Depression in midlife women

Depression is one of the leading causes of disease-related disability in women, and they are nearly twice as likely as men to suffer from an episode of depression. The difference begins in early life and persists through to mid-life, and as such, these reproductive years have been labelled by some as a ‘window of vulnerability’. The prevalence has been reported to be particularly high during the menopausal transition, but there is no consensus supporting a direct association with reproductive status. This may be partly due to methodological limitations and inconsistencies in the available studies, resulting from a large number of confounding factors. In addition, relationships between sex hormones and the neurotransmitters purported to be responsible for depression are complex. What appears to be universally accepted is that treatment, with oestrogen, for low mood in women during midlife years may be beneficial, and should be considered.     

Characteristics of Condom and Lubricant Use among a Nationally Representative Probability Sample of Adults Ages 18–59 in the United States

IntroductionAlthough most Americans have used condoms and/or lubricant during sex, little is known about the context of sexual events that involve the use of such products outside of experimentally manipulated studies.AimsTo assess, in a nationally representative study of men and women in the United States ages 18–59, the characteristics of condom and lubricant use during participants' most recent sexual event and the relationship of their condom and lubricant use to event‐level ratings of sexual quality.MethodsData are from the National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of the U.S. adults.Main Outcome MeasuresSociodemographic items: event‐level items related to sexual behavior, condom use, lubricant use, and participants' perceptions of their arousal, pleasure, ease of erection or lubrication, and pain associated with sex.ResultsDuring their most recent sexual experience, 27.5% of men (N = 237) and 22.3% of women (N = 175) reported using a condom. More than twice as many women as men were unsure whether the condom was lubricated (26.6% vs. 11.4%) and the material it was made of (23.6% vs. 8.9%). Participants consistently rated sex to be arousing and pleasurable whether or not they used condoms or lubricant. No significant differences were found in regard to men's ratings of the ease of their erections based on condom and lubricant use.ConclusionsAlthough some have concerns about how condoms or lubricants may impact their enjoyment of sex, in a nationally representative sample of men and women ages 18–59, ratings of sex were largely quite high, with few differences based on condom and lubricant use. Women, more often than men, reported being unsure about the type of condom and lubricant used, which has implications for patient education. Herbenick D, Schick V, Reece M, Sanders SA, Smith N, Dodge B, and Fortenberry JD. Characteristics of condom and lubricant use among a nationally representative probability sample of adults ages 18–59 in the United States. J Sex Med **;**:**–**.     

Intracavernosal OnabotulinumtoxinA Exerts a Synergistic Pro-Erectile Effect When Combined With Sildenafil in Spontaneously Hypertensive Rats

BackgroundBotulinum toxin A (BTX-A) has a variety of uses in medicine. Some evidence suggests that intracavernosal (ic) BTX-A injection administered in addition to phosphodiesterase type 5 inhibitors (PDE5-Is) could effectively treat erectile dysfunction (ED) in insufficient responders to PDE5-Is.AimTo provide experimental pharmacological evidence for the use of onabotulinumtoxinA ic alone or in combination with PDE5-Is for difficult-to-treat ED. We thus compared the effects of BTX-A ic alone and BTX-A ic combined with PDE5-I iv, and a placebo treatment ic or iv.MethodsErectile function was evaluated following cavernous nerve electrical stimulation (6 V, 1-millisecond pulse, 45-second duration) at different frequencies (0, 2, 3, 4, 5, 7.5, and 10 Hz) in 4 groups (n = 8 / group) of anesthetized, spontaneously hypertensive rats, a robust animal model of ED of vascular origin. Rats were treated by onabotulinumtoxinA 10U or saline ic 1 week prior to erectile function testing and sildenafil (0.3 mg/kg) or saline iv 4 minutes prior to testing. Frequency-response curves were compared with a 2 way ANOVA.OutcomesBoth onabotulinumtoxinA ic, and sildenafil iv significantly improved erectile responses in spontaneously hypertensive rats, however the effect was greatly amplified when the treatments were combined.ResultsIntracavernosal pressure and/or mean arterial pressure ratios were significantly increased by sildenafil and onabotulinumtoxinA ic versus the control condition. OnabotulinumtoxinA 10U ic combined with sildenafil iv significantly potentiated erectile responses. Area under the curve and/or mean arterial pressure ratio increased by 19% with sildenafil iv, by 15% with onabotulinumtoxinA ic and by 58% with the combined treatment following cavernous nerve electrical stimulation at 6V, 1 ms, 10 Hz: these stimulation parameters elicited the maximal erectile response.Clinical TranslationThese data provide a pharmacological rationale for the combined administration of onabotulinumtoxinA ic and sildenafil iv since the effects of both treatments were potentiated when their administration was combined.Strengths & LimitationsFirst evidence of a synergistic pro-erectile effect of BTX-A combined with PDE5-I, however the mechanism behind the pro-erectile effect of BTX-A ic remains hypothetical.ConclusionsThese results support further studies into the mechanisms behind the pro-erectile effect of BTX-A ic, as well as multicenter randomized control trials to evaluate the safety and efficacy of BTX-A ic combined with sildenafil for difficult-to-treat ED.Giuliano F., Joussain C., Denys P., et al. Intracavernosal OnabotulinumtoxinA Exerts a Synergistic Pro-Erectile Effect When Combined With Sildenafil in Spontaneously Hypertensive Rats. J Sex Med 2022;19:899–906.     

