: FVC (MD = 0.21, 95%CI: 0.10 to 0.33, P = 0), FVC% (MD = 6.90, 95%CI: 3.10 to 10.70, P = 0.001), FEV₁ (MD = 0.18, 95%CI: 0.07 to 0.29, P = 0.001); SAS score (MD = −4.90, 95%CI: −8.28 to −1.52, P = 0.005), SDS score (MD = −5.83, 95%CI: −9.46 to −2.21, P = 0.002); physical component summary (PCS) of SF-36 (MD = 5.03, 95%CI: 2.54 to 7.51, P = 0), mental component summary (MCS) of SF-36 (MD = 5.78, 95%CI: 2.64 to 8.92, P = 0.001). Linear regression analysis was performed to study the influence of confounder variables on the improvements of primary outcomes, and no significant change was found. Moreover, Pearson correlation coefficient analysis demonstrated that ameliorations in lung function (FVC, FVC%, FEV₁, FEV₁/FVC, and PEF) were significantly associated with a decrease in anxious symptoms and depressive symptoms.ConclusionGGN patients in the Baduanjin intervention group showed greater benefits in pulmonary function and psychological outcomes than those in the health education control group, and the effectiveness was stable. The findings support Baduanjin as an effective, safe, enjoyable, and promising complementary intervention for management of GGN in patients with physical and psychological distress.     

Effect of Low-Energy Linear Shockwave Therapy on Erectile Dysfunction—A Double-Blinded,Sham-Controlled,Randomized Clinical Trial

IntroductionPrevious studies have shown that focal low-energy extracorporeal shockwave therapy (Li-ESWT) can have a positive effect in men with erectile dysfunction (ED). Linear Li-ESWT (LLi-ESWT) for ED has not been previously assessed in a randomized trial.AimTo evaluate the treatment outcome of LLi-ESWT for ED.MethodsMen with ED (n = 126) and a score lower than 25 points on the International Index of Erectile Function erectile function domain (IIEF-EF) were included. Subjects were allocated to receive LLi-ESWT once a week for 5 weeks or sham treatment once a week for 5 weeks. After a 4-week break, the two groups received active treatment once a week for 5 weeks. Subjects completed the IIEF, Erection Hardness Scale (EHS), Sexual Quality of Life–Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction at baseline, after 9 weeks, and after 18 weeks.Main Outcome MeasuresThe primary outcome measurement was an increase of at least five points on the IIEF-EF score. The secondary outcome measurement was an increased EHS score to at least 3 in men with a score no higher than 2 at baseline. Data were analyzed by linear and logistic regression.ResultsMean IIEF-EF scores were 11.5 at baseline (95% CI = 9.8–13.2), 13.0 after five sessions (95% CI = 11.0–15.0), and 12.6 after 10 sessions (95% CI = 11.0–14.2) in the sham group and correspondingly 10.9 (95% CI = 9.1–12.7), 13.1 (95% CI = 9.3–13.4), and 11.8 (95% CI = 10.1–13.4) in the ESWT group. Success rates based on IIEF-EF score were 38.3% in the sham group and 37.9% in the ESWT group (odds ratio = 0.95, 95% CI = 0.45–2.02, P = .902). Success rates based on EHS score were 6.7% in the sham group and 3.5% in the ESWT group (odds ratio = 0.44, 95% CI = 0.08–2.61, P = .369). A limitation of this study is that device settings (number of shockwaves and penetration depth) were estimated based on an existing trial on focused ESWT.ConclusionNo clinically relevant effect of LLi-ESWT on ED was found.     

Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies

BackgroundStress urinary incontinence (SUI) is a common, distressing health issue which affects many women. Mid-urethral sling (MUS) surgeries are recommended as gold standard interventions, although evidence regarding their impact on female sexual function remains controversial.AimTo provide high-quality evidence of the impact of MUS surgeries on sexual functions in women with SUI.MethodsA systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies assessing the effect of MUS treatments on sexual functions in women with SUI. The included studies were prospective randomized or non-randomized trials which assessed patients using 2 validated questionnaires, the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Pre- and postoperative data regarding sexual function were extracted. Meta-analysis of comparable data was performed using Review Manager (version 5.3) software.Main outcome measuresThe relationship between MUS interventions and sexual functions was analyzed by pooling weighted mean differences (WMD) with 95% CI from studies which used either the FSFI or PISQ-12 questionnaires, before and after receiving surgical interventions.ResultsOf the 22 eligible studies, 13 utilized FSFI and 9 adopted the PISQ-12. Pooled analysis indicates that 6-month postoperative PISQ-12 scores were significantly higher than preoperative scores (WMD −3.31 points; 95% CI −5.32 to −1.30; P = .001). Similar results were found at the 12-month juncture (WMD −3.30 points; 95% CI −6.01 to −0.58; P = .02) and at 24 months (WMD −4.44 points; 95% CI −5.45 to −3.44; P < .00001). Likewise, pooled postoperative FSFI total scores were significantly higher than preoperative scores at 6 months (WMD −2.22 points; 95% CI −3.36 to −1.08; P = .00001) and 12 months (WMD −3.49 points; 95% CI −5.96 to −1.02; P = .006). Postoperative FSFI sub-scores also suggest that desire, arousal, orgasm, lubrication, satisfaction, and pain during sexual intercourse significantly improved postoperatively (all P < .05). Moreover, combined evidence highlighted a significant reduction in coital incontinence postoperatively (risk ratio 5.78; 95% CI 3.16–10.58; P < .00001).Clinical ImplicationsThese assessment tools might be more appropriately used to create opportunities for counseling.Strengths & LimitationsWe encountered substantial heterogeneity and insufficient long term follow-up data. There is also a distinct lack of standards, in terms of data recording and reporting across this evidence base which adds to the problems with the PISQ-12 and FSFI which, even though validated, appear unsophisticated and not necessarily fit-for-purpose.ConclusionThis meta-analysis confirms that sexual functions do improve after MUS surgeries for women with SUI.Lai S, Diao T, Zhang W, et al. Sexual Functions in Women With Stress Urinary Incontinence After Mid-Urethral Sling Surgery: A Systematic Review and Meta-Analysis of Prospective Randomized and Non-Randomized Studies. J Sex Med 2020;17:1956–1970.     

Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials

ObjectiveThis study aimed to evaluate the effects of motor imagery (MI) on walking function and balance in patients after stroke.MethodsRelated randomized controlled trials (RCTs) were searched in 12 electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Science Direct, Web of Science, Allied and Complementary Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP) from inception to November 30, 2016, and Review Manager 5.3 was used for meta-analysis. References listed in included papers and other related systematic reviews on MI were also screened for further consideration.ResultsA total of 17 studies were included. When compared with “routine methods of treatment or training”, meta-analyses showed that MI was more effective in improving walking abilities (standardized mean difference [SMD] = 0.69, random effect model, 95% confidence interval [CI] = 0.38 to 1.00, P < 0.0001) and motor function in stroke patients (SMD = 0.84, random effect model, 95% CI = 0.45 to 1.22, P < 0.0001), but no statistical difference was noted in balance (SMD = 0.81, random effect model, 95% CI = −0.03 to 1.65, P = 0.06). Statistically significant improvement in walking abilities was noted at short-term (0 to < six weeks) (SMD = 0.83, fixed effect model, 95% CI = 0.24 to 1.42, P = 0.006) and long-term (≥six weeks) assessments (SMD = 0.45, fixed effect model, 95% CI = 0.25 to 0.64, P < 0.00001). Subgroup analyses suggested that MI had a positive effect on balance with short-term duration (0 to < six weeks) (SMD = 4.67, fixed effect model, 95% CI = 2.89 to 6.46, P < 0.00001), but failed to improve balance (SMD = 0.82, random effect model, 95% CI = −0.27 to 1.90, P = 0.14) with long-term (≥six weeks) duration.ConclusionMI appears to be a beneficial intervention for stroke rehabilitation. Nonetheless, existing evidence regarding the effects of MI in patients after stroke remains inconclusive because of significantly statistical heterogeneity and methodological flaws identified in the included studies. More large-scale and rigorously designed RCTs in future research with sufficient follow-up periods are needed to provide more reliable evidence on the effects of MI in post-stroke patients.     

The association between placental histopathology and autism spectrum disorder

IntroductionResearch suggests that autism spectrum disorder (ASD) has its origins in utero. This study examines the association between evidence of placental histopathology and ASD.MethodsAdministrative claims data and medical records data were used to identify ASD cases (N = 55) and matched controls (N = 199) born at New York Methodist Hospital between 2007 and 2014 and subsequently seen in affiliated pediatrics clinics. Placentas from all births during this time period were reviewed as part of routine care. Data were analyzed using conditional logistic regression to account for the matched (gender, gestational age, and birth weight) design.ResultsAcute placental inflammation, regardless of type was associated with an increased risk of ASD (odds ratio [OR] = 3.14, 95% CI = 1.39, 6.95). Chronic uteroplacental vasculitis (OR = 7.13; 95% CI = 1.17, 43.38), the fetal inflammatory response in the chorionic plate vessels (OR = 5.12; 95% CI = 2.02, 12.96), and maternal vascular malperfusion pathology (OR = 12.29; 95% CI = 1.37, 110.69) were associated with an increased risk of ASD. Placental villous edema was associated with a decreased risk of ASD (OR = 0.05; 95% CI = 0.0005, 0.42). In subanalyses among male placentas acute inflammation overall, fetal inflammatory response in the chorionic plate vessels, and maternal vascular malperfusion pathology remained significantly associated with an increased risk of ASD whereas placental villous edema remained associated with a decreased risk of ASD.DiscussionHistologic evidence of placental inflammation and maternal vascular malperfusion pathology are associated with ASD.     