The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

BackgroundErectile dysfunction (ED) may be common in patients with inflammatory bowel disease (IBD), but its prevalence and risk factors still remain debatable.AimTo evaluate the prevalence of ED in the IBD population and the potential role of risk factors in the development of ED.MethodsAn extensive search in the PubMed, Cochrane Library, and Web of Science was performed to identify relevant English-language articles published up to December 2021 that evaluated the prevalence of ED on IBD patients. The included studies were evaluated by 2 independent reviewers for eligibility. We used an adapted Assessment Tool for Prevalence Studies to evaluate the quality of enrolled studies. Data were analyzed and graphed using the STATA software (version 16.0; Stata Corporation, College Station, TX, USA). The ORs with 95% CIs were pooled using a fixed or random-effects model according to heterogeneity. Subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was conducted to evaluate the stability of the results.OutcomesThe pooled prevalence of ED in IBD patients was calculated, and the OR value and 95% CIs were used to assess the strength of the association between IBD-related risk factors and ED.ResultsFourteen studies included 32,858 individuals totally were enrolled for this meta-analysis. The overall pooled prevalence estimate of ED in IBD patients was 27% (95% CI: 20–34%). Operation (OR 1.28; 95% CI: 1.17–1.39; P < .00001; I² = 0.0%), disease activity (OR 2.06; 95% CI: 1.07–3.05; P < .00001), and depression (crude OR 3.31; 95% CI: 1.08–5.54; P = .004; I² = 0.0%) significantly increase the risk of ED in people with IBD. The association of depression and ED was further confirmed by calculating the pooled estimates of adjusted OR (1.58; 95% CI: 0.05–3.12; P < .05; I² = 0.0%). The pooled prevalence estimates of ED were 30, 33, and 17% in the age <40, IIEF diagnostic tool, and IPAA surgery subgroups, respectively.Clinical ImplicationsIBD patients had a significantly increased prevalence of ED, indicating that erectile function in men with IBD should be concerned by clinicians.Strengths & LimitationsThe strength of this study is that this is the first meta-analysis to assess the global prevalence and risk factors of ED in IBD patients. A limitation is that the results after pooling the included articles showed significant heterogeneity.ConclusionThe results of our meta-analysis and systematic review provide evidence of the high prevalence and risk factors of ED in IBD patients.Wu X, Zhang Y, Zhang W, et al. The Prevalence and Associated Risk Factors of Erectile Dysfunction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Sex Med 2022;19:950–960.     

Management of disorders of sex development: editorial commentary

In 2005, the Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology convened a conference on intersex to review clinical management practices and data from long-term health-related and gender-related outcomes research and to identify key areas for future research. Romao and colleagues provide an overview of the evolving changes after publication of this guidance, informed by experiences in their multidisciplinary clinic. This commentary highlights and expands on several of the topics explored, with a special emphasis on the psychosocial aspects of care for persons affected by disorders of sex development and their families.     

中国大陆男男性接触者艾滋病性病高危险行为情况调查

目的 调查中国大陆男男性接触者（men who have sex with men,MSM)的艾滋病（acpuired immunodeficiency syndrome,AIDS）和性病（sexually transmitted diseases,STD）高危险行为及相关情况。方法 采用不同记名邮寄问卷形式调查。结果 发放调查问卷1800份,回收有效问卷729份,应答率40.5%。调查对象平均31.0岁。首次男男性交平均18.6岁。累计男性伴平均数39.2人,75.7%有过肛交行为。近一年内,63.6%有过陌生男性伴,39.8%曾群交,9.3%“买”过性,３.8％“卖”过性。约半数与女性性交过。　133人自述患过性病（18.2%）。62人检测过人类免疫缺陷病毒（human immune deficiency virus,HIV）抗体,11人阳性（17.7%）。约2/3使用过避孕套。结论 被调查的MSM在性方面相当活跃,HIV感染率在这一人群中巳达较高水平,而且流行全直接蔓延到异性恋人群。     