Effects of neural mobilization in disorders associated with chronic secondary musculoskeletal pain: A systematic review and meta-analysis

PurposeTo evaluate the effect of neural mobilization (NM) in people with disorders associated with chronic secondary musculoskeletal pain due to persistent inflammation or diseases of the nervous system.MethodsA database search was conducted to select randomized controlled trials where NM, alone or within a multimodal protocol, was the main intervention for patients with neurological, autoimmune, or autoinflammatory disorders. The risk of bias and the certainty of evidence were assessed using the Cochrane Risk of Bias Tool for Randomized Trials and the GRADE approach. The primary outcome was pain intensity. Secondary measures were inflammatory biomarkers, range of motion and the level of spasticity.ResultsEleven studies were included (360 participants; 57% females). The most reported condition was arthritis, and the overall risk of bias was high in more than half of the studies. Pooled data showed a significant effect of NM, based on very low quality of evidence, on reducing pain intensity in people with systemic disorders (three studies: SMD = −0.58; 95% CI = −0.98, −0.18; p = 0.005), and the level of spasticity in individuals with brain or spinal cord injury (two studies: SMD = −0.85; 95% CI = −1.70, 0.00; p = 0.05).ConclusionsThere is scant and very low certainty of evidence to support that NM, compared to control interventions, may improve pain intensity and spasticity in patients with disorders associated with chronic secondary musculoskeletal pain. Further research with high methodological quality is needed to recommend for or against the use of NM in this population.     

Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis

BackgroundPenile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice.AimTo clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation.MethodsA comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests.OutcomesChange in sexual function before and after treatment.ResultsAfter screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95% CI = 1.932–4.059, P = .000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95% CI = 4.032–7.760, P = .000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95% CI = 1.600–2.895, P = .000; case-control studies: OR = 2.800, 95% CI = 1.932–4.059, P = .000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95% CI = 1.675–2.788, P = .000) and IIEF scores (SMD = 0.922, 95% CI = 0.545–1.300, P = .000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95% CI = 0.713–1.478, P = .610).Clinical TranslationThis study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies.Strengths and LimitationsThis meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects.ConclusionOur meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion.Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496–1503.     

Prevalence and Predictors of Low Sexual Desire,Sexually Related Personal Distress,and Hypoactive Sexual Desire Dysfunction in a Community-Based Sample of Midlife Women

BackgroundLow desire is the most common sexual problem in women at midlife. Prevalence data are limited by lack of validated instruments or exclusion of un-partnered or sexually inactive women.AimTo document the prevalence of and factors associated with low desire, sexually related personal distress, and hypoactive sexual desire dysfunction (HSDD) using validated instruments.MethodsCross-sectional, nationally representative, community-based sample of 2,020 Australian women 40 to 65 years old.OutcomesLow desire was defined as a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI); sexually related personal distress was defined as a score of at least 11.0 on the Female Sexual Distress Scale–Revised; and HSDD was defined as a combination of these scores. The Menopause Specific Quality of Life Questionnaire was used to document menopausal vasomotor symptoms. The Beck Depression Inventory–II was used to identify moderate to severe depressive symptoms (score ≥ 20).ResultsThe prevalence of low desire was 69.3% (95% CI = 67.3–71.3), that of sexually related personal distress was 40.5% (95% CI = 38.4–42.6), and that of HSDD was 32.2% (95% CI = 30.1–34.2). Of women who were not partnered or sexually active, 32.4% (95% CI = 24.4–40.2) reported sexually related personal distress. Factors associated with HSDD in an adjusted logistic regression model included being partnered (odds ratio [OR] = 3.30, 95% CI = 2.46–4.41), consuming alcohol (OR = 1.48, 95% CI = 1.16–1.89), vaginal dryness (OR = 2.08, 95% CI = 1.66–2.61), pain during or after intercourse (OR = 1.63, 95% CI = 1.27–2.09), moderate to severe depressive symptoms (OR = 2.69, 95% CI 1.99–3.64), and use of psychotropic medication (OR = 1.42, 95% CI = 1.10–1.83). Vasomotor symptoms were not associated with low desire, sexually related personal distress, or HSDD.Clinical ImplicationsGiven the high prevalence, clinicians should screen midlife women for HSDD.Strengths and LimitationsStrengths include the large size and representative nature of the sample and the use of validated tools. Limitations include the requirement to complete a written questionnaire in English. Questions within the FSFI limit the applicability of FSFI total scores, but not desire domain scores, in recently sexually inactive women, women without a partner, and women who do not engage in penetrative intercourse.ConclusionsLow desire, sexually related personal distress, and HSDD are common in women at midlife, including women who are un-partnered or sexually inactive. Some factors associated with HSDD, such as psychotropic medication use and vaginal dryness, are modifiable or can be treated with safe and effective therapies.Worsley R, Bell RJ, Gartoulla P, Davis SR. Prevalence and Predictors of Low Sexual Desire, Sexually Related Personal Distress, and Hypoactive Sexual Desire Dysfunction in a Community-Based Sample of Midlife Women. J Sex Med 2017;14:675–686.     

Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial

IntroductionThe effect of intensive blood pressure control upon erectile function in men with hypertension, but without diabetes, is largely unknown.AimTo examine the effects of intensive systolic blood pressure (SBP) lowering on erectile function in a multiethnic clinical trial of men with hypertension.MethodsWe performed subgroup analyses from the Systolic Blood Pressure Intervention Trial ([SPRINT]; ClinicalTrials.gov: NCT120602, in a sample of 1255 men aged 50 years or older with hypertension and increased cardiovascular disease risk. Participants were randomly assigned to an intensive treatment group (SBP goal of <120 mmHg) or a standard treatment group (SBP goal of <140 mmHg).Main Outcome MeasureThe main outcome measure was change in erectile function from baseline, using the 5-item International Index of Erectile Function (IIEF-5) total score, and erectile dysfunction ([ED]; defined as IIEF-5 score ≤21) after a median follow-up of 3 years.ResultsAt baseline, roughly two-thirds (66.1%) of the sample had self-reported ED. At 48 months after randomization, we determined that the effects of more intensive blood pressure lowering were significantly moderated by race-ethnicity (p for interaction = 0.0016), prompting separate analyses stratified by race-ethnicity. In non-Hispanic whites, participants in the intensive treatment group reported slightly, but significantly better change in the IIEF-5 score than those in the standard treatment group (mean difference = 0.67; 95% CI = 0.03, 1.32; P = 0.041). In non-Hispanic blacks, participants in the intensive group reported slightly worse change in the IIEF-5 score than those in the standard group (mean difference = −1.17; 95% CI = −1.92, −0.41; P = 0.0025). However, in non-Hispanic whites and non-Hispanic blacks, further adjustment for the baseline IIEF-5 score resulted in nonsignificant differences (P > 0.05) according to the treatment group. In Hispanic/other participants, there were no significant differences in change in the IIEF-5 score between the two treatment groups (P = 0.40). In a subgroup of 280 participants who did not report ED at baseline, the incidence of ED did not differ in the two treatment groups (P = 0.53) and was without interaction by race-ethnicity.Clinical ImplicationsThe effect of intensive treatment of blood pressure on erectile function was very small overall and likely not of great clinical magnitude.Strength & LimitationsAlthough this study included a validated measure of erectile function, testosterone, other androgen, and estrogen levels were not assessed.ConclusionIn a sample of male patients at high risk for cardiovascular events but without diabetes, targeting a SBP of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in statistically significant effects on erectile function that differed in accordance with race-ethnicity, although the clinical importance of the differences may be of small magnitude.Foy CG, Newman JC, Russell GB, et al. Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial. J Sex Med 2020;17:238–248.     

Aromatase Inhibitors Are Associated With Low Sexual Desire Causing Distress and Fecal Incontinence in Women: An Observational Study

BackgroundLittle is known of the impact of aromatase inhibitor (AI) therapy on sexual and pelvic floor function.AimTo document the prevalence of, and factors associated with, low desire, sexually related personal distress, hypoactive sexual desire dysfunction (HSDD), and pelvic floor dysfunction in women 10 years after breast cancer diagnosis.MethodsThis was a prospective, observational, community-based cohort study of Australian women with invasive breast cancer recruited within 12 months of diagnosis. 1,053 of the 1,305 who completed the initial 5 years of study follow-up agreed to be re-contacted, and 992 of these women alive 10 years after diagnosis were sent the study questionnaire.OutcomesThe main outcome measure was HSDD determined by a score no higher than 5.0 on the desire domain of the Female Sexual Function Index (FSFI) plus a score of at least 11.0 on the Female Sexual Distress Scale–Revised (FSDS-R). Pelvic floor disorders, including urinary incontinence, fecal incontinence, and pelvic organ prolapse, were assessed using validated questionnaires. Multivariable logistic regression was used to assess factors associated with low desire, personal distress, and HSDD.Results625 completed questionnaires were returned. The respondents’ median age was 65.1 years (range = 36.4–95.5). Current AI use was reported by 10% and tamoxifen use was reported by 3.4%. 521 of the 608 women (85.7%; 95% CI = 82.9–88.5) who competed the FSFI desire domain had low sexual desire, and 246 of the 563 women (43.7%; 95% CI = 39.6–47.8%) who completed the FSDS-R had sexually related personal distress. 221 of the 559 women (39.5%; 95% CI = 35.5–43.6%) who completed the 2 questionnaires had HSDD. Current AI users were more likely to have HSDD than non-users (55.2% [95% CI = 42.2–68.1] vs 37.8% [95% CI = 33.5–42.0]; P = .01). HSDD was more prevalent in sexually active, current AI users (66.7%; 95% CI = 49.4–83.9) vs current non-users (43.6%; 95% CI = 37.0–50.2; P = .02). In a logistic regression model, HSDD was significantly associated with current AI use and inversely associated with age. Fecal incontinence was more prevalent in AI users than in current non-users (29.8% [95% CI = 17.8–41.8] vs 16.4% [95% CI = 13.2–19.6], respectively; P = .01).Clinical ImplicationsIt is important to address women’s sexual health even many years after their breast cancer diagnosis.Strengths and LimitationsStrengths include a representative sample, use of validated questionnaires, and few missing data. Limitations include sexual activity being a 4-week recall.ConclusionsAI use is associated with HSDD and fecal incontinence in women who are 10 years after breast cancer diagnosis.Robinson PJ, Bell RJ, Christakis MK, et al. Aromatase Inhibitors Are Associated With Low Sexual Desire Causing Distress and Fecal Incontinence in Women: An Observational Study. J Sex Med 2017;14:1566–1574.     

Bicycle ergometer exercise during hemodialysis and its impact on quality of life,aerobic fitness and dialysis adequacy: A pilot study

BackgroundChronic kidney disease patients on hemodialysis commonly have a worse quality of life (QoL) due to complications of the disease and dialysis procedure. Physical exercise has emerged as a strategy to improve this scenario. The objective of this study was to evaluate the effect of an intradialytic aerobic exercise program on QoL and aerobic fitness in hemodialysis patients.Material and methodsThese are a secondary analysis of clinical trial data previously published in which hemodialysis patients were randomized into “bike group” (using an adapted exercise bicycle) or “control group” (usual care). The exercise sessions lasted 45 min (5 min of warm-up, 35 min of moderate-intensity and 5 min of cool-down) three times/week for three months. The QoL domains were assessed using the SF-36 QoL questionnaire. Aerobic fitness was evaluated using the 6-min walk test (6MWT). Circulating cytokines, biochemical parameters and Kt/V were also assessed.ResultsNine patients completed three months of exercise (5 men, 44 ± 11 years), and nine were in the control group (6 men, 44 ± 14 years). In the bike group, there was a trend to improve the physical role domain (p = 0.06) regarding QoL, an improvement in the 6MWT (p = 0.02), and in the Kt/V (p = 0.03) after three months. There was a positive correlation between the general health domain and Kt/V (r = 0.691; p = 0.003) and an inverse correlation between the physical functioning domain and plasma TNF-α levels (r = −0.514; p = 0.04).Conclusions12 weeks of intradialytic aerobic exercise was enough to benefit hemodialysis patients' quality of life, aerobic fitness, and quality of dialysis.Clinicaltrials.gov id: NCT04375553.     

Personal,professional and workplace factors associated with burnout in Jordanian midwives: A national study