Treatment of Low Sexual Desire or Frequency Using a Sexual Enhancement Group Couples Therapy Approach

BackgroundSexual desire or frequency problems are exceedingly common, but treatment of them has been less than effective.AimThe goal of this study was to develop a cost-effective, accessible intervention to deal with sexual desire or frequency problems, including sexual desire discrepancy, by enhancing the quality of couples’ erotic intimacy.Methods45 couples (38 heterosexual and 7 same-sex couples) distressed by sexual desire or frequency problems were seen in a 16-hour, group couples therapy intervention. Participants completed the New Sexual Satisfaction Scale (NSSS) at pretest, posttest, and at 6-month follow-up.OutcomesThe NSSS plus 3 additional items at pretest, posttest, and at 6-month follow-up and patients’ written feedback.ResultsStatistically significant differences were found between pre-tests and post-tests in satisfaction with intensity of sexual arousal; creativity; frequency; sexual functioning; partner's sexual availability; partner's initiation of sexual activity; emotional opening up during sex; positive sexual reactions to the partner; communication of sexual wishes, preferences and desires; and balance between giving and receiving during sex. The largest improvement and effect sizes were found in overall satisfaction with one's sex life from pre-test to post-test and 6-month follow-up.Clinical ImplicationsLow sexual desire or frequency problems can be treated effectively by enhancing the quality of the couple's erotic connection, thereby creating desirable sex.Strengths & LimitationsThe strengths include the combination of quantitative and qualitative data. Limitations included the small number of same-sex couples.ConclusionSexual enhancement group couples therapy provides an effective, accessible, and affordable approach to low desire or frequency complaints in distressed couples.Kleinplatz PJ, Charest M, Paradis N, et al. Treatment of Low Sexual Desire or Frequency Using a Sexual Enhancement Group Couples Therapy Approach. J Sex Med 2020;17:1288–1296.     

Distal Biologic Cap for Impending Distal Erosion

IntroductionManagement for distal impending erosion can be difficult and has been previously managed with counter incisions which can lead to unsightly scars and increased infection risk.AimTo demonstrate a novel technique in management of impending erosion.MethodsWe retrospectively reviewed patients who underwent placement of a distal biologic cap for impending erosion.Main Outcome MeasureThe main outcome was thesuccessful placement of inflatable penile prosthesis through a single incision.ResultsAll patients who underwent this procedure are functional and have had no evidence of recurrence.Clinical ImplicationsA simple approach to manage impending distal erosion.Strength & LimitationsLimitations include small sample size and short duration of follow-up.ConclusionThe distal biologic cap is a simple alternative technique to treat distal impending erosion of an inflatable penile prosthesis and can be performed safely without the need for additional incisions on the penis and with a minimal increase in operative times.Karpman E, DiGiorgio L, Carrion RE. Distal Biologic Cap for Impending Distal Erosion. J Sex Med 2020;17:551–555.     

Women's Use and Perceptions of Commercial Lubricants: Prevalence and Characteristics in a Nationally Representative Sample of American Adults

IntroductionUse of commercial lubricant is common in the United States among adult women. However, little is known about the sexual behaviors for which women use lubricant, women's perceptions of lubricant, or reasons for use, particularly in a nationally representative sample.AimThe aim of this study was to document the prevalence and characteristics of lubricant use among adult women in the United States and their perceptions of lubricants in relation to subjective sexual experiences.MethodsData are from a subset of individuals who were sampled as part of the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of U.S. adults ages 18 and older.Main Outcome MeasuresSociodemographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use of participants were studied for the article.ResultsOf the women who participated in the study, 65.5% (n = 1,021) reported ever having used lubricant and 20% had used a lubricant within the past 30 days. Across age groups, lubricant was most commonly used during intercourse (58.3% of women) or partnered sexual play (49.6%). Common reasons for lubricant use included to make sex more comfortable, fun, and pleasurable and to decrease discomfort/pain.ConclusionsMost American women have used lubricant. Also, lubricant is more common as part of partnered intercourse and sexual play or foreplay compared with other solo and partnered sexual behaviors. Clinicians may find it helpful to broaden conversations with patients to include questions about their sexual behaviors, comfort and/or pain during sex, and lubricant use and to share, particularly with younger women, that lubricant use is prevalent and commonly used for reasons related to pleasure as well as comfort. Herbenick B, Reece M, Schick V, Sanders SA, and Fortenberry JD. Women's use and perceptions of commercial lubricants: Prevalence and characteristics in a nationally representative sample of American adults. J Sex Med 2014;11:642–652.