ObjectiveTo investigate the prevalence of burnout and explore associated socio-demographic and work-related factors among Jordanian midwives.DesignA cross-sectional survey design. The survey tool included the Copenhagen Burnout Inventory (CBI) and socio-demographic and work-related data forms.SettingAll government-funded hospitals in Jordan (18 hospitals) that provide antenatal, labour and birth, or postnatal care for women.ParticipantsA sample of 321 midwives participated.Data analysisFrequencies, means, and standard deviations were calculated as appropriate on the demographic variables and scale scores. The CBI was assessed for internal consistency using Cronbach's alpha. Multiple regression analyses using backward elimination were undertaken to determine associations between variables and CBI subscales. An alpha level of 0.05 was used for all statistical tests.FindingsOver three-quarters of midwives reported personal (78.1%), work-related (82.2%), and client-related (71.3%) burnout (scored >50 on CBI). Compared to midwives aged between 21 - 30 years, those between 31 - 40 years of age scored on average a 11.75 (95% CI = 7.05 - 16.45) points lower personal burnout score. Married midwives had on average a 6.44 (95% CI = 1.57 - 11.31) points higher personal burnout score compared to single midwives. Midwives with ≥ 10 years' experience had on average a 4.29 (95% CI = 1.93 - 6.64), 5.27 (95% CI = 3.17 - 7.36), and 7.31 (95% CI = 4.84 - 9.78) points lower personal, work-related, and client-related burnout scores respectively compared to midwives with < 10 years' experience.Compared to midwives providing care for 1 - 5 women per shift, those providing care for > 10 women per shift reported 9.98 (95% CI = 6.06 - 13.90) and 5.35 (95% CI = 0.71 – 9.99) points higher work-related and client-related burnout scores respectively. Midwives who rotated between shifts had on average a 5.87 (95% CI = 1.27 - 10.48) and 11.2 (95% CI = 5.78 - 16.66) points higher work-related and client-related burnout scores respectively than those who did not rotate.Key conclusions and implications for practiceThe high prevalence of burnout identifies the urgent need for a national plan to address midwives’ psychological health in Jordan. Midwives should be appropriately trained to recognize the signs and symptoms of burnout in a timely way, and for support services to be offered. The government could consider implementing continuity of midwifery care models, reducing the administrative burden on midwives, and empowering them to work to their full scope of practice.     

Effects of Low-Intensity Extracorporeal Shockwave Therapy on Erectile Dysfunction: A Systematic Review and Meta-Analysis

IntroductionLow-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as an effective non-invasive treatment option for erectile dysfunction (ED).AimTo use systematic review and meta-analysis to assess the efficacy of Li-ESWT by comparing change in erectile function as assessed by the erectile function domain of the International Index of Erectile Function (IIEF-EF) in men undergoing Li-ESWT vs sham therapy for the treatment of ED.MethodsSystematic search was conducted of MEDLINE, EMBASE, and ClinicalTrials.gov for randomized controlled trials that were published in peer-reviewed journals or presented in abstract form of Li-ESWT used for the treatment of ED from January 2010 through March 2016. Randomized controlled trials were eligible for inclusion if they were published in the peer-reviewed literature and assessed erectile function outcomes using the IIEF-EF score. Estimates were pooled using random-effects meta-analysis.Main Outcome MeasuresChange in IIEF-EF score after treatment with Li-ESWT in patients treated with active treatment vs sham Li-ESWT probes.ResultsData were extracted from seven trials involving 602 participants. The average age was 60.7 years and the average follow-up was 19.8 weeks. There was a statistically significant improvement in pooled change in IIEF-EF score from baseline to follow-up in men undergoing Li-ESWT vs those undergoing sham therapy (6.40 points; 95% CI = 1.78–11.02; I² = 98.7%; P < .0001 vs 1.65 points; 95% CI = 0.92–2.39; I² = 64.6%; P < .0001; between-group difference, P = .047). Significant between-group differences were found for total treatment shocks received by patients (P < .0001).ConclusionIn this meta-analysis of seven randomized controlled trials, treatment of ED with Li-ESWT resulted in a significant increase in IIEF-EF scores.     

Neonatal outcomes and its association among gestational diabetes mellitus with and without depression,anxiety and stress symptoms in Malaysia: A cross-sectional study

ObjectivePrevalence of depression, anxiety and stress symptoms in gestational diabetes mellitus ranges from 10.2% to 39.9% based on previous studies in Malaysia. Presence of depression, anxiety or stress in pregnancy may increase the risk of neonatal morbidity and mortality. The aim of this study was to determine the prevalence of neonatal outcomes and its association among mothers with gestational diabetes mellitus with and without the presence of depression, anxiety and stress symptoms in Malaysia.DesignThis was a cross-sectional study.SettingTertiary hospitals in Malaysia.ParticipantsMothers with gestational diabetes mellitus (n = 418) who deliver their neonates at two major tertiary hospitals in Malaysia.MeasurementsNeonatal outcomes, such as low birth weight, preterm birth, macrosomia, metabolic and electrolyte disorders, neonatal respiratory distress and congenital anomalies were determined.FindingsPrevalence of low birth weight in neonates born to mothers with gestational diabetes mellitus was 14.6%, followed by metabolic and electrolyte disorders 10.5%, preterm birth 9.1%, macrosomia 4.8%, neonatal respiratory distress 5.8% and congenital anomalies (2.4%). Among the adverse neonatal outcomes, neonatal respiratory distress was significantly associated with the presence of depression symptoms in mothers with gestational diabetes mellitus using univariate analysis (p = 0.010). After controlling for confounding factors, predictors for neonatal respiratory distress at delivery were the presence of depression symptoms in mothers with gestational diabetes mellitus (Adjusted OR = 3.87, 95% CI = 1.32-11.35), living without a husband (Adjusted OR = 9.74, 95% CI = 2.04–46.51), preterm delivery (Adjusted OR = 7.20, 95% CI = 2.23–23.30), caesarean section (Adjusted OR = 3.33, 95% CI = 1.09–10.15), being nulliparous and primiparous (Adjusted OR = 3.62, 95% CI = 1.17–11.17) and having family history of diabetes (Adjusted OR = 3.20, 95% CI = 1.11–9.21).Key conclusionsThe findings of this study demonstrate the positive association of neonatal respiratory distress with the presence of depression symptoms in mothers with gestational diabetes mellitus.Implications for practiceIt is therefore important to identify depression symptoms after a diagnosis of gestational diabetes mellitus in pregnant mothers is made to enable early referral and interventions.     

The benefits of yoga for people living with HIV/AIDS: A systematic review and meta-analysis

BackgroundPeople living with HIV/AIDS (PLWHA) often experience psychological stress associated with disease management. This meta-analysis examines the benefits of yoga interventions on psychological distress among PLWHA.MethodsIncluded were studies that (a) evaluated a yoga intervention in PLWHA; (b) provided between-group or within-group changes; and (c) assessed a psychological, physiological, or biomedical outcome.ResultsSeven studies sampling 396 PLWHA (M age = 42 years, SD = 5 years; 40% women) met inclusion criteria. PLWHA who received yoga interventions reported significant improvements in perceived stress (d+ = 0.80, 95% Confidence Interval [CI] = 0.53, 1.07), positive affect (d + = 0.73, 95% CI = 0.49, 0.98), and anxiety (d+ = 0.71, 95% CI = 0.27, 1.14) compared to controls.ConclusionYoga is a promising intervention for stress management. However, the literature is limited by the small number of studies. Randomized controlled trials with objective measures of HIV-related outcomes are needed to further evaluate the benefits of yoga.     

Associations Among Physical Activity,Sedentary Behavior,and Weight Status With Sexuality Outcomes: Analyses from National Health and Nutrition Examination Survey

IntroductionPhysical activity is likely to be associated with sexual activity. However, to date, there is no literature on the relationship between overweight/obesity and sexual activity outcomes.AimThus, the present study assessed the associations among physical activity, sedentary behavior, and weight status with sexual activity and number of previous sexual partners in a representative sample of U.S. adults.MethodsData on leisure time physical activity, total sitting time, weight status, sexual behavior outcomes, and other characteristics were extracted from the National Health and Nutrition Study cycle 2007 to 2016. Logistic regression models were used to evaluate associations among body mass index, leisure time physical activity, and total sitting time with past-year sexual activity and number of sexual partners.Main Outcome MeasureSelf reported frequency of past-year sexual activity and number of sex partners in the past year.ResultsIn a sample of 7,049 men (mean age: 38.3 ± 0.3 years) and 7,005 women (mean age: 38.7 ± 0.2 years) being overweight was associated with higher odds of frequent sexual activity (OR = 1.5; 95% CI = 1.2−1.7) among men, but lower odds among women (OR = 0.8; 95% CI = 0.6−0.9). Sufficient physical activity was associated with higher odds of frequent sexual activity among both men (OR = 1.3; 95% CI = 1.1−1.5) and women (OR = 1.2; 95% CI = 1.0−1.4). In those living alone, being obese was associated with lower odds of having at least 1 sexual partner for men (OR = 0.7; 95% CI = 0.5−0.9) and women (OR = 0.6; 95% CI = 0.4−0.8). Being sufficiently physically active was associated with higher odds of having at least 1 sexual partner only in men (OR = 1.6; 95% CI = 1.2−2.2).Clinical ImplicationsHealthcare professionals need to be made aware of these results, as they could be used to plan tailored interventions.Strengths & LimitationsStrengths include the large, representative sample of U.S. adults and objective measures of anthropometry. Limitations include the cross-sectional design of the study and that all variables on sexual history were self-reported.ConclusionThe present study identifies novel modifiable behavioral and biological antecedents of sexuality outcomes.Grabovac I, Cao C, Haider S, et al. Associations Between Physical Activity, Sedentary Behavior and Weight Status With Sexuality Outcomes: Analyses from National Health and Nutrition Examination Survey. J Sex Med 2020;17:60–68.     

Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study

BackgroundMarijuana use is increasingly prevalent in the United States. Effects of marijuana use on sexual function are unclear, with contradictory reports of enhancement and detriment existing.AimTo elucidate whether a relation between marijuana use and sexual frequency exists using a nationally representative sample of reproductive-age men and women.MethodsWe analyzed data from cycle 6 (2002), cycle 7 (2006–2010), and continuous survey (2011–2015) administrations of the National Survey of Family Growth, a nationally representative cross-sectional survey. We used a multivariable model, controlling for demographic, socioeconomic, and anthropographic characteristics, to evaluate whether a relationship between marijuana use and sexual frequency exists.OutcomesSexual frequency within the 4 weeks preceding survey administration related to marijuana use and frequency in the year preceding survey administration.ResultsThe results of 28,176 women (average age = 29.9 years) and 22,943 men (average age = 29.5) were analyzed. More than 60% of men and women were Caucasian, and 76.1% of men and 80.4% of women reported at least a high school education. After adjustment, female monthly (incidence rate ratio [IRR] = 1.34, 95% CI = 1.07–1.68, P = .012), weekly (IRR = 1.36, 95% CI = 1.15–1.60, P < .001), and daily (IRR = 1.16, 95% CI = 1.01–1.32, P = .035) marijuana users had significantly higher sexual frequency compared with never users. Male weekly (IRR = 1.22, 95% CI = 1.06–1.41, P = .006) and daily (IRR = 1.36, 95% CI = 1.21–1.53, P < .001) users had significantly higher sexual frequency compared with never users. An overall trend for men (IRR = 1.08, 95% CI = 1.05–1.11, P < .001) and women (IRR = 1.07, 95% CI = 1.04–1.10, P < .001) was identified showing that higher marijuana use was associated with increased coital frequency.Clinical ImplicationsMarijuana use is independently associated with increased sexual frequency and does not appear to impair sexual function.Strengths and LimitationsOur study used a large well-controlled cohort and clearly defined end points to describe a novel association between marijuana use and sexual frequency. However, survey responses were self-reported and represent participants only at a specific point in time. Participants who did not answer questions related to marijuana use and sexual frequency were excluded.ConclusionA positive association between marijuana use and sexual frequency is seen in men and women across all demographic groups. Although reassuring, the effects of marijuana use on sexual function warrant further study.Sun AJ, Eisenberg ML. Association Between Marijuana Use and Sexual Frequency in the United States: A Population-Based Study. J Sex Med 2017;14:1342–1347.     

Levels of Depression and Anxiety,Sexual Functions,and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners

BackgroundDepression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of women with lifelong vaginismus (LLV) and their male partners may have important effects on the development, maintenance, and exacerbation of LLV.AimWe aimed to investigate depression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of both women with LLV and their male partners.Methods56 women with LLV, their 56 male partners, and 44 couples with no complaints of any sexual function as a control group were included in this study. Dyadic data were analyzed using the Actor-Partner Interdependence Model.OutcomesThe Beck Depression Inventory, Beck Anxiety Inventory, Golombok Rust Inventory of Sexual Satisfaction, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale were completed by all participants.ResultsWomen with LLV had higher levels of anxiety and depression and had more sexual dysfunctions except for avoidance than those of female controls. Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale scores were significantly higher in women with LLV for depressive (odds ratio [OR] = 1.27, 95% CI = 1.09–1.49), cyclothymic (OR = 1.31, 95% CI = 1.15–1.49), anxious (OR = 1.22, 95% CI = 1.09–1.38), and irritable (OR = 1.22, 95% CI = 1.04–1.42) temperament than in female controls. It was found that anxiety levels of male partners of women with LLV were higher than those of male controls and that they experienced less sexual satisfaction. Depressive (OR = 1.31, 95% CI = 1.07–1.61) and cyclothymic (OR = 1.18, 95% CI = 1.04–1.34) temperament scores were significantly higher in male partners of women with LLV than in male controls. The Actor-Partner Interdependence Model analyses show that hyperthymic temperament in male partners of women with LLV and anxious and depressive temperament in women with LLV have a negative effect on their own sexual functions. In terms of partner effect, it was found that men with hyperthymic temperament had a negative effect on the sexual functions of women with LLV and men with depressive temperament had a positive effect.Clinical ImplicationsThe individual characteristics of both the women and their male partners have an impact on LLV.Strengths & LimitationsThe sample size was relatively small to assess affective temperaments. The inclusion of male partners in the study contributed to our understanding of couples with LLV.ConclusionOur results indicate that affective temperaments detected in women with LLV (depressive, cyclothymic, anxious and irritable) and their male partners (depressive and cyclothymic) have an effect on the development, maintenance, and exacerbation of LLV, and affective temperaments have an effect on both their own and partner's sexual functions.Turan Ş, Usta Sağlam NG, Bakay H, et al. Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners. J Sex Med 2020;17:2434–2445